急性缺血性脑卒中伴脑白质高信号患者静脉溶栓的疗效。
The efficacy of intravenous thrombolysis in acute ischemic stroke patients with white matter hyperintensity.
机构信息
Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China.
The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
出版信息
Brain Behav. 2018 Dec;8(12):e01149. doi: 10.1002/brb3.1149. Epub 2018 Oct 31.
OBJECTIVES
We aimed to investigate effects of deep white matter hyperintensity (DWMH) and periventricular hyperintensity (PVH) on the efficacy of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS).
METHODS
A total of 113 AIS patients with WMH were categorized into the PVH group and the DWMH group according to the lesion location, with the division of two subgroups based on whether or not they received IVT treatment: the thrombolysis group and the control group. Kaplan-Meier analysis was used for proportional hazards of recurrent stroke. Further, multivariate Cox regression analysis was employed.
RESULTS
Of total patients, there were 62 PVH patients and 51 DWMH patients: 27 of PVH patients and 22 of DWMH patients received IVT, and the remaining patients only received routine treatment. DWMH patients had a higher risk of END (36.4% vs. 11.1%; p = 0.034) and HT (22.7% vs. 3.7%; p = 0.038) than PVH patients in the thrombolysis group. Moreover, DWMH patients undergoing IVT also had a higher risk of END (36.4% vs. 10.3%; x = 5.050; p = 0.025) and HT (22.7% vs. 3.4%; x = 4.664; p = 0.031) than DWMH patients without IVT. Again, PVH patients had a higher rate of recurrent stroke (20.0% vs. 3.4%; p = 0.034) than DWMH patients in the control group after 90-day follow-up. Kaplan-Meier analysis showed a significant difference in cumulative probability of no major endpoint events (p = 0.039). Further, multivariate Cox regression revealed that PVH is an independent risk factor for stroke recurrence in AIS patients after adjusting confounding factors.
CONCLUSIONS
The location of WMH is closely associated with the efficacy of IVT in AIS patients.
目的
本研究旨在探讨深部脑白质高信号（DWMH）和脑室周围高信号（PVH）对急性缺血性脑卒中（AIS）患者静脉溶栓（IVT）疗效的影响。
方法
根据病灶位置，将 113 例伴有脑白质疏松症（WMH）的 AIS 患者分为 PVH 组和 DWMH 组，并根据是否接受 IVT 治疗将其分为溶栓组和对照组：PVH 组 62 例，DWMH 组 51 例，其中 27 例 PVH 患者和 22 例 DWMH 患者接受 IVT 治疗，其余患者仅接受常规治疗。采用 Kaplan-Meier 分析评估卒中复发的比例风险，进一步采用多变量 Cox 回归分析。
结果
在溶栓组中，与 PVH 患者相比，DWMH 患者发生 END（36.4% vs. 11.1%；p = 0.034）和 HT（22.7% vs. 3.7%；p = 0.038）的风险更高；此外，接受 IVT 治疗的 DWMH 患者发生 END（36.4% vs. 10.3%；x 2 = 5.050；p = 0.025）和 HT（22.7% vs. 3.4%；x 2 = 4.664；p = 0.031）的风险也更高。此外，与 DWMH 无 IVT 组患者相比，90 天后 DWMH 患者发生卒中复发的风险更高（20.0% vs. 3.4%；p = 0.034）。Kaplan-Meier 分析显示，两组患者在无主要终点事件的累积概率方面存在显著差异（p = 0.039）。多变量 Cox 回归分析显示，调整混杂因素后，PVH 是 AIS 患者卒中复发的独立危险因素。
结论
WMH 的位置与 AIS 患者 IVT 的疗效密切相关。
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