中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2014年
9期
628-632
,共5页
蔡新%孙建忠%陈智才%张圣%楼敏
蔡新%孫建忠%陳智纔%張聖%樓敏
채신%손건충%진지재%장골%루민
脑梗死%血栓溶解疗法%脑动脉疾病%缩窄,病理性%磁共振成像%再灌注%疾病严重程度指数
腦梗死%血栓溶解療法%腦動脈疾病%縮窄,病理性%磁共振成像%再灌註%疾病嚴重程度指數
뇌경사%혈전용해요법%뇌동맥질병%축착,병이성%자공진성상%재관주%질병엄중정도지수
Brain infarction%Thrombolytic therapy%Cerebral arterial diseases%Constriction,pathologic%Magnetic resonance imaging%Reperfusion%Severity of illness index
目的 探讨磁共振液体衰减反转恢复序列血管高信号(FVH)与静脉溶栓预后的关系.方法 回顾性分析浙江大学医学院附属第二医院神经内科2009年5月至2013年12月连续收集的缺血性卒中静脉溶栓患者的临床和影像资料.选取前循环梗死的病例,评估大脑中动脉远端供血区域FVH的情况,并分析其与溶栓后再灌注以及临床预后的关系.结果 共纳入93例患者,55例(59.1％)存在FVH,较FVH阴性者基线美国国立卫生院神经功能缺损评分(NIHSS;分)更高(11.8±6.0与7.2 ±4.5,t =-4.82,P＜0.01),弥散加权成像所显示的病灶更大(中位数分别为5.5 ml与2.0 ml,Z=-3.030,P=0.002)、灌注成像低灌注区更大(中位数分别为42.0 ml与3.0 ml,Z=-6.104,P=0.005),差异均有统计学意义.其中FVH阳性的独立影响因素为近端大血管闭塞(OR =48.874,95％ CI 11.6～205.9,P＜0.01)和高脂血症病史(OR =0.264,95％CI 0.07～0.90,P=0.048).FVH阳性是3个月预后不良的独立危险因素(OR =4.143,95％CI 1.440～11.919,P=0.008),但FVH伴早期再灌注则能明显改善3个月预后(OR=8.500,95％CI1.964～36.790,P=0.004).结论 FVH的存在与近端大血管闭塞有关,且影响静脉溶栓远期预后.早期再灌注可改善FVH阳性者的溶栓预后.
目的 探討磁共振液體衰減反轉恢複序列血管高信號(FVH)與靜脈溶栓預後的關繫.方法 迴顧性分析浙江大學醫學院附屬第二醫院神經內科2009年5月至2013年12月連續收集的缺血性卒中靜脈溶栓患者的臨床和影像資料.選取前循環梗死的病例,評估大腦中動脈遠耑供血區域FVH的情況,併分析其與溶栓後再灌註以及臨床預後的關繫.結果 共納入93例患者,55例(59.1％)存在FVH,較FVH陰性者基線美國國立衛生院神經功能缺損評分(NIHSS;分)更高(11.8±6.0與7.2 ±4.5,t =-4.82,P＜0.01),瀰散加權成像所顯示的病竈更大(中位數分彆為5.5 ml與2.0 ml,Z=-3.030,P=0.002)、灌註成像低灌註區更大(中位數分彆為42.0 ml與3.0 ml,Z=-6.104,P=0.005),差異均有統計學意義.其中FVH暘性的獨立影響因素為近耑大血管閉塞(OR =48.874,95％ CI 11.6～205.9,P＜0.01)和高脂血癥病史(OR =0.264,95％CI 0.07～0.90,P=0.048).FVH暘性是3箇月預後不良的獨立危險因素(OR =4.143,95％CI 1.440～11.919,P=0.008),但FVH伴早期再灌註則能明顯改善3箇月預後(OR=8.500,95％CI1.964～36.790,P=0.004).結論 FVH的存在與近耑大血管閉塞有關,且影響靜脈溶栓遠期預後.早期再灌註可改善FVH暘性者的溶栓預後.
목적 탐토자공진액체쇠감반전회복서렬혈관고신호(FVH)여정맥용전예후적관계.방법 회고성분석절강대학의학원부속제이의원신경내과2009년5월지2013년12월련속수집적결혈성졸중정맥용전환자적림상화영상자료.선취전순배경사적병례,평고대뇌중동맥원단공혈구역FVH적정황,병분석기여용전후재관주이급림상예후적관계.결과 공납입93례환자,55례(59.1％)존재FVH,교FVH음성자기선미국국립위생원신경공능결손평분(NIHSS;분)경고(11.8±6.0여7.2 ±4.5,t =-4.82,P＜0.01),미산가권성상소현시적병조경대(중위수분별위5.5 ml여2.0 ml,Z=-3.030,P=0.002)、관주성상저관주구경대(중위수분별위42.0 ml여3.0 ml,Z=-6.104,P=0.005),차이균유통계학의의.기중FVH양성적독립영향인소위근단대혈관폐새(OR =48.874,95％ CI 11.6～205.9,P＜0.01)화고지혈증병사(OR =0.264,95％CI 0.07～0.90,P=0.048).FVH양성시3개월예후불량적독립위험인소(OR =4.143,95％CI 1.440～11.919,P=0.008),단FVH반조기재관주칙능명현개선3개월예후(OR=8.500,95％CI1.964～36.790,P=0.004).결론 FVH적존재여근단대혈관폐새유관,차영향정맥용전원기예후.조기재관주가개선FVH양성자적용전예후.
Objective To explore the prognostic effect of fluid-attenuated inversion recovery imaging vascular hyperintensity (FVH)on intravenous thrombolysis of acute ischemic stroke.Methods We retrospectively reviewed the clinical and imaging data of intravenous thrombolytic patients with acute anterior circulation infarction admitted from May 2009 to December 2013.The presence of FVH was evaluated,and its associations with reperfusion and clinical outcome after thrombolysis were assessed.Results Ninety-three patients were analyzed.FVH was detectable in 55 (59.1％) cases.Patients with FVH had higher NIHSS scores (11.8 ± 6.0 vs 7.2 ± 4.5,P ＜ 0.01),larger initial DWI lesions (5.5 ml vs 2.0 ml,Z =-3.030,P=0.002) and perfusion lesions (42.0 ml vs 3.0 ml,Z=-6.104,P =0.005),compared with those without FVH.The history of hyperlipidemia (OR =0.264,95％ CI 0.07-0.90,P =0.048) and proximal large vessel occlusion(OR =48.874,95％ CI 11.6-205.924,P ＜ 0.01) were independently associated with the presence of FVH.The presence of FVH independently predicted the poor neurological outcome at 3 months (OR =4.143,95 ％ CI 1.440-11.919,P =0.008).However,early reperfusion was associated with favorable outcome in patients with FVH after intravenous thrombolysis (OR =8.500,95％ CI 1.964-36.790,P =0.004).Conclusions The presence of FVH is associated with proximal large vessel occlusion,which predicts poor outcome in patients with intravenous thrombolysis.However,early reperfusion among patients with FVH can improve the outcome.
