CAJ | 학술논문

目的探讨脑白质疏松和陈旧性腔隙性脑梗死对于首发缺血性卒中患者预后的影响。 　　方法连续选取791例7 d以内首次发病的非心源性缺血性卒中患者。收集患者的人口学信息和脑血管病的危险因素，评价患者的头颅磁共振成像包括脑白质疏松的严重程度、无症状性腔隙性脑梗死的数量、缺血性卒中的病因分型以及急性梗死灶的分布特征，通过多因素Logistic回归分析脑白质疏松和陈旧性腔隙性脑梗死与缺血性卒中患者预后相关的危险因素。 　　结果分别有14例（1.8%）、38例（4.8%）患者在缺血性卒中发病1年内死亡、缺血性卒中或短暂性脑缺血发作（transient ischemic attack，TIA）复发。多元Logistic回归发现：存在陈旧性腔隙性脑梗死、有皮层新发脑梗死灶、入院后未给予抗血小板药物、出院时未服用他汀药物是缺血性卒中患者1年内死亡的危险因素；而脑白质疏松对于缺血性卒中患者1年内的死亡无显著影响。冠状动脉粥样硬化性心脏病、入院美国国立卫生研究院卒中量表（National Institute of Health stroke scale，NIHSS）评分<4分、新发梗死灶的责任脑动脉闭塞或狭窄程度≥70%、出院时未给予抗血小板药物是缺血性卒中患者1年内缺血性卒中或TIA复发的危险因素；而脑白质疏松和陈旧性腔隙性脑梗死对于缺血性卒中患者1年内缺血性卒中或TIA的复发无显著影响。 　　结论陈旧性腔隙性脑梗死是缺血性卒中患者1年内死亡的危险因素。而脑白质疏松和陈旧性腔隙性脑梗死对于缺血性卒中患者1年内缺血性卒中或TIA的复发无显著影响。
목적탐토뇌백질소송화진구성강극성뇌경사대우수발결혈성졸중환자예후적영향。 　　방법련속선취791례7 d이내수차발병적비심원성결혈성졸중환자。수집환자적인구학신식화뇌혈관병적위험인소，평개환자적두로자공진성상포괄뇌백질소송적엄중정도、무증상성강극성뇌경사적수량、결혈성졸중적병인분형이급급성경사조적분포특정，통과다인소Logistic회귀분석뇌백질소송화진구성강극성뇌경사여결혈성졸중환자예후상관적위험인소。 　　결과분별유14례（1.8%）、38례（4.8%）환자재결혈성졸중발병1년내사망、결혈성졸중혹단잠성뇌결혈발작（transient ischemic attack，TIA）복발。다원Logistic회귀발현：존재진구성강극성뇌경사、유피층신발뇌경사조、입원후미급여항혈소판약물、출원시미복용타정약물시결혈성졸중환자1년내사망적위험인소；이뇌백질소송대우결혈성졸중환자1년내적사망무현저영향。관상동맥죽양경화성심장병、입원미국국립위생연구원졸중량표（National Institute of Health stroke scale，NIHSS）평분<4분、신발경사조적책임뇌동맥폐새혹협착정도≥70%、출원시미급여항혈소판약물시결혈성졸중환자1년내결혈성졸중혹TIA복발적위험인소；이뇌백질소송화진구성강극성뇌경사대우결혈성졸중환자1년내결혈성졸중혹TIA적복발무현저영향。 　　결론진구성강극성뇌경사시결혈성졸중환자1년내사망적위험인소。이뇌백질소송화진구성강극성뇌경사대우결혈성졸중환자1년내결혈성졸중혹TIA적복발무현저영향。
Objective To investigate the relationship between cerebral small vessel disease and the outcome of ischemic stroke. Methods Overall, 791 patients within 7 days of their ifrst-ever non-cardiogenicischemic stroke were enrolled consecutively. Demographic information, vascular risk factors were recorded. We evaluated cranial magnetic resonance imaging includingseverity of leukoaraiosis, number of silent lacunar infarction(SLI), etiologic subtype of ischemic stroke, and topographic patterns of acute cerebral infarcts. Factors associated with the outcome of ischemic stroke were analyzed. Results A total of 14 patients (1.8%) died, and 38 patients (4.8%) developed recurrence of ischemic stroke or transient ischemic attack(TIA) in one year after stroke onset. In multivariable logistic regression analysis, presence of SLI, and presence of acute cortical cerebral infarction, without antithromboticsat admission, without statins at discharge were predictors of death in one year, while leukoaraiosis had no influence on death in one year.Coronary heart disease,admission National Institute of Health stroke scale <4, responsible artery stenosis ≥70%, and without antithrombotics at discharge were risk factors associated with recurrence of ischemic stroke or TIA in 1 year, while leukoaraiosisand SLI had no impacts on recurrence of ischemic stroke or TIA in 1 year. Conclusion Presence of SLI werepredictors of death at one year after stroke. However, leukoaraiosis and SLI had no inlfuence on the recurrence of ischemic stroke or TIA in 1 year.