脑白质高信号与缺血性卒中患者康复期独立生活预后的相关性研究

发布时间：2018-12-12 09:44

【摘要】：目的功能独立性测量(functional independence measure,FIM)评分主要评估缺血性卒中疗养康复期患者日常生活活动独立程度,脑白质高信号(white matter hyperintensities,WMH)对疗养康复期的影响研究甚少。文中旨在分析不同部位及不同程度WMH对疗养康复期卒中患者的日常活动独立程度的影响。方法回顾性分析2015年1月到2015年10月南京医科大学附属脑科医院神经内科治疗的缺血性卒中康复期271例患者的临床资料,依据急性卒中治疗Org10172试验(TOAST)分型将患者分为:大动脉粥样硬化性卒中、心源性脑栓塞、小血管闭塞性卒中等。根据患者运动功能评分和认知功能评分进行FIM评分,按照修订后的Fazekas标准对患者MRI检查结果进行脑室旁白质高信号(periventricular hyperintensity,PVH)和深部脑白质高信号(deep white matter hyperintensity,DWMH)严重程度的评估,并采用多元线性回归分析确定患者恢复期日常活动功能恢复与WMH的关系。结果按照TOAST分型分类,大动脉粥样硬化性卒中患者120例,心源性脑栓塞患者67例,小血管闭塞患者39例,其他原因卒中患者20例,不明原因卒中25例。患者PVH和DWMH分级为1(1,2)和2(1,2),入院FIM评分为(79.1±9.4)分,出院FIM评分为(91.8±9.0)分。多元线性回归分析结果显示,卒中患者入院FIM评分(β=0.570,P0.001)与患者出院FIM评分呈正相关,年龄(β=-0.212,P=0.001)和PVH分级(β=-0.126,P=0.020)与患者出院FIM评分呈负相关。按照TOSAT分型分层分析显示,大动脉粥样硬化性卒中患者入院FIM评分(β=0.250,P=0.002)、年龄(β=-0.305,P=0.018)和PVH分级(β=-0.350,P=0.003)与出院FIM评分相关;亦与心源性栓塞患者出院FIM评分相关。小血管闭塞性患者入院FIM评分(β=0.748,P0.001)和PVH分级(β=-0.36,P=0.03)与出院FIM评分相关。所有患者及TOAST分层后的患者多元线性回归分析结果显示,患者DWMH分级与出院FIM评分均未见相关性(P0.05)。结论缺血性卒中恢复期患者PVH严重程度可以预测患者日常活动的康复程度。
[Abstract]:Objective to evaluate the degree of independence of daily life (ADL) in patients with ischemic stroke during convalescent rehabilitation by measuring functional independence (functional independence measure,FIM). The effect of high signal (white matter hyperintensities,WMH in white matter on convalescent rehabilitation was seldom studied. The purpose of this study was to analyze the influence of different sites and degrees of WMH on the independence of daily activities of stroke patients in convalescent and convalescent period. Methods from January 2015 to October 2015, 271 patients with ischemic stroke treated by Department of Neurology, affiliated brain Hospital of Nanjing Medical University, were retrospectively analyzed. According to the (TOAST) classification of acute stroke treatment Org10172 test, the patients were divided into three groups: atherosclerotic stroke, cardiogenic cerebral embolism, small vessel occlusion stroke and so on. According to the patients' motor function score and cognitive function score, the FIM score was carried out. According to the revised Fazekas standard, the ventricular white matter hyperintense signal (periventricular hyperintensity,PVH) and the deep white matter hyperintense (deep white matter hyperintensity, were performed on the patients with MRI. DWMH) and multiple linear regression analysis were used to determine the relationship between the recovery of daily activities and WMH during convalescence. Results according to TOAST classification, there were 120 patients with atherosclerotic stroke, 67 patients with cardiogenic cerebral embolism, 39 patients with small vessel occlusion, 20 patients with other causes and 25 patients with unknown cause stroke. The scores of PVH and DWMH were 1 (1 / 2) and 2 (1 / 2), the scores of admission FIM were (79.1 卤9.4), and the scores of discharged FIM were (91.8 卤9.0). Multiple linear regression analysis showed that there was a positive correlation between admission FIM score (尾 = 0.570) and discharge FIM score, age (尾 = -0.212) and PVH grade (尾 = -0.126). There was a negative correlation between P0. 020 and FIM score. According to the stratification analysis of TOSAT classification, the admission FIM score (尾 = 0.250 P0. 002), age (尾 = -0.305) and PVH grade (尾 = -0.350 P0. 003) were correlated with the discharged FIM score in patients with atherosclerotic stroke. It was also related to the FIM score of patients with cardiac embolism. The FIM score (尾 = 0.748) and the PVH grade (尾 = -0.36) were correlated with the FIM score in patients with small vessel occlusion. Multiple linear regression analysis of all patients and patients after TOAST stratification showed that there was no correlation between DWMH grading and discharged FIM score (P0.05). Conclusion the severity of PVH in patients with ischemic stroke in convalescence stage can predict the rehabilitation degree of daily activities.
【作者单位】：南京医科大学附属脑科医院神经内科;
【分类号】：R743.3

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