Wei Chen-Chen, Zhang Shu-Ting, Wang Yun-Han, Liu Jun-Feng, Li Jie, Yuan Ruo-Zhen, Tan Ge, Zhang Shi-Hong, Liu Ming
Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China.
Department of Ultrasound, Chengdu First People's Hospital, 18 Wanxiang North Road, Chengdu 610041, Sichuan Province, PR China.
J Neurol Sci. 2017 Jul 15;378:94-99. doi: 10.1016/j.jns.2017.05.001. Epub 2017 May 2.
Cardioembolic stroke due to atrial fibrillation (AF) and/or rheumatic heart disease (RHD) often involves hemorrhagic transformation (HT), and we examined whether leukoaraiosis (LA) was associated with HT in these cases. We prospectively enrolled 251 patients who were admitted to two hospitals within one month of experiencing cardioembolic stroke due to AF/RHD. LA severity was assessed using three visual rating scales. HT was identified in 99 patients (39.4%) based on baseline computed tomography (CT) and post-admission magnetic resonance imaging or second CT. Univariate analysis identified risk of HT as higher in the presence of frontal LA based on the age-related white matter changes scale and in the presence of anterior LA based on the VSS scale. Multivariate analysis confirmed that moderate to severe LA was independently associated with higher HT risk. Of the various sites affected in LA, frontal LA correlated with highest risk of HT (OR 3.199, 95%CI 1.555-6.580). These results suggest that moderate to severe LA, especially at periventricular and anterior sites, is associated with HT after cardioembolic stroke due to AF/RHD. These findings suggest the need to take LA into account as a HT risk factor when considering the use of anticoagulation and thrombolysis in these patients.
由心房颤动（AF）和/或风湿性心脏病（RHD）导致的心源性栓塞性卒中常伴有出血性转化（HT），我们研究了在这些病例中脑白质疏松（LA）是否与HT相关。我们前瞻性纳入了251例因AF/RHD导致心源性栓塞性卒中后1个月内入住两家医院的患者。使用三种视觉评分量表评估LA严重程度。根据基线计算机断层扫描（CT）以及入院后磁共振成像或第二次CT，在99例患者（39.4%）中发现了HT。单因素分析确定，基于年龄相关性白质变化量表，额叶LA的存在以及基于视觉评分量表（VSS）前侧LA的存在使HT风险更高。多因素分析证实，中度至重度LA与更高的HT风险独立相关。在LA所累及的各个部位中，额叶LA与HT的最高风险相关（比值比3.199，95%置信区间1.555 - 6.580）。这些结果表明，中度至重度LA，尤其是在脑室周围和前侧部位，与AF/RHD导致的心源性栓塞性卒中后的HT相关。这些发现提示，在考虑对这些患者使用抗凝和溶栓治疗时，需要将LA作为HT的一个风险因素加以考虑。
