Cho Kyung-Hee, Kang Dong-Wha, Kwon Sun U, Kim Jong S
Stroke Center and Department of Neurology, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
J Neurol Sci. 2009 Sep 15;284(1-2):163-7. doi: 10.1016/j.jns.2009.05.013. Epub 2009 Jun 4.
It remains unknown whether subacute lesion volume increase is related to neurologic progression (NP) and clinical outcome (CO) in patients with single subcortical infarct (SSI) in the middle cerebral artery (MCA) territory. We studied 77 patients who underwent diffusion-weighted MRI (DWI) within 48 h after stroke onset, which revealed unilateral SSI in the MCA territory, and follow-up DWI and MR angiography within 7 days of onset. Neurologic progression was defined as the increase of the National Institutes of Health Stroke Scale (NIHSS) score by > or = 2 during the first week. Clinical outcome was dichotomized as good (< or = 2) and poor (> or = 3) according to the modified Rankin Scale at 1 month after the onset. Lesion volume increase was defined when the infarct volume in the follow-up MRI exceeds the initial one by either > or = 30% or 50%. Fourteen patients (18.2%) had NP, and 17 (22.1%) had poor CO. Increase in lesion volume, found in 42 patients (54.5%) when defined by 50% increase and in 51 (66.2%) by 30%, was significantly associated with NP (50%, p=0.010; 30%, p=0.027) and poor CO (50%, p=0.040; 30%, 0.111). Multivariate logistic analyses revealed that lesion volume increase was independently related to NP (odd ratio, 8.48; 95% CI, 1.55-46.46) and that NP was the important predictor for poor CO (odd ratio, 39.69; 95% CI, 3.44-458.68). We conclude that subacute lesion volume growth is closely related to the NP and that the NP predicts subsequent poor CO.
大脑中动脉（MCA）区域单发皮质下梗死（SSI）患者亚急性病灶体积增加是否与神经功能进展（NP）及临床结局（CO）相关尚不清楚。我们研究了77例在卒中发作后48小时内接受弥散加权磁共振成像（DWI）检查的患者，这些检查显示MCA区域存在单侧SSI，并在发病7天内进行了随访DWI及磁共振血管造影。神经功能进展定义为发病第一周内美国国立卫生研究院卒中量表（NIHSS）评分增加≥2分。根据发病后1个月的改良Rankin量表，将临床结局分为良好（≤2分）和不良（≥3分）。当随访磁共振成像中的梗死体积比初始体积增加≥30%或50%时，定义为病灶体积增加。14例患者（18.2%）出现NP，17例（22.1%）临床结局不良。当以50%增加定义时病灶体积增加见于42例患者（54.5%），以30%增加定义时见于51例患者（66.2%），其与NP（50%，p = 0.010；30%，p = 0.027）及不良CO（50%，p = 0.040；30%，p = 0.111）显著相关。多因素logistic分析显示病灶体积增加与NP独立相关（比值比，8.48；95%可信区间，1.55 - 46.46），且NP是不良CO的重要预测因素（比值比，39.69；95%可信区间，3.44 - 458.68）。我们得出结论，亚急性病灶体积增长与NP密切相关，且NP可预测随后的不良CO。
