Shimoyama Takashi, Kimura Kazumi, Uemura Junichi, Yamashita Shinji, Saji Naoki, Shibazaki Kensaku, Iguchi Yasuyuki
Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City, Okayama 701-0192, Japan.
Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City, Okayama 701-0192, Japan.
J Neurol Sci. 2014 Mar 15;338(1-2):102-6. doi: 10.1016/j.jns.2013.12.024. Epub 2013 Dec 21.
The aim of the present study was to devise a simple grading scale for assessing the risk of development of malignant MCA infarction (MMI).
Using MRI, patients with MCA infarction and proximal vessel occlusion (ICA or M1) within 24h of onset were retrospectively studied. MMI was defined as clinical deterioration, midline shift ≥ 5 mm, or brain herniation within 48 h of admission. We evaluated clinical factors independently associated with MMI and created a simple score according to the multivariate logistic regression analysis.
Subjects comprised 119 patients, 57 of which (47.9%) developed MMI. Multivariate logistic regression analysis revealed the following independent factors associated with MMI: DWI ASPECTS ≤ 3 [odds ratio (OR), 4.16; 95% CI, 1.36-12.66, P=0.012], ACA territory involvement [OR, 6.90; 95% confidence interval [CI], 2.06-23.10, P=0.002], M1 susceptibility vessel sign (SVS) on T2*-gradient echo [OR, 4.55; 95% CI, 1.38-14.98, P=0.013], and hyperglycemia (glucose value ≥ 145 mg/dl) [OR, 5.31; 95% CI, 1.80-15.68, P=0.002]. These four variables were selected for use in the DASH score, with DWI ASPECTS ≤ 3 as 1 point, ACA territory involvement as 1 point, M1 SVS as 1 point, and hyperglycemia as 1 point. The likelihood of developing MMI for each score was as follows: score 0, 9.1%; score 1, 20.5%; score 2, 63.0%; score 3-4, 96.8%. The C statistic for the score was 0.88 (95% CI, 0.82-0.94, P<0.001).
Our DASH score reliably assessed a risk for development of MMI in large MCA infarctions.
本研究旨在设计一种简单的分级量表，用于评估恶性大脑中动脉梗死（MMI）的发生风险。
利用磁共振成像（MRI），对发病24小时内出现大脑中动脉梗死且近端血管闭塞（颈内动脉或M1段）的患者进行回顾性研究。MMI定义为入院后48小时内临床症状恶化、中线移位≥5mm或脑疝形成。我们评估了与MMI独立相关的临床因素，并根据多因素逻辑回归分析创建了一个简单的评分系统。
研究对象包括119例患者，其中57例（47.9%）发生了MMI。多因素逻辑回归分析显示，与MMI相关的独立因素如下：扩散加权成像（DWI）的脑区范围评分（ASPECTS）≤3[比值比（OR），4.16；95%置信区间（CI），1.36 - 12.66，P = 0.012]，前交通动脉（ACA）供血区受累[OR，6.90；95%CI，2.06 - 23.10，P = 0.0 .002]，T2*梯度回波序列上M1段磁敏感血管征（SVS）[OR，4.55；95%CI，1.38 - 14.98，P = 0.013]，以及高血糖（血糖值≥145mg/dl）[OR，5.31；95%CI，1.80 - 15.68，P = 0.002]。这四个变量被选入DASH评分系统，DWI ASPECTS≤3计1分，ACA供血区受累计1分，M1段SVS计1分，高血糖计1分。每个评分对应的发生MMI的可能性如下：评分0分，9.1%；评分1分，20.5%；评分2分，63.0%；评分3 - 4分，96.8%。该评分系统的C统计量为0.88（95%CI，0.82 - 0.94，P < 0.001）。
我们的DASH评分系统能够可靠地评估大脑中动脉大面积梗死发生MMI的风险。
