CAJ | 학술논문

目的探讨急性大脑中动脉闭塞患者MRI液体衰减反转恢复序列(FLAIR)高信号血管征( hyperintense vessel,HV)对于其预后的评估作用.方法从南京卒中注册系统中提取2009年5月至2011年2月间表现为大脑中动脉区首次急性梗死的患者共74例,其中男性48例(64.9％)；平均(60.7±15.3)岁,NIHSS评分12(1 ～25)分[采用中位数(范围)表示].所有患者均已行头颅MRI检查(包括DWI、FLAIR),并且经MRA或DSA提示大脑中动脉近端闭塞(MI段或M2段).根据FLAIR序列HV出现的部位和范围,将患者分为无HV组、近端HV组和远端HV组；比较各组间基线资料及神经功能评分,并以90d改良Rankin评分(mRS)为预后指标,行Logistic回归分析.结果 74例中无HV组25例(33.8％),近端HV组7例(9.5％),远端HV组42例(56.8％).远端HV组患者入院时NIHSS评分[11(1～22)分]、入院10 d NIHSS评分[14(4 ～25)分]、梗死体积[大面积梗死5例(6.8％)]及90 d mRS评分[3～6分者12例(16.2％)]明显低于无远端HV组[即近端HV组合并无HV组,分别为15(6 ～25)分,Z=-3.544;7(0～22)分,Z=-4.461;20例(27.0％),x2=20.916；27例(36.5％),x2=22.689；均P＜0.01]；从早期神经功能恢复及短期预后改善程度上看,远端HV组均明显优于无远端HV组.Logistic回归分析发现,年龄(OR=1.111,95％ CI 1.036 ～1.191,P=0.003)、梗死体积(OR=3.679,95％ CI1.350～10.025,P=0.011)、远端HV(OR =0.131,95％ CI0.027 ～0.638,P=0.012)与90 d mRS评分显著相关.结论远端HV是急性脑梗死预后的重要预测指标.
목적 탐토급성대뇌중동맥폐새환자MRI액체쇠감반전회복서렬(FLAIR)고신호혈관정( hyperintense vessel,HV)대우기예후적평고작용.방법 종남경졸중주책계통중제취2009년5월지2011년2월간표현위대뇌중동맥구수차급성경사적환자공74례,기중남성48례(64.9％)；평균(60.7±15.3)세,NIHSS평분12(1 ～25)분[채용중위수(범위)표시].소유환자균이행두로MRI검사(포괄DWI、FLAIR),병차경MRA혹DSA제시대뇌중동맥근단폐새(MI단혹M2단).근거FLAIR서렬HV출현적부위화범위,장환자분위무HV조、근단HV조화원단HV조；비교각조간기선자료급신경공능평분,병이90d개량Rankin평분(mRS)위예후지표,행Logistic회귀분석.결과 74례중무HV조25례(33.8％),근단HV조7례(9.5％),원단HV조42례(56.8％).원단HV조환자입원시NIHSS평분[11(1～22)분]、입원10 d NIHSS평분[14(4 ～25)분]、경사체적[대면적경사5례(6.8％)]급90 d mRS평분[3～6분자12례(16.2％)]명현저우무원단HV조[즉근단HV조합병무HV조,분별위15(6 ～25)분,Z=-3.544;7(0～22)분,Z=-4.461;20례(27.0％),x2=20.916；27례(36.5％),x2=22.689；균P＜0.01]；종조기신경공능회복급단기예후개선정도상간,원단HV조균명현우우무원단HV조.Logistic회귀분석발현,년령(OR=1.111,95％ CI 1.036 ～1.191,P=0.003)、경사체적(OR=3.679,95％ CI1.350～10.025,P=0.011)、원단HV(OR =0.131,95％ CI0.027 ～0.638,P=0.012)여90 d mRS평분현저상관.결론 원단HV시급성뇌경사예후적중요예측지표.
Objective To evaluate the prognostic value of hyperintense vessel (HV) in patients with acute middle cerebral artery (MCA) occlusion.Methods Seventy-four consecutive patients with first ever stroke(48 male and 26 female,the mean age was (60.7 ± 15.3) years) in the territory of MCA,retrieved from Nanjing Stroke Registry Program between May 2009 and February 2011,were enrolled assubjects.All subjects completed brain MRI,and MRA or DSA indicated proximal MCA occlusion.According to the location and extent of HV,all subjects were classified into 3 groups:without HV,proximal HV and distal HV.Clinical data were obtained and compared among patients with different grades of HV.Logistic regression analysis was employed to confirm the relevant factors of prognosis 90 days after index stroke.Results HV was observed in 49 (66.2％ ) of the 74 enrolled patients.Among patients with HV,7 (9.4％ ) were classified as proximal HV and 42 ( 56.8％ ) as distal HV.Initial NIHSS score ( 11 ( 1 -22) ),10-day NIHSS score ( 13.5(4-25) ),infarction size ( ＞2/3:5 cases(6.8％ ) ),and 90-day mRSscore (3-6 scores:12 cases( 16.2％ )) were significantly lower in patients with distal HV than those without (15(6-25),Z=-3.544;7(0-22),Z=-4.461;20 cases(27.0％),x2 =20.916;27 cases (36.5％),x2 =22.689;all P＜0.01).The NIHSS score decreased from baseline to that on 10 days and the mRS score decreased from 10 days to that on 90 days in patients with distal HV was more than that in patients without distal HV. Multivariate analysis revealed that patients with older age ( OR =1.111,95％ CI 1.036-1.191,P=0.003),high infarction size (OR=3.679,95％ CI 1.35-10.025,P=0.011) worsened outcome,whereas distal HV (P =0.012,OR =0.131,95％ CI 0.027-0.638)improved outcome.Conclusion Distal HV on FLAIR may predict a favorable outcome in patients with acute middle cerebral artery occlusion.