de Jong G, Kessels F, Lodder J
Department of Neurology, Isala Clinics Location Weezenlanden, Zwolle, The Netherlands.
Stroke. 2002 Aug;33(8):2072-6. doi: 10.1161/01.str.0000022807.06923.a3.
Earlier, we found that lacunar stroke patients with > or =1 asymptomatic lacunar infarcts on CT had leukoaraiosis and hypertension significantly more often than patients without such lesions, and we hypothesized that 2 types of small-vessel disease could be distinguished during life: arteriolosclerosis and microatheromatosis, respectively. Differences in prognosis might sustain this hypothesis of 2 lacunar stroke entities. Therefore, we performed a follow-up in 333 patients with first lacunar stroke, distinguishing those with > or =1 asymptomatic lacunar lesions (LACI+) from those without such lesions (LACI-).
Cross-sectional follow-up was performed after 785+/-479 days (mean+/-SD) in 104 LACI+ patients and 865+/-545 days in 229 LACI- patients.
Mortality at the end of follow-up was 33% in LACI+ and 21% in LACI- patients [odds ratio (OR), 1.74; 95% confidence interval (CI), 1.01 to 3.01]. Stroke recurrence rate was 21% in LACI+ and 11% in LACI- (OR, 2.09; 95% CI, 1.08 to 4.06). Forty percent of LACI+ and 26% of LACI- patients had unfavorable outcome at the end of follow-up (OR, 1.95; 95% CI, 1.17 to 3.26). Kaplan-Meier curves showed less favorable survival in LACI+ (log-rank test, P=0.0218) and survival free of stroke (log-rank test, P=0.0121) than in LACI-. When we restricted the analysis to patients with both silent lesions and leukoaraiosis (n=63) compared with those without (n=196), differences were even more pronounced.
Prognosis for mortality, recurrent stroke, and overall functional outcome in lacunar stroke patients with > or =1 silent lacunar lesions is more unfavorable than in patients without such lesions. These findings sustain the idea of 2 lacunar stroke entities.
此前，我们发现CT显示有≥1个无症状腔隙性梗死灶的腔隙性卒中患者，与无此类病灶的患者相比，脑白质疏松症和高血压更为常见。我们推测，在临床上可区分出两种类型的小血管疾病：分别为小动脉硬化症和微动脉粥样硬化症。预后差异可能支持这两种腔隙性卒中类型的假说。因此，我们对333例首次发生腔隙性卒中的患者进行了随访，区分出有≥1个无症状腔隙性病灶的患者（LACI+）和无此类病灶的患者（LACI-）。
对104例LACI+患者在785±479天（均值±标准差）后进行横断面随访，对229例LACI-患者在865±545天进行随访。
随访结束时，LACI+患者的死亡率为33%，LACI-患者为21%[比值比（OR），1.74；95%置信区间（CI），1.01至3.01]。LACI+患者的卒中复发率为21%，LACI-患者为11%（OR，2.09；95%CI，1.08至4.06）。40%的LACI+患者和26%的LACI-患者在随访结束时预后不良（OR，1.95；95%CI，1.17至3.26）。Kaplan-Meier曲线显示，LACI+患者的生存情况（对数秩检验，P = 0.0218）和无卒中生存情况（对数秩检验，P = 0.0121）比LACI-患者更差。当我们将分析限制在既有无症状病灶又有脑白质疏松症的患者（n = 63）与无此类情况的患者（n = 196）时，差异更为明显。
有≥1个无症状腔隙性病灶的腔隙性卒中患者在死亡率、复发性卒中和总体功能预后方面比无此类病灶的患者更差。这些发现支持了两种腔隙性卒中类型的观点。
