CAJ | 학술논문

目的通过分析急性期缺血性小卒中患者磁共振成像（magnetic resonance imaging，MRI）弥散加权成像（diffusion weighted imaging，DWI）的病灶模式及磁共振血管成像（magnetic resonance angiography， MRA）/增强磁共振血管成像（contrast enhanced magnetic resonance angiography，CE-MRA）反映的大血管病变情况，结合临床信息，探讨对小卒中1年卒中复发有较强预测作用的评价指标。 　　方法以中国颅内动脉粥样硬化研究（Chinese IntraCranial Atherosclerosis Study，CICAS）数据库中的患者资料为数据来源，纳入发病7d内、病前改良Rankin量表（modified Rankin Scale，mRS）评分≤2分、脑部MRI-DWI发现新梗死病灶、入院时美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分＜4分的缺血性卒中患者；收集患者的基线信息和影像信息所示不同病变模式及大血管病变情况，以单变量分析和多变量分析确定小卒中后1年卒中复发的预测因素。 　　结果本研究最终纳入843例缺血性小卒中患者，平均年龄（61.67±11.04）岁。1年累计卒中复发率4.39%。1年预后的Cox回归分析结果显示：年龄＞75岁[风险比（hazard ratio，HR）3.18，95%可信区间（confidence interval，CI）1.140～7.211，P=0.006）]，症状相关性动脉闭塞（HR2.35，95%CI 1.094～5.030，P=0.029），多发非症状相关性动脉狭窄（HR 2.74，95%CI 1.311～5.730， P=0.007），多发皮层、皮层下和（或）深部白质梗死（HR 2.06，95%CI 1.006～4.229，P=0.048）是1年卒中复发的独立预测因子。 　　结论急性缺血性小卒中患者影像学检查对于判断预后有重要意义，DWI所示多发皮层、皮层下和（或）深部白质病变、多发颅内外动脉狭窄是小卒中1年卒中复发的独立预测因子。
목적통과분석급성기결혈성소졸중환자자공진성상（magnetic resonance imaging，MRI）미산가권성상（diffusion weighted imaging，DWI）적병조모식급자공진혈관성상（magnetic resonance angiography， MRA）/증강자공진혈관성상（contrast enhanced magnetic resonance angiography，CE-MRA）반영적대혈관병변정황，결합림상신식，탐토대소졸중1년졸중복발유교강예측작용적평개지표。 　　방법이중국로내동맥죽양경화연구（Chinese IntraCranial Atherosclerosis Study，CICAS）수거고중적환자자료위수거래원，납입발병7d내、병전개량Rankin량표（modified Rankin Scale，mRS）평분≤2분、뇌부MRI-DWI발현신경사병조、입원시미국국립위생연구원졸중량표（National Institutes of Health Stroke Scale，NIHSS）평분＜4분적결혈성졸중환자；수집환자적기선신식화영상신식소시불동병변모식급대혈관병변정황，이단변량분석화다변량분석학정소졸중후1년졸중복발적예측인소。 　　결과본연구최종납입843례결혈성소졸중환자，평균년령（61.67±11.04）세。1년루계졸중복발솔4.39%。1년예후적Cox회귀분석결과현시：년령＞75세[풍험비（hazard ratio，HR）3.18，95%가신구간（confidence interval，CI）1.140～7.211，P=0.006）]，증상상관성동맥폐새（HR2.35，95%CI 1.094～5.030，P=0.029），다발비증상상관성동맥협착（HR 2.74，95%CI 1.311～5.730， P=0.007），다발피층、피층하화（혹）심부백질경사（HR 2.06，95%CI 1.006～4.229，P=0.048）시1년졸중복발적독립예측인자。 　　결론급성결혈성소졸중환자영상학검사대우판단예후유중요의의，DWI소시다발피층、피층하화（혹）심부백질병변、다발로내외동맥협착시소졸중1년졸중복발적독립예측인자。
Objective To evaluate various brain magnetic resonance imaging diffusion weighted imaging (MRI-DWI) lesion patterns and the severity of large vessel stenosis assessed in the acute phase of minor ischemic stroke to ifgure out the predictors for recurrent stroke at 1 year. Methods We studied patients presenting with minor ischemic stroke in the Chinese Intracranial Atherosclerosis Study (CICAS)-group. The inclusion criteria of our study have included that within 7 days of stroke onset, the modiifed Rankin Scale (mRS) score was2 before enrollment, minor ischemic stroke (National Institutes of Health Stroke Scale [NIHSS]<4), the complete baseline and follow-up data and acute MRI-DWI lesions. Baseline characteristics, treatment, different MRI-DWI lesion patterns and the severity of large vessel stenosis were collected. Predictors of recurrent stroke, combined cardiac and cerebrovascular events, poor outcome at 1 year were analyzed by univariate and multivariate analysis. Results A total of 843 patients, mean age of (61.67±11.04) years, were included in the study. The incidence of cumulative stroke recurrence rate at 1 year were 4.39%. Multivariate analysis showed that age>75 years ([hazard ratio]HR3.18, 95% [confidence interval]CI1.140~7.211,P=0.006), symptomatic artery occlusion (HR2.35, 95%CI1.094~5.030,P=0.029), multiple asymptomatic artery stenosis (HR2.74, 95%CI1.311~5.730,P=0.007), multiple cortical, subcortical and deep white matter DWI lesions (HR2.06, 95%CI1.006~4.229,P=0.048) were signiifcant predictors for recurrent stroke at 1 year. Conclusion Imaging is a useful judgment implement for the outcome of patients with minor ischemic stroke. Multiple cortical, subcortical or deep white matter lesions, multiple intracranial and extracraninal arterial stenosis are signiifcant predictors for recurrent stroke at 1 year.