脑白质损害对急性缺血性卒中患者短期功能结局的影响

发布时间：2018-05-06 21:48

本文选题：缺血性卒中 + 功能结局　；参考：《临床神经病学杂志》2017年03期

【摘要】：目的探讨脑白质损害对急性缺血性卒中患者3个月功能结局的影响。方法收集2013年8月~2016年1月入院的首次急性缺血性卒中患者402例,进行头颅MRI检查,采用与年龄相关的白质改变评分(ARWMC)对脑白质损害严重程度进行评估。通过mRS评估患者发病3个月的功能结局。采用多元Logistic回归分析筛选有意义的独立危险因素。结果单因素分析显示,功能结局良好与不良组年龄、NIHSS评分、冠心病、TOAST分型、三酰甘油、极低密度脂蛋白、ARWMC评分以及额叶、顶枕叶白质评分差异有统计学意义(均P0.05)。多元Logistic回归分析发现,在未考虑白质损害的情况下,年龄(OR=1.051,P0.01)及NIHSS评分(OR=1.597,P0.05)为3个月预后的独立危险因素;当白质损害进入回归方程,调整年龄和NIHSS评分后,ARWMC总分(OR=1.118,P=0.008)及额叶白质评分(OR=1.223,P=0.017)为3个月预后的独立危险因素。Spearman秩相关显示白质损害严重程度与3个月mRS评分相关(r=0.21,P0.05)。结论白质损害的严重程度及部位可以预测首次急性缺血性卒中患者3个月功能结局,且NIHSS评分、ARWMC、年龄预测预后的作用独立且依次减小。
[Abstract]:Objective to investigate the effect of white matter damage on 3-month functional outcome in patients with acute ischemic stroke. Methods 402 patients with first acute ischemic stroke admitted from August 2013 to January 2016 were examined with MRI. The severity of white matter damage was evaluated by age related white matter change score (ARWMC). The functional outcome of 3 months was evaluated by mRS. Multivariate Logistic regression analysis was used to screen significant independent risk factors. Results univariate analysis showed that there were significant differences in age NIHSS score, TOAST classification, triacylglycerol, very low density lipoprotein (VLDL) ARWMC score and white matter score in frontal lobe and parietal occipital lobe between patients with good functional outcome and those with poor outcome (all P 0.05). Multivariate Logistic regression analysis showed that age and NIHSS scores were independent risk factors for 3-month prognosis without taking white matter damage into account, and when the white matter damage entered the regression equation, it was found that the age was 1.051% (P 0.01) and the NIHSS score was 1.597% (P 0.05). After adjustment for age and NIHSS score, the total score of ARWMC was 1.118P0. 008) and the frontal lobe white matter score (ORL) was 1. 223p0. 017). Spearman rank correlation showed that the severity of white matter damage was correlated with mRS score of 0. 21P0. 05. Conclusion the severity and location of white matter damage can predict the 3-month functional outcome of patients with acute ischemic stroke, and the NIHSS score of ARWMC.Age can predict prognosis independently and in turn.
【作者单位】：河北省人民医院神经内科;
【基金】：河北省重大医学科研课题(zd2013001) 河北省科技支撑计划项目(12276104D-18)
【分类号】：R743.3

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