Walters M R, Weir C J, Adams F G, Lees K R
University Department of Medicine and Therapeutics, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, Scotland, UK.
J Neuroimaging. 2005 Oct;15(4):331-5. doi: 10.1177/1051228405279993.
Substantial variability in functional outcome and relatively few factors predictive of death or degree of recovery have been observed in patients with lacunar stroke. Such indicators are of great use in the selection of optimal rehabilitation strategies after stroke. Although computed tomography (CT) of patients with a clinical diagnosis of lacunar stroke performed within the first 10 days shows evidence of cerebral infarction in 50% to 60%, the prognostic significance of a visible ischemic lesion on CT is unclear.
633 patients who presented with symptoms consistent with lacunar stroke between June 1990 and February 1998 were studied. One hundred fourteen patients imaged with magnetic resonance, 41 patients with nonischemic diagnoses (hemorrhage or tumor), 57 patients imaged within 12 hours of ictus, and 17 patients with incomplete follow-up were excluded from the analysis. The remaining 404 patients were divided into 2 groups, depending on the appearance of the CT scan. Patients with a low-attenuation area on the CT scan consistent with an ischemic lesion in an appropriate region of the brain to explain the presenting symptoms were classified as "CT positive." Patients with either a normal CT scan of the brain or a scan that showed a lesion in an area inconsistent with the presenting symptoms were classified as "CT negative." A series of known or suspected prognostic factors were recorded for each patient: blood pressure, age, smoking, plasma glucose level, serum cholesterol level, and serum triglyceride level. Delay from stroke onset to scanning was also noted. The authors considered 3 outcome measures: survival time, outcome at 6 months after the stroke, and total length of hospital stay for the stroke admission. Six-month outcome was categorized as good (alive at home) or poor (alive in care or dead).
There was no difference in survival between the 2 groups (P= .29, log-rank test). After adjusting for other significant prognostic factors (age; relative hazard per additional decade 1.67, P< .0001: plasma glucose level; relative hazard per additional mmol/l 1.08, P= .03) in a proportional hazards model, presence of visible infarction remained nonsignificant (relative hazard 0.84, P= .40). After adjustment for the other significant factor (age, P= .0001), there was no significant difference in 6-month outcome between CT positive and CT negative patients (P= .61). Median total length of hospital stay was not significantly different between the 2 groups (CT positive, 9 days; CT negative, 8 days; Mann-Whitney test, P= .29).
The authors conclude that in their cohort of patients, having corrected for other prognostic variables, the presence of visible infarction on CT brain scan performed between 12 hours and 30 days of onset of lacunar symptoms is not predictive of duration of hospital stay or of longer term outcome.
腔隙性卒中患者的功能转归存在显著差异，而预测死亡或恢复程度的因素相对较少。此类指标在选择卒中后的最佳康复策略方面具有重要作用。尽管临床诊断为腔隙性卒中的患者在发病后10天内进行的计算机断层扫描（CT）显示，50%至60%的患者有脑梗死证据，但CT上可见缺血性病变的预后意义尚不清楚。
对1990年6月至1998年2月间出现符合腔隙性卒中症状的633例患者进行研究。114例接受磁共振成像检查的患者、41例诊断为非缺血性疾病（出血或肿瘤）的患者、57例在发病后12小时内接受成像检查的患者以及17例随访不完整的患者被排除在分析之外。其余404例患者根据CT扫描结果分为两组。CT扫描显示低衰减区域，且该区域与脑内适当区域的缺血性病变相符，能够解释所出现症状的患者被分类为“CT阳性”。脑部CT扫描正常或显示的病变区域与所出现症状不一致的患者被分类为“CT阴性”。为每位患者记录一系列已知或疑似的预后因素：血压、年龄、吸烟情况、血浆葡萄糖水平、血清胆固醇水平和血清甘油三酯水平。还记录了从卒中发作到扫描的延迟时间。作者考虑了3项转归指标：生存时间、卒中后6个月的转归以及因卒中入院的总住院时间。6个月的转归分为良好（在家中存活）或不良（在护理机构存活或死亡）。
两组患者的生存率无差异（P = 0.29，对数秩检验）。在比例风险模型中对其他显著的预后因素（年龄；每增加十岁的相对风险为1.67，P < 0.0001；血浆葡萄糖水平；每增加1 mmol/L的相对风险为1.08，P = 0.03）进行校正后，可见梗死灶的存在仍无显著意义（相对风险为0.84，P = 0.40）。在对另一个显著因素（年龄，P = 0.0001）进行校正后，CT阳性和CT阴性患者在6个月时的转归无显著差异（P = 0.61）。两组患者的中位总住院时间无显著差异（CT阳性组为9天；CT阴性组为8天；Mann-Whitney检验，P = 0.29）。
作者得出结论，在他们的患者队列中，在对其他预后变量进行校正后，腔隙性症状发作后12小时至30天内进行的脑部CT扫描上可见梗死灶，不能预测住院时间或长期转归。
