脑白质病变对急性脑梗死近期预后的影响

发布时间：2018-10-24 06:56

【摘要】：背景和目的急性脑梗死(ACI)是脑组织血供系统突然中断后导致的脑组织坏死性脑血管疾病,具有较高的致死及致残率。脑白质病变(WML)是脑小血管病变(SVD)的影像学表现之一,是指脑室周围或皮层下区脑白质的弥漫性斑点影像或斑片状影像。近年研究发现,伴有WML及脑萎缩的急性脑梗死患者脑血流速度减慢,往往预后不良。本研究通过观察伴有WML的ACI患者近期预后,探讨WML对ACI患者预后的影响及评估价值。方法病例选自2015年9月~2016年1月安徽省医科大学第一附属医院神经内科住院ACI患者,其中磁共振成像(MRI)图像(FLAIR及T2WI)检查结果提示为ACI合并WML的患者40例(WML组),ACI无合并WML患者40例作为对照组,分析患者入院时的血管危险因素(年龄、高血压病史、糖尿病史,吸烟史,既往脑出血、脑梗死病史等)、美国国立卫生院神经功能缺损评分(NIHSS评分)、实验室检查指标(如糖化血红蛋白、肌酐、血脂水平等),根据改良Rankin预后等级量表评分(MRS)结果评价患者出院后1月临床近期预后。对WML情况与患者临床资料及近期预后进行统计学相关分析,探讨WML与ACI近期预后之间的相关性。结果对WML组(n=40)及对照组(n=40)两组患者临床基本资料及实验室检查治疗进行比较,WML组患者年龄较对照组患者[(72.68±8.46岁)vs(68.75±8.79岁),P=0.045]明显偏大,MRS评分偏高[(2.63±1.00分)vs(2.10±0.67分),P=0.007],近期不良临床预后比例高[22(55.0%)vs 12(30.0%),P=0.024]。比较近期预后临床情况将患者分为预后良好组(n=46)及预后不良组(n=34),预后不良组较预后良好组年龄偏大[(68.57±7.32岁)vs.(73.62±9.85岁),P=0.021],WML患病率更高[18(39.1%)vs.22(64.7%),P=0.034],预后不良组入院时NIHSS评分偏高[(7.71±4.74分)vs.(3.96±3.18),P=0.024],差异具有统计学意义。进一步统计学分析表明:年龄是评估急性脑梗死患者近期临床预后的较有价值的预测因子,其ROC曲线下面积(AUC)为0.71(95%(CI):0.59-0.83,P=0.002),WML的AUC为0.64(95%(CI):0.52-0.77,P=0.032),NIHSS的AUC为0.74((95%(CI):0.63-0.83,P0.001),差异具有统计学意义;二元logistic回归分析WML与所有ACI患者近期预后的关系发现,WML是ACI患者近期预后的危险因素,优势比为2.65(1.00-7.09)。结论脑白质病变(WML)是ACI患者近期预后不良的独立危险因素,可作为评估ACI患者近期预后的参考指标。临床上将MRI上WML与年龄、NIHSS评分三者联合使用可更加准确评估ACI患者的近期预后。
[Abstract]:Background and objective Acute cerebral infarction (ACI) is a necrotic cerebrovascular disease caused by sudden interruption of cerebral blood supply system. The white matter lesion (WML) is one of the imaging manifestations of the small cerebral vascular disease (SVD). It refers to the diffuse speckle or patchy image of the white matter around the ventricle or subcortical area. In recent years, it has been found that the cerebral blood flow velocity of patients with acute cerebral infarction with WML and cerebral atrophy is slower and the prognosis is often poor. In this study, we observed the short-term prognosis of ACI patients with WML, and explored the influence of WML on the prognosis of ACI patients and its evaluation value. Methods patients with ACI were selected from September 2015 to January 2016 in Department of Neurology, the first affiliated Hospital of Anhui Medical University. The results of (MRI) (FLAIR and T2WI) showed that 40 patients with ACI and WML (40 patients with), ACI without WML in WML group as control group) were analyzed the vascular risk factors (age, history of hypertension, history of diabetes) at admission. History of smoking, previous cerebral hemorrhage, history of cerebral infarction, National Institutes of Health neurological impairment score (NIHSS score), laboratory indicators (such as glycosylated hemoglobin, creatinine, etc.), According to the modified Rankin prognostic rating scale (MRS), the clinical short-term prognosis was evaluated 1 month after discharge. To analyze the correlation between WML and clinical data and short term prognosis, and to explore the correlation between WML and ACI. Results the basic clinical data and laboratory examination in WML group and control group were compared. The patients in WML group were significantly older than those in control group [(72.68 卤8.46 years old,) vs (68.75 卤8.79 years old), P < 0.045], MRS score was higher [(2.63 卤1.00) vs (2.10 卤0.67), P < 0.007], and the proportion of short term adverse clinical prognosis was higher [22 (55.0%) vs 12 (30.0%), P < 0.024]. The patients were divided into good prognosis group (nn 46) and poor prognosis group (nn 34). The patients in poor prognosis group were older than those in good prognosis group [(68.57 卤7.32 years old) vs. (73.62 卤9.85 years old, P < 0.021], the prevalence of WML was higher (18 (39.1%) vs.22 (64.7%), P < 0.034], the NIHSS score of poor prognosis group was higher than that of good prognosis group [(7.71 卤4.74) vs. (3.96 卤3.18), P < 0.024]. The difference is statistically significant. Further statistical analysis showed that age was a valuable predictor of short-term clinical prognosis in patients with acute cerebral infarction. The area of AUC under the ROC curve was 0.71 (95% (CI): 0.59-0.83), WML) AUC was 0.64 (95% (CI): 0.52-0.77), NIHSS AUC was 0.74 (95% (CI): 0.63-0.83P0.001), the difference was statistically significant; The relationship between WML and the short-term prognosis of all ACI patients by binary logistic regression analysis showed that WML was a risk factor for the short-term prognosis of ACI patients, and the odds ratio was 2.65 (1.00-7.09). Conclusion (WML) is an independent risk factor for the poor prognosis of patients with ACI in the near future and can be used as a reference index for evaluating the short-term prognosis of patients with ACI. Clinical use of WML on MRI, age and NIHSS score can more accurately evaluate the short term prognosis of ACI patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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