缺血型烟雾病手术疗效的多中心研究

Efficacy of surgical revascularization for stroke prevention and prognosis in ischemictype moyamoya disease:A multicenter study

目的通过多中心回顾性研究探讨脑血运重建术及不同手术方式在预防脑卒中再发生及神经功能预后的疗效。方法研究纳入了中南大学湘雅医院、常德市人民医院和湖南省儿童医院462例缺血型烟雾病患者的临床信息、影像学资料和随访资料,进行倾向性评分匹配后采用Kaplan-Meier曲线比较手术与保守治疗后卒中再发生的差异;多因素Cox回归分析筛选手术治疗的影响因素。结果462例烟雾病患者平均随访时间为33.6个月,242例手术治疗和220例保守治疗患者中分别有31例(12.8%)和63例(28.6%)新发脑卒中,进行倾向性评分匹配后,185例手术治疗和185例保守治疗患者纳入进一步分析。Kaplan-Meier曲线分析显示两者新发脑卒中发生存在差异(P=0.018);多因素Cox生存分析提示后循环受累(95%CI:2.343~11.375,P<0.001)和脑白质病变(95%CI:1.083~4.828,P=0.030)是手术后卒中再发的危险因素,两种手术方式(联合和间接血运重建术)在卒中再发生预防方面无统计学差异(P=0.777)。结论与保守治疗相比,手术能降低缺血型烟雾病卒中再发生的风险和取得良好预后,不同手术方式对防止脑卒中再发生无差异。

Objective To investigate the efficacy of cerebral revascularization(different surgical procedures)for stroke prevention and prognosis in ischemic-type moyamoya disease(MMD)through a multicenter retrospective study.Methods Clinical,neuroradiologic,and follow-up data of 462 patients with ischemic-type MMD from Xiangya Hospital of Central South University,Changde People’s Hospital,and Hunan Children’s Hospital were analyzed in this study.Propensity score matching was performed,and then the Kaplan-Meier curve was used to compare the recurrence rate of stroke between the patients receiving surgical treatment and those receiving conservative treatment.A multivariable Cox regression analysis was performed to identify the risk factors for stroke recurrence after surgical treatment.Results The mean follow-up time was 33.6 months in the 462 patients.Stroke occurred in 31(12.8%)of the 242 surgically treated patients and 63(28.6%)of the 220 conservatively treated patients.A total of 185 pairs were selected through propensity score matching.The Kaplan-Meier curve showed a significant difference in the incidence of recurrent stroke between the two groups(P=0.018).The multivariable Cox regression analysis revealed that posterior cerebral artery involvement(95%confidence interval[CI]:2.343-11.375,P<0.001)and cerebral white matter hyperintensities(95%CI:1.083-4.828,P=0.030)were risk factors for stroke recurrence after surgery.There was no significant difference between the two surgical procedures(combined and indirect revascularization)in the prevention of recurrent stroke(P=0.777).Conclusions Compared with conservative treatment,surgical revascularization can reduce the incidence of recurrent stroke and achieve favorable outcome in ischemic-type MMD,and different surgical procedures are similar in preventing recurrent stroke.