CAJ | 학술논문

目的探讨急性腔隙性脑梗死患者早期神经功能恶化(END)的相关因素及其与脑白质病变(WMH)的联系.方法前瞻性纳入2009年3月至2012年3月发病,且在发病4.5～24.0 h内收治于南京军区南京总医院神经内科的急性腔隙性脑梗死患者.END定义为入院72 h内任一时刻复评美国国立卫生研究院卒中量表(NIHSS)评分较入院时增加2分或2分以上.另外,所有患者入院后完成头颅磁共振检查,探讨不同位置WMH分级与END的联系.结果共入组患者223例,其中70例(31.4％)在入院72 h内发生END.多因素分析提示入院收缩压(OR=1.02,95％ CI1.00～ 1.04,P=0.049),基线NIHSS评分(OR=1.32,95％ CI 1.15 ～ 1.52,P＜0.01)以及入院血糖(OR=1.14,95％ CI 1.01 ～1.29,P=0.034)是END的独立预测因素.以Fazekas 0级为参照,侧脑室旁WMH 1级、2级、3级与END均不存在有统计学意义的联系.半卵圆中心WMH 1级、2级、3级同样与END无有统计学意义的联系.在不同年龄段、不同性别、不同动脉系统供血区病灶的亚组分析中,WMH侧脑室旁及半卵圆中心分级与END均未发现有统计学意义的联系.结论在急性腔隙性梗死患者中,基线NIHSS评分及入院收缩压、入院血糖是END的独立预测因素.不同区域的WMH分级在患者总体及不同年龄、性别、动脉供血区的亚组患者中与END均无联系.但本文为单中心研究,样本代表性可能不足.
목적 탐토급성강극성뇌경사환자조기신경공능악화(END)적상관인소급기여뇌백질병변(WMH)적련계.방법 전첨성납입2009년3월지2012년3월발병,차재발병4.5～24.0 h내수치우남경군구남경총의원신경내과적급성강극성뇌경사환자.END정의위입원72 h내임일시각복평미국국립위생연구원졸중량표(NIHSS)평분교입원시증가2분혹2분이상.령외,소유환자입원후완성두로자공진검사,탐토불동위치WMH분급여END적련계.결과 공입조환자223례,기중70례(31.4％)재입원72 h내발생END.다인소분석제시입원수축압(OR=1.02,95％ CI1.00～ 1.04,P=0.049),기선NIHSS평분(OR=1.32,95％ CI 1.15 ～ 1.52,P＜0.01)이급입원혈당(OR=1.14,95％ CI 1.01 ～1.29,P=0.034)시END적독립예측인소.이Fazekas 0급위삼조,측뇌실방WMH 1급、2급、3급여END균불존재유통계학의의적련계.반란원중심WMH 1급、2급、3급동양여END무유통계학의의적련계.재불동년령단、불동성별、불동동맥계통공혈구병조적아조분석중,WMH측뇌실방급반란원중심분급여END균미발현유통계학의의적련계.결론 재급성강극성경사환자중,기선NIHSS평분급입원수축압、입원혈당시END적독립예측인소.불동구역적WMH분급재환자총체급불동년령、성별、동맥공혈구적아조환자중여END균무련계.단본문위단중심연구,양본대표성가능불족.
Objective To investigate the predictors of early neurological deterioration (END) as well as the correlation between white matter hyperintensities (WMH) and END in patients with acute ischemic stroke.Methods Consecutive patients diagnosed as acute lacunar infarction and admitted to Jinling Hospital between 4.5 and 24.0 hours after symptom onset were prospectively recruited in the study.END was defined as an increase of National Institutes of Health Stroke Scale (NIHSS) score ≥2 points in the first 72 hours after admission.Besides,all patients received magnetic resonance imaging within 24 hours after admission.The WMH were graded according to the Fazekas rating scale.Results A total of 223patients were finally enrolled.Of them,70(31.4％)patients suffered END in the initial 72 hours after admission.Multivariable analysis indicated that systolic blood pressure (OR =1.02,95％ CI 1.00-1.04,P =0.049),baseline NIHSS score (OR =1.32,95％ CI 1.15-1.52,P ＜ 0.01) and fasting plasma glucose on admission (OR =1.14,95％ CI 1.01-1.29,P =0.034) were independent predictors for END.However,for periventricular WMH,compared to Fazekas grade 0,no statistically significant correlation existed between END and WMH grade 1,grade 2 and grade 3.For WMH in centrum semiovale,similarly,END did not correlate with WMH grade 1,grade 2 and grade 3.Likewise,in the post-hoc subgroup analysis of patients with different age,sex and different territory,END did not significantly correlate with WMH neither in periventricular nor in centrum semiovale.Conclusions Systolic blood pressure,baseline NIHSS score and the fasting plasma glucose on admission were independent predictors for END in patients with acute lacunar infarction.However,WMH located neither in periventricular spaces nor in centrum semiovale was related to END.