Liang Yan, Chen Yang-Kun, Deng Min, Mok Vincent C T, Wang De-Feng, Ungvari Gabor S, Chu Chiu-Wing W, Kamiya Akane, Tang Wai-Kwong
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.
Department of Neurology, Dongguan People's Hospital, Dongguan, China.
Front Aging Neurosci. 2017 Nov 13;9:372. doi: 10.3389/fnagi.2017.00372. eCollection 2017.
: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke. : Patients admitted with acute ischemic stroke of any etiology were prospectively screened between January 2010 to December 2014 and enrolled in the study if they met study entry criteria. HRQoL was evaluated with the 12-item Stroke Specific Quality of Life (SSQoL) at 3 months after the onset of acute ischemic stroke. SVD was ascertained by the presence of any of the SVD markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds (CMB) and enlarged perivascular spaces (EPVS) in the basal ganglia or their combinations on brain magnetic resonance imaging (MRI). The presence of each individual marker scored 1 point and was summed up to generate an ordinal "SVD score" (0-4) capturing total SVD burden. Linear regression was used to determine the associations between SVD burden and HRQoL. : Of the743 acute ischemic stroke patients that formed he study sample (mean age: 66.3 ± 10.6 years; 41.7% women), 49.3%, 22.5%, 16.0%, 9.2% and 3.1% had SVD scores of 0, 1, 2, 3 and 4, respectively. After adjusting for demographic, clinical and imaging variables, the SVD score was independently associated with lower overall score of SSQoL ( = -1.39, SE = 0.56, = 0.01), and its domains of mobility ( = -0.41, SE = 0.10, < 0.001) and vision ( = -0.12, SE = 0.06, = 0.03). Acute infract volume ( = -1.44, SE = 0.54, = 0.01), functional independence ( = 5.69, SE = 0.34, < 0.001) and anxious ( = -1.13, SE = 0.23, < 0.001) and depressive symptoms ( = -3.41, SE = 0.22, < 0.001) were also the significant predictors of the overall score of SSQoL. : The brain's SVD burden predicts lower HRQoL, predominantly in domains of mobility and vision at 3 months after acute ischemic stroke. The evaluation of SVD burden could facilitate developing individual treatment strategies.
脑小血管病（SVD）与死亡率增加、残疾、认知衰退以及中风幸存者的抑郁相关。本研究探讨了由SVD标志物组合定义的SVD负担与急性缺血性中风患者健康相关生活质量（HRQoL）之间的关联。2010年1月至2014年12月期间，对因任何病因入院的急性缺血性中风患者进行前瞻性筛查，符合研究纳入标准者纳入研究。急性缺血性中风发病3个月后，采用12项卒中特异性生活质量量表（SSQoL）评估HRQoL。通过脑磁共振成像（MRI）检查基底节区是否存在任何SVD标志物，包括腔隙、白质高信号（WMH）、脑微出血（CMB）和血管周围间隙增宽（EPVS），或其组合来确定SVD。每个个体标志物存在计1分，将分数相加生成一个序数“ SVD评分”（0 - 4），以反映总的SVD负担。采用线性回归确定SVD负担与HRQoL之间的关联。在构成研究样本的743例急性缺血性中风患者中（平均年龄：66.3±10.6岁；41.7%为女性），SVD评分为0、1、2、3和4的患者分别占49.3%、22.5%、16.0%、9.2%和3.1%。在调整了人口统计学、临床和影像学变量后，SVD评分与SSQoL总分较低独立相关（β = -1.39，标准误 = 0.56，P = 0.01），及其活动能力（β = -0.41，标准误 = 0.10，P < 0.001）和视力（β = -0.12，标准误 = 0.06，P = 0.03）领域相关。急性梗死体积（β = -1.44，标准误 = 0.54，P = 0.01）、功能独立性（β = 5.69，标准误 = 0.34，P < 0.001）以及焦虑（β = -1.13，标准误 = 0.23，P < 0.001）和抑郁症状（β = -3.41，标准误 = 0.22，P < 0.001）也是SSQoL总分的显著预测因素。急性缺血性中风后3个月，脑SVD负担预示着较低的HRQoL，主要体现在活动能力和视力领域。评估SVD负担有助于制定个体化治疗策略。
