Zhang Zheng, Ren Wenwei, Shao Bei, Xu Huiqin, Cheng Jianhua, Wang Qiongzhang, Gu Yingying, Zhu Beilei, He Jincai
Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Neurol Med Chir (Tokyo). 2017 Mar 15;57(3):136-143. doi: 10.2176/nmc.oa.2016-0188. Epub 2017 Feb 10.
Whether leukoaraiosis burden retards short-term recovery after minor stroke is unclear. We investigated the association between leukoaraiosis and early recovery of neurological function after a first minor ischemic stroke in 217 acute stroke patients (National Institutes of Health Stroke Scale (NIHSS) score ≤5). Leukoaraiosis severity was graded according to the Fazekas scale and categorized into none to mild (0-2; n = 143) or severe (3-6; n = 74) groups. NIHSS and Minimum Mental State Examination (MMSE) were assessed at baseline and at 30 days. Univariate analysis revealed that the severe leukoaraiosis group was older in age (P < 0.001) and had fewer low MMSE patients than non-mild group at baseline (39.1% vs 55.9%, P = 0.003). However, the MMSE improved in none to mild group but not in the severe group at 30-day (15.4% vs 36.5%, P < 0.001). At 30-day, the severe leukoaraiosis group had higher NIHSS scores than the none-mild group (P = 0.04). Multiple linear regression analyses demonstrated that leukoaraiosis severity and admission NIHSS were independently associated with the NIHSS score on day 30 (P = 0.034, 95% CI 0.004-0.091 and P = 0.001, 95% CI 0.011-0.04). Binary regression analyses showed that leukoaraiosis severity and admission MMSE were significantly associated with MMSE (dichotomized) at 30-day (OR 2.1, P < 0.01, 95% CI 1.7-2.6 and OR 5.1, P < 0.01, 95% CI 2.1-12.8). Leukoaraiosis burden is an independent predictor of worse short-term functional and cognitive recovery after a minor ischemic stroke.
脑白质疏松症负担是否会阻碍轻度中风后的短期恢复尚不清楚。我们调查了217例急性中风患者(美国国立卫生研究院卒中量表(NIHSS)评分≤5)首次轻度缺血性中风后脑白质疏松症与神经功能早期恢复之间的关联。脑白质疏松症严重程度根据 Fazekas 量表分级,并分为无至轻度(0 - 2;n = 143)或重度(3 - 6;n = 74)组。在基线和30天时评估NIHSS和简易精神状态检查表(MMSE)。单因素分析显示,重度脑白质疏松症组年龄较大(P < 0.001),且在基线时低MMSE患者少于非轻度组(39.1% 对55.9%,P = 0.003)。然而,在30天时,无至轻度组的MMSE有所改善,而重度组则未改善(15.4% 对36.5%,P < 0.001)。在30天时,重度脑白质疏松症组的NIHSS评分高于非轻度组(P = 0.04)。多元线性回归分析表明,脑白质疏松症严重程度和入院时NIHSS与30天时的NIHSS评分独立相关(P = 0.034,95% CI 0.004 - 0.091和P = 0.001,95% CI 0.011 - 0.04)。二元回归分析显示,脑白质疏松症严重程度和入院时MMSE与30天时的MMSE(二分法)显著相关(OR 2.1,P < 0.01,95% CI 1.7 - 2.6和OR 5.1,P < 0.01,95% CI 2.1 - 12.8)。脑白质疏松症负担是轻度缺血性中风后短期功能和认知恢复较差的独立预测因素。