脑白质病变与小动脉闭塞性脑梗死早期神经功能恶化的关系
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摘要
目的:探讨小动脉闭塞性脑梗死患者发生早期神经功能恶化(END)与脑白质病变(WMLs)的关系。方法:连续纳入2015年1月-2016年12月收治于本院神经内科发病48 h内的小动脉闭塞性脑梗死患者154例,按照发病72 h内是否出现神经功能恶化分为END组(n=36)和非END组(n=118)。比较两组的年龄、性别、既往病史、个人史、入院时基线美国国立卫生研究院卒中量表(NIHSS)评分、基线血压及相关实验室检查,同时应用头部MRI评估并比较两组的WMLs严重程度。结果:两组患者的年龄、性别、既往病史、个人史、基线血压、血脂、超敏C-反应蛋白和空腹血糖比较,差异均无统计学意义(P>0.05);END组基的线NIHSS评分高于非END组,差异有统计学意义(P=0.047)。END组的侧脑室周围及深部白质Fazekas量表评分均显著高于非END组,差异均有统计学意义(P<0.05)。结论:WMLs受损严重的患者发生病情恶化的风险更高,评估WMLs有助于临床预测急性小动脉闭塞性脑梗死患者的病情进展情况。
Objective:To explore the association between white matter lesions(WMLs) and early neurological deterioration(END) in patients with small artery occlusion stroke.Method:Consecutive 154 patients with small artery occlusion stroke were admitted to our Hospital from January 2015 to December 2016,they were divided into END group(n=36)and non-END group(n=118) according to neurological deterioration within 72 hours of symptom onset. The WMLs,age,sex,previous history,personal history,baseline National Institute of Health Stroke Scale(NIHSS) scores,blood pressure and related laboratory examination of two groups were analyzed,the head MRI was used to assess and compare the WMLs severity of the two groups.Result:There were no statistically significant differences in age,sex,past medical history,personal history,baseline blood pressure,blood lipids, high sensitivity C-reactive protein,and fasting glucose between the two groups(P>0.05);the NIHSS score of END group was higher than that in non-END group,the difference was statistically significant(P=0.047).The Fazekas scale scores at periventricular and deep white matter of the END group were significantly higher than those of the non-END group,the differences were statistically significant(P<0.05).Conclusion:Patients with severely impaired WMLs are at a higher risk of worsening the condition,assessment of WMLs is useful in predicting the progression of acute arteriolar occlusion in patients with cerebral infarction.
Objective:To explore the association between white matter lesions(WMLs) and early neurological deterioration(END) in patients with small artery occlusion stroke.Method:Consecutive 154 patients with small artery occlusion stroke were admitted to our Hospital from January 2015 to December 2016,they were divided into END group(n=36)and non-END group(n=118) according to neurological deterioration within 72 hours of symptom onset. The WMLs,age,sex,previous history,personal history,baseline National Institute of Health Stroke Scale(NIHSS) scores,blood pressure and related laboratory examination of two groups were analyzed,the head MRI was used to assess and compare the WMLs severity of the two groups.Result:There were no statistically significant differences in age,sex,past medical history,personal history,baseline blood pressure,blood lipids, high sensitivity C-reactive protein,and fasting glucose between the two groups(P>0.05);the NIHSS score of END group was higher than that in non-END group,the difference was statistically significant(P=0.047).The Fazekas scale scores at periventricular and deep white matter of the END group were significantly higher than those of the non-END group,the differences were statistically significant(P<0.05).Conclusion:Patients with severely impaired WMLs are at a higher risk of worsening the condition,assessment of WMLs is useful in predicting the progression of acute arteriolar occlusion in patients with cerebral infarction.
引文
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[2]Suda S,Kanamaru T,Okubo S,et al.Urinary albumin-tocreatinine ratio is associated with white matter lesions severity in first-ever stroke patients[J].J Neurol Sci,2017,15(373):258-262.
[3]Melkas S,Sibolt G,Oksala N K,et al.Extensive white matter changes predict stroke recurrence up to 5 years after a first-ever ischemic stroke[J].Cerebrovasc Dis,2012,34(3):191-198.
[4]孙伟平,贾志荣,王朝霞,等.同型半胱氨酸与脑卒中患者脑白质病变的相关性研究[J].中华老年心脑血管病杂志,2011,13(1):53-55.
[5]蔄红好,毕玉华,于永鹏,等.单侧孤立基底节区腔隙性脑梗死早期神经功能恶化的多因素分析及缺血耐受的相关性研究[J].中国卒中杂志,2016,11(8):642-648.
[6]王昭君,李芸,肖露露,等.腔隙性脑梗死患者早期神经功能恶化相关因素及与脑白质病变的关联研究[J].中华神经科杂志,2014,47(9):633-637.
[7]Ryu W S,Woo S H,Schellingerhout D,et al.Stroke outcomes are worse with larger leukoaraiosis volumes[J].Brain,2017,140(Pt1):158-170.
[8]陆翔,黄卫.缺血性卒中的分型:ASCO、CISS和TOAST的比较研究[J].国际脑血管病杂志,2013,21(6):430-434.
[9]Hallevi H,Chernyshev O Y,Khoury R E,et al.Intracranial atherosclerosis is associated with progression of neurological deficit in subcortical stroke[J].Cerebrovasc Dis,2012,33(1):64-68.
[10]Iwasaki A,Suzuki K,Takekawa H,et al.The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine:a single center study[J].J Headache Pain,2017,18(1):3-8.
[11]Rustom S W,Sandesh K G,Joshita S,et al.Clinical correlates of leukoaraiosis:A study of 175 patients[J].Ann Indian Acad Neurol,2016,19(4):478-481.
[12]张爱玲,冯来会,张道培,等.脑出血后再发脑梗死与脑白质病变、脑动脉狭窄及血压波动的相关性研究[J].中华神经医学杂志,2016,15(8):819-824.
[13]Kim B J,Lee S H.Prognostic Impact of Cerebral Small Vessel Disease on Stroke Outcome[J].J Stroke,2015,17(2):101-110.
[14]David J P,Ferrat E,Parisot J,et al.White Matter Lesions:Prevalence and Clinical Phenotype in Asymptomatic Individuals Aged≥50 Years[J].Dement Geriatr Cogn Disord,2016,42(3-4):159-168.
[15]杨晓萌,刘丽萍,荆京,等.幕上皮层下梗死的病因及发病机制研究现状[J].中国卒中杂志,2012,7(3):242-246.
[16]王晨,高培毅.急性腔隙性脑梗死患者脑白质疏松磁共振影像分层研究[J].中国卒中杂志,2009,4(9):721-725.
[17]李贯绯,李丽,牛晓立,等.脑血管储备与腔隙性脑梗死早期神经功能恶化的相关性研究[J].国际老年医学杂志,2016,37(6):241-244.
[18]Li L,Simoni M,Küker W,et al.Population-based casecontrol study of white matter changes on brain imaging in transient ischemic attack and ischemic stroke[J].Stroke,2013,44(11):3063-3070.
[19]Louis R C.Lacunar infarction and small vessel disease:pathology and pathophysiology[J].J Stroke,2015,17(1):2-6.
[20]Alton S,Karen A,Amelia K B,et al.The NIHSS score and its components can predict cortical stroke[J].J Neurol Disord Stroke,2013,2(1):1026-1036.