摘要
目的探讨脑白质高信号(WMH)、脑微出血与急性前循环大血管闭塞脑梗死机械取栓再通术后预后的相关性。方法回顾性纳入2019年1月至2021年12月入住郑州大学附属洛阳中心医院神经内科的接受机械取栓并成功再通(改良脑梗死溶栓分级2b/3级)的急性前循环大血管闭塞脑梗死患者,头MRI及SWI均在术前已完善。WMH的程度采用视觉Fazekas量表评定,分为无-轻度(Fazekas 0~2分)、中重度(Fazekas 3~6分)。90 d改良Rankin评分≤2分为预后良好,≥3分为预后不良。记录患者的临床数据。应用单因素及多因素logistic回归分析评估WMH程度及脑微出血与90 d功能预后、出血转化、症状性颅内出血的相关性。结果共纳入126例患者,其中无-轻度脑白质高信号85例(67.5%),中重度41例(32.5%),脑微出血37例(29.4%),预后良好61例(48.4%),预后不良65例(51.6%),出血转化20例(15.9%),其中症状性颅内出血14例(11.1%)。与预后不良组相比,预后良好组入院收缩压低、入院美国国立卫生研究院卒中量表评分低、入院扩散加权成像的Alberta卒中早期CT评分高、发病至再通时间短、中重度WMH多,差异有统计学意义(P<0.05)。而脑微出血的负荷(数量、分级)、部位与预后的差异均无统计学意义(P>0.05)。进一步logistic回归分析提示入院美国国立卫生研究院卒中量表评分(OR=1.180,95%CI:1.069~1.302,P=0.001)、入院收缩压(OR=1.029,95%CI:1.010~1.049,P=0.003)、发病至再通时间(OR=1.002,95%CI:1.000~1.004,P=0.043)、中重度WMH(OR=2.562,95%CI:1.043~6.292,P=0.040)是术后90 d功能预后不良的独立危险因素。中重度WMH组出血转化率更高(26.8%比10.6%,P=0.035),两组症状性颅内出血差异无统计学意义(19.5%比7.06%,P=0.075),脑微出血负荷、部位与出血转化及症状性颅内出血差异均无统计学意义(P>0.05)。结论中重度脑白质高信号是急性前循环脑梗死机械取栓术后预后不良的独立预测因素,其术后出血转化发生率更高,虽然症状性颅内出血发生率增加,但差异无统计学意义。脑微出血不增加术后短期功能预后不良及出血风险。
Objective To investigate the association of white matter hyperintensity(WMH)and cerebral microbleed with outcomes after mechanical thrombectomy in acute cerebral infarction with large vessel occlusion in anterior circulation.Methods Retrospective inclusion of patients with acute anterior circulation ischemic stroke who underwent mechanical thrombectomy and successfully recanalized(modified thrombolysis in cerebral infarction grade 2b/3)admitted to the Department of Neurology of Luoyang Central Hospital Affiliated to Zhengzhou University from January 2019 to December 2021 were retrospectively analyzed.Both head MRI and SWI were perfected before mechanical thrombectomy.The degree of WMH was assessed using the visual Fazekas scale,which was divided into none-mild(Fazekas 0-2),moderate to severe(Fazekas 3-6).Ninety days modified Rankin scale score≤2 was defined as a good functional outcome,conversely the score≥3 was defined as a poor functional outcome.Patients’clinical data was recorded.Then multivariate logistic regression were used to explore the correlation of WMH and cerebral microbleed with the 90 days functional outcome,hemorrhagic transformation and symptomatic intracranial hemorrhage.Results A total of 126 patients were enrolled,which contained 85 cases(67.5%)none to mild white matter hyperintensity,41 cases(32.5%)moderate to severe WMH subjects,37 cases(29.4%)with cerebral microbleed,61 cases(48.4%)with good outcome and 65 cases(51.6%)with poor outcome,20 cases(15.9%)with hemorrhagic transformation and 14 cases(11.1%)with symptomatic intracranial hemorrhage.Compared with the poor outcome group,the good outcome group had lower systolic blood pressure,lower National Institute of Health stroke scale scores,higher baseline diffusion-weighted imaging-alberta stroke program early CT score,shorter onset to recanalization time and moderate to severe WMH,the difference was statistically significant(P<0.05).Neither the cerebral microbleed burden,nor location had no statistical difference(P>0.05)in the two groups.On multivariate logistic regression analysis,baseline National Institute of Health stroke scale scores(OR=1.180,95%CI:1.069-1.302,P=0.001),baseline systolic blood pressure(OR=1.029,95%CI:1.010-1.049,P=0.003),onset to recanalization time(OR=1.002,95%CI:1.000-1.004,P=0.043),moderate to severe WMH(OR=2.562,95%CI:1.043-6.292,P=0.040)were independent risk factors for poor 90 days functional outcome after mechanical thrombectomy(P<0.05).The rate of hemorrhagic transformation was higher in the moderate-severe WMH group(26.8%vs 10.6%,P=0.035),and there was no difference between the two groups in symptomatic intracranial hemorrhage(19.5%vs 7.06%,P=0.075).There were no significant differences between the burden,location of cerebral microbleed and hemorrhagic transformation,symptomatic intracranial hemorrhage(P>0.05).Conclusion WMH was an independent risk factor for poor functional outcome in the patients of acute cerebral infarction treated WMH in anterior circulation.white matter hyperintensity increased the risk of hemorrhagic transformation.The incidence of symptomatic intracranial hemorrhage increased,but there was no statistical significance.The patients with cerebral microbleed did not increase the risk of poor outcome,hemorrhagic transformation and symptomatic intracranial hemorrhage.
作者
商丹丹
李艳
王浩
刘佳成
范真真
杜艳姣
段智慧
SHANG Dandan;LI Yan;WANG Hao;LIU Jiacheng;FAN Zhenzhen;DU Yanjiao;DUAN Zhihui(Department of Neurology,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000,China;Department of Radiology,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000,China;Luoyang Clinical Medicine Research Center for Cerebrovascular(Stroke)Diseases,Luoyang 471000,China)
出处
《河南医学研究》
2025年第16期2900-2905,共6页
Henan Medical Research
基金
河南省医学科技攻关计划联合共建项目(LHGJ20220942)
洛阳市科技局项目(2001024A)。
关键词
大血管闭塞
机械取栓
脑白质高信号
脑微出血
预后
large vessel occlusion
mechanical thrombectomy
white matter hyperintensity
cerebral microbleed
outcome
