白质疏松对大动脉粥样硬化型脑卒中患者预后的影响

发布时间：2018-05-03 05:19

  本文选题：大动脉粥样硬化型脑卒中 + 白质疏松　； 参考：《郑州大学》2014年硕士论文

【摘要】：背景与目的： 白质疏松（white matter hyperintensities， WMHs）是小血管病主要的表现类型之一，脑卒中合并WMHs的占有44%-86.4％，更常与腔隙性梗塞、微出血等伴随出现。大动脉粥样硬化型脑卒中（1arge artery atherosclerosis，LAA）是常见的缺血性脑卒中类型，估计在亚洲卒中人群中占20％-50％。而流行病学资料显示WMHs也可伴随LAA。白质疏松区域白质纤维联系障碍，脑组织灌注减少，合并WMHs可能增加LAA预后不良的风险。WMHs可以根据解剖定位于分为两部分：侧脑室旁白质疏松(periventricular WMHs PVWMHs)和深部白质疏松分(subcortical WMHs SWMHs)。既往的研究大都聚焦于LAA或WMHs。很少关注同时合并的WMHs，特别是不同部位WMHs对缺血性卒中的结局影响。本研究对此进行探索。 对象与方法： 研究对象：来自基于郑州大学第一附属医院神经内科的单中心的前瞻性卒中登记数据库，筛选数据库中自2009年11月至2012年10月住院发病14天内的急性缺血性卒中患者。 研究方法：连续纳入符合标准的缺血性卒中患者，记录患者基线临床资料，完成标准入院登记表。 1知情同意：书面告知符合纳入标准的患者和/或家属本研究的目的、方法及可能对患者及其家属带来的益处及风险，患者和/或家属决定是否加入本研究，并可在研究过程任一阶段退出。 2记录基线资料：收集患者的年龄、性别、吸烟史、高血压史、糖尿病史、心房颤动史、卒中史。收集入院时美国国立健康研究院卒中评分(NIHSS)、实验室检查、心电图(EKG)、胸片，颈部血管彩超、CTA结果、TOAST分型、WMHs严重程度评分。所有患者均行3.0Tesla MRI检查，，包括常规序列T1加权像、T2加权像、液体衰减反转回复（FLAIR）序列、弥散加权成像（DWI）序列。 3随访：在患者发病后12月后进行电话随访，由经统一培训且未参加纳入工作的研究人员对患者进行记录临床结局（卒中复发、生活依赖或死亡）、二级预防药物使用情况等。 4输机及统计分析：上述资料输入SPSS17.0保存并分析，通过Kaplan-Meier方法进行生存分析（p0.05），通过多因素Cox回归、Logistic回归分析卒中复发以及生活依赖事件发生的危险因素（p0.05）。 结果： 在1003例连续缺血性卒中患者中，51例（5.1%）资料不齐全，541例(心源型97例（10.2%），小血管型189例（19.8%），其他型92例（9.7%），不明原因型163例（17.1%）。最终411例符合研究标准而入选，男278例，女133例，平均年龄59.55±17.41岁（16-94岁），复发50例（12.2%），预后不佳（生活依赖或死亡）116例（28.2%），失访22例（5.3%）。在411例大动脉粥样硬化型脑卒中患者中，129例（32.4％）合并重度WMHs,193例（49.6％）合并重度PVWMHs，146例（36.7％）合并重度SWMHs。 通过K-M生存分析，对数秩检验显示合并重度WMHs（P＜0.001）、重度PVWMHs（P＜0.001），卒中复发风险均增加。合并重度SWMHs（P=0.06），LAA复发风险均无统计学差异。为了控制其他中风危险因素，分别采用多因素logistic回归分析、Cox生存分析来探讨不同位置的重度WMHs对LAA复发及生活依赖的影响。为了避免白质疏松的交互作用，重度WMHs （根据Fazekas＞3）进入模型一进行分析，不同位置的重度WMHs进入模型二分析。在模型一，重度WMHs与LAA复发（P＜0.001HR=6.7795%CI3.30-13.89）、生活依赖(P＜0.001HR=3.0495%CI1.69-5.44)呈正相关。另外，LDL（P=0.021HR=1.5095%CI1.06-2.11）与复发呈正相关。年龄（P=0.021HR=1.0395%CI1.01-1.06），NIHSS评分（P＜0.001HR=1.1995%CI1.12-1.25）、LDL（P=0.037HR=1.4295%CI1.02-1.97）与生活依赖呈正相关。在模型二中，年龄（P=0.035HR=1.03CI95%1.00-1.07）、LDL（P=0.040HR=1.4895%CI1.02-2.15）、重度PVWMHs（P=0.013HR=2.4195%CI1.21-4.81）与复发呈正相关；但重度SWMHs（P=0.721HR=0.8995%CI0.46-1.71）与LAA复发无相关性。年龄(P=0.017HR=1.0395%CI1.01-1.06)、NHISS评分(P＜0.001HR=1.1895%CI1.11-1.24)、重度PVWMH(P＜0.001HR=3.3495%CI1.83-6.07)与生活依赖呈正相关；但重度SWMHs（P=0.806HR=1.0895%CI0.59-1.95）与生活依赖无相关性。 结论： 合并重度白质疏松、重度侧脑室旁白质疏松的大动脉粥样硬化型脑卒中病人的卒中复发以及生活依赖风险显著高于对照组。
[Abstract]:Background and purpose:
Leukoaraiosis (white matter hyperintensities, WMHs) is one of the major manifestations of small vascular disease. Cerebral Apoplexy Combined with WMHs is 44%-86.4%, more often associated with lacunar infarction and micro bleeding. Large atherosclerotic stroke (1arge artery atherosclerosis, LAA) is a common type of ischemic stroke, estimated in subtype The population of stroke in the continent is 20%-50%. and epidemiological data show that WMHs can also be associated with leukofibrinous disorders in the LAA. leukoaraiosis area and the decrease in cerebral tissue perfusion. The combination of WMHs may increase the risk of poor prognosis of LAA,.WMHs can be divided into two parts according to the anatomical location: lateral ventricle leukoaraiosis (periventricular WMHs PVWMHs). Deep leukoaraiosis (subcortical WMHs SWMHs). Previous studies have mostly focused on LAA or WMHs. with little attention to simultaneous WMHs, especially the effects of WMHs on ischemic stroke in different sites. This study explored this study.
Objects and methods:
Participants: a single center prospective stroke registration database based on the neurology department of the First Affiliated Hospital of Zhengzhou University was selected to screen for acute ischemic stroke patients in the database for 14 days from November 2009 to October 2012.
Research methods: continuous ischemic stroke patients with standard compliance, record baseline clinical data and complete the standard admission registration form.
1 informed consent: the purpose, method, and risk of the patient and / or family members of the patient and / or family members of the patient and / or family members in writing to meet the inclusion criteria, and whether the patient and / or family members decide whether to join this study and exit at any stage of the study.
2 baseline data: the age, sex, smoking history, history of hypertension, diabetes, atrial fibrillation, stroke history. The National Institutes of Health Stroke score (NIHSS), laboratory examination, electrocardiogram (EKG), chest radiography, neck vascular color Doppler, CTA results, TOAST classification, WMHs severity score were collected at the admission. All patients received 3.0T Esla MRI examination, including conventional sequence T1 weighted images, T2 weighted images, fluid attenuated inversion recovery (FLAIR) sequences, and diffusion weighted imaging (DWI) sequences.
3 follow up: the patients were followed up after December after the onset of the disease. The researchers who had been trained and did not participate in the work recorded the patient's clinical outcome (the recurrence of stroke, life dependence or death), and the use of two levels of preventive drugs.
4 transmission and statistical analysis: the above data were stored and analyzed by SPSS17.0, and the survival analysis (P0.05) was carried out by the Kaplan-Meier method. By multiple factor Cox regression, Logistic regression was used to analyze the risk factors for the recurrence of stroke and the occurrence of life dependent events (P0.05).
Result锛

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