Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan.
Stroke. 2012 Nov;43(11):3088-90. doi: 10.1161/STROKEAHA.112.670737. Epub 2012 Sep 4.
The mechanism of progressive neurological deficit (PND) in patients with ischemic stroke remains unclear. The aim of this study was to clarify whether arterial stiffness, a marker of vascular endothelial impairment and arteriosclerosis, is associated with PND in patients with acute deep subcortical infarction.
We evaluated 156 consecutive first-ever ischemic stroke patients with acute deep subcortical infarction. PND was defined as an increment of ≥2 points in the National Institute of Health Stroke Scale score or an increase of ≥1 point in the limb weakness score within 7 days of stroke onset. Patients were assessed for risk factors, and infarct size was measured on initial diffusion-weighted magnetic resonance imaging. We measured brachial-ankle pulse wave velocity (baPWV) as a marker of arterial stiffness. We divided patients into 2 groups according to the presence or absence of PND to compare their clinical characteristics.
Fifty-two patients (33%) had PND, and baPWV was significantly higher in patients with than in those without PND. The baPWV cut-off value for PND was 18.24 m/s, with 90% sensitivity and 47% specificity. In multivariable logistic regression analysis, high baPWV (≥18.24 m/s; odds ratio, 8.22; 95% confidence interval, 2.55-31.9), large infarct size (≥15 mm; odds ratio, 2.76; 95% confidence interval, 1.01-7.92), and ≥3 infarct slices on serial axial diffusion-weighted imaging (odds ratio, 3.38; 95% confidence interval, 1.22-10.0) were independently associated with PND.
Arterial stiffness indicated by baPWV is independently associated with PND in patients with acute deep subcortical infarction.
缺血性脑卒中患者进行性神经功能缺损（PND）的机制仍不清楚。本研究旨在阐明急性深部皮质下脑梗死患者的动脉僵硬度（血管内皮损伤和动脉硬化的标志物）是否与 PND 相关。
我们评估了 156 例首次发生的急性深部皮质下脑梗死的连续缺血性脑卒中患者。PND 定义为发病后 7 天内 NIHSS 评分增加≥2 分或肢体无力评分增加≥1 分。评估了患者的危险因素，并在初始弥散加权磁共振成像上测量了梗死灶大小。我们测量了肱踝脉搏波速度（baPWV）作为动脉僵硬度的标志物。根据是否存在 PND 将患者分为 2 组，比较其临床特征。
52 例（33%）患者出现 PND，且伴有 PND 的患者的 baPWV 明显更高。PND 的 baPWV 截断值为 18.24 m/s，具有 90%的敏感性和 47%的特异性。在多变量逻辑回归分析中，高 baPWV（≥18.24 m/s；优势比，8.22；95%置信区间，2.55-31.9）、大梗死灶大小（≥15 mm；优势比，2.76；95%置信区间，1.01-7.92）和连续轴位弥散加权成像上≥3 个梗死灶（优势比，3.38；95%置信区间，1.22-10.0）与 PND 独立相关。
baPWV 所示的动脉僵硬度与急性深部皮质下脑梗死患者的 PND 独立相关。
