脑白质病变对自发性脑出血远期预后的影响

发布时间：2018-04-13 08:46

本文选题：脑出血 + 预后　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:脑白质病变(white matter lesions,WMLs)又常被称作脑白质高信号(white matter hyperintensities,WMH)、脑白质疏松(Leukoaraiosis,LA),常见于阿尔兹海默病、血管性痴呆、缺血性卒中、脑出血(intracerebral hemorrhage,ICH)等多种疾病。目前已有研究报道脑白质病与缺血性卒中预后不良有关,但关于脑白质病变与脑出血预后方面的报道却较少,故本研究探讨脑白质病变对脑出血远期预后不良的影响。方法:1、前瞻性登记2015年1月1日至2016年4月30日入住四川省人民医院神经内科的脑出血患者,并详细记录他们的临床资料,对于完善头部MRI检查的患者,基于MRI图像使用Fazekas量表分别评估侧脑室旁和深部脑白质病变的严重程度。2、对比分析纳入研究组和未纳入研究组之间基线资料和预后的差异。根据6个月时m RS评分将纳入患者分为两组,定义m RS≥4分为预后不良组,m RS≤3分为预后良好组。利用单因素分析筛选出可能影响脑出血远期预后的危险因素,再对这些因素进行Logistic回归分析,确定影响脑出血患者远期预后的独立危险因素。利用Goodman-Kruskal Gamma方法分析脑白质病变的严重程度与脑出血远期预后不良的严重程度之间相互伴随变化的趋势和关联强度。结果:1、登记脑出血患者共178例,有127例完善头部MRI检查,其中10例失访;有51例未完善头部MRI检查,其中有2例数据不完整。纳入研究组和未纳入研究组基线对比显示:两组在高血压病史、肺部感染、GCS评分、NIHSS评分、血肿量、出血部位、血肿破入脑室、血肿不规则、6个月时m RS评分方面存在显著差异。2、脑白质病变对自发性脑出血远期预后影响的研究中,除去10例失访,最终纳入117例脑出血患者。单因素分析显示年龄、吸烟、肺部感染、血肿破入脑室、血肿不规则、血肿量、GCS评分、NIHSS评分、入院时收缩压、脑白质病变(white matter lesions,WMLs)的严重程度是自发性脑出血患者远期预后不良的危险因素。3、将上述因素纳入Logistic回归分析,结果显示自发性ICH患者远期预后不良的独立危险因素包括NIHSS评分(OR=3.467,95%CI:1.207~9.955,P0.05)、年龄(OR=1.065,95%CI:1.001~1.133,P0.05)、血肿破入脑室(OR=5.475,95%CI:1.428~20.994,P0.05)、出血量(OR=2.366,95%CI:1.206~4.641,P0.05)、脑白质病变的严重程度(OR=5.706,95%CI:1.556~20.927,P0.05)。肺部感染有影响脑出血远期预后不良的趋势(OR=3.316,95%CI:0.925~11.885,P=0.066)。4、侧脑室旁脑白质病变和深部脑白质病变的严重程度均与脑出血远期预后不良的严重程度呈正相关,相关系数分别为0.547和0.499。结论:1、脑白质病变的严重程度是脑出血远期预后不良的独立危险因素;2侧脑室旁脑白质病变较深部脑白质病变对脑出血远期预后不良有更好的预测意义3、在评估急性脑出血远期预后时可考虑将脑白质病变的严重程度考虑在内,但它影响脑出血远期预后的病理生理机制仍需进一步研究。
[Abstract]:At present, some studies have reported that leukoencephalopathy is associated with poor prognosis of ischemic stroke, but there are few reports on the prognosis of leukoencephalopathy and cerebral hemorrhage. Therefore, this study is to explore the effect of leukoencephalopathy on the long-term poor prognosis of cerebral hemorrhage.Methods: to prospectively register patients with intracerebral hemorrhage admitted to the Department of Neurology of Sichuan Provincial people's Hospital from January 1, 2015 to April 30, 2016, and record their clinical data in detail.The severity of paraventricular and deep white matter lesions was evaluated with Fazekas scale based on MRI images. The baseline data and prognosis were compared between the two groups.According to the score of Mrs at 6 months, the patients were divided into two groups, which were divided into two groups. The patients with poor prognosis were divided into two groups: the group with poor prognosis and the group with good prognosis.Single factor analysis was used to screen out the risk factors which might affect the long-term prognosis of cerebral hemorrhage. The Logistic regression analysis was carried out to determine the independent risk factors affecting the long-term prognosis of patients with intracerebral hemorrhage.Goodman-Kruskal Gamma method was used to analyze the correlation between the severity of leukoencephalopathy and the severity of long-term poor prognosis of intracerebral hemorrhage.Results among 178 patients with intracerebral hemorrhage (ICH), there were 127 cases with complete head MRI examination, including 10 cases with missing visit, 51 cases with incomplete head MRI examination and 2 cases with incomplete data.Baseline comparison between the study group and the study group showed that the two groups had a history of hypertension, a GCS score of pulmonary infection, a NIHSS score, a hematoma volume, a site of hemorrhage, and a hematoma broke into the ventricle.The hematoma was irregular, and there was significant difference in mRS score at 6 months. In the study of the long-term prognosis of spontaneous cerebral hemorrhage, 10 cases were lost, and 117 cases were included in the study.Univariate analysis showed age, smoking, pulmonary infection, hematoma breaking into the ventricle, irregular hematoma, hematoma volume, GCS score and NIHSS score, systolic blood pressure on admission.The severity of white matter lesions was the risk factor of poor long-term prognosis in patients with spontaneous intracerebral hemorrhage. The above factors were included in Logistic regression analysis.Pulmonary infection has a tendency to influence the long-term poor prognosis of intracerebral hemorrhage (CI: 0.925) 11.885Pu 0.066 .4.The severity of paraventricular white matter lesions and deep white matter lesions are positively correlated with the severity of long-term poor prognosis of intracerebral hemorrhage, and the correlation coefficients are 0.547 and 0.499respectively.Conclusion the severity of cerebral white matter lesions is an independent risk factor for long-term poor prognosis of intracerebral hemorrhage. 2 sides of paraventricular white matter lesions have better prognostic significance than deep white matter lesions in the long term prognosis of cerebral hemorrhage.In the long term prognosis of acute intracerebral hemorrhage, the severity of leukoencephalopathy may be taken into account.However, the pathophysiological mechanism of its influence on the long-term prognosis of intracerebral hemorrhage still needs to be further studied.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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