Bang Oh Young, Ovbiagele Bruce, Liebeskind David S, Restrepo Lucas, Yoon Sa Rah, Saver Jeffrey L
Dept. of Neurology, Samsung Medical Center, Seoul, South Korea.
J Neurol. 2009 Apr;256(4):591-9. doi: 10.1007/s00415-009-0125-x. Epub 2009 Apr 27.
Although stroke from large vessel atherothromboembolism has a common pathogenesis, its topographic presentation is variable. Given the impact of cerebral infarct size and location on incident stroke magnitude and subsequent prognosis, we evaluated the determinants of cerebral infarct topography among patients with atherosclerotic stroke.
We analyzed data on 148 consecutive patients admitted over a 4-year period to a university medical center with acute ischemic stroke within the MCA distribution on DWI, presumed due to atherosclerosis. Based on the DWI data, we divided the patients into three stroke phenotypes: large cortical, small (< 1 cm in diameter) cortical, and deep pattern. Independent factors for each stroke phenotype were evaluated using logistic regression.
After adjusting for covariates, premorbid statin use (OR, 3.05; 95% CI, 1.40-6.65) and older age (OR, 1.05 per 1 year increase; 95% CI, 1.02-1.08) were independently associated with the small cortical phenotypic pattern. In contrast, younger age (OR, 0.95 per 1 year increase; 95% CI, 0.92-0.98), premorbid statin non-use (OR, 0.40; 95% CI, 0.17-0.99), and higher levels of fasting s-glucose (OR, 1.01 per 1 mg/dl increase; 95% CI, 1.00-1.02) and admission peripheral WBC counts (OR, 1.13 per 1 x 10(9) cells/L; 95% CI, 1.00-1.27) were independently associated with the large cortical pattern. There was no relation between DWI patterns and LDL-cholesterol levels.
Age, premorbid statin use, s-glucose and WBC count predict atherosclerotic stroke phenotype. Further studies should examine whether modifying some of these factors may result in more favorable phenotypic patterns.
尽管大动脉粥样血栓形成性卒中具有共同的发病机制，但其局部表现存在差异。鉴于脑梗死大小和位置对卒中发作严重程度及后续预后的影响，我们评估了动脉粥样硬化性卒中患者脑梗死局部表现的决定因素。
我们分析了一所大学医学中心在4年期间连续收治的148例急性缺血性卒中患者的数据，这些患者在DWI上表现为大脑中动脉分布区急性梗死，推测病因是动脉粥样硬化。根据DWI数据，我们将患者分为三种卒中表型：大面积皮质型、小面积（直径<1 cm）皮质型和深部型。使用逻辑回归评估每种卒中表型的独立因素。
在对协变量进行校正后，病前使用他汀类药物（OR = 3.05；95%CI：1.40 - 6.65）和年龄较大（每增加1岁OR = 1.05；95%CI：1.02 - 1.08）与小面积皮质型表型独立相关。相比之下，年龄较小（每增加1岁OR = 0.95；95%CI：0.92 - 0.98）、病前未使用他汀类药物（OR = 0.40；95%CI：0.17 - 0.99）、空腹血糖水平较高（每增加1 mg/dl OR = 1.01；95%CI：1.00 - 1.02）和入院时外周血白细胞计数（每增加1×10⁹个细胞/L OR = 1.13；95%CI：1.00 - 1.27）与大面积皮质型独立相关。DWI模式与低密度脂蛋白胆固醇水平之间无关联。
年龄、病前他汀类药物使用情况、血糖和白细胞计数可预测动脉粥样硬化性卒中表型。进一步研究应探讨改变其中一些因素是否可能导致更有利的表型模式。
