脑白质高信号负荷与缺血性脑卒中后 1 年的卒中复发和死亡率。
White matter hyperintensity load on stroke recurrence and mortality at 1 year after ischemic stroke.
机构信息
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
出版信息
Neurology. 2019 Aug 6;93(6):e578-e589. doi: 10.1212/WNL.0000000000007896. Epub 2019 Jul 15.
OBJECTIVE
To define the role and risks associated with white matter hyperintensity (WMH) load in a stroke population with respect to recurrent stroke and mortality after ischemic stroke.
METHODS
A total of 7,101 patients at a network of university hospitals presenting with ischemic strokes were followed up for 1 year. Multivariable Cox proportional hazards model and competing risk analysis were used to examine the independent association between quartiles of WMH load and stroke recurrence and mortality at 1 year.
RESULTS
Overall recurrent stroke risk at 1 year was 6.7%/y, divided between 5.6%/y for recurrent ischemic and 0.5%/y for recurrent hemorrhagic strokes. There was a stronger association between WMH volume and recurrent hemorrhagic stroke by quartile (hazard ratio [HR] 7.32, 14.12, and 33.52, respectively) than for ischemic recurrence (HR 1.03, 1.37, and 1.61, respectively), but the absolute incidence of ischemic recurrence by quartile was higher (3.8%/y, 4.5%/y, 6.3%/y, and 8.2%/y by quartiles) vs hemorrhagic recurrence (0.1%/y, 0.4%/y, 0.6%/y, and 1.3%/y). All-cause mortality (10.5%) showed a marked association with WMH volume (HR 1.06, 1.46, and 1.60), but this was attributable to nonvascular rather than vascular causes.
CONCLUSIONS
There is an association between WMH volume load and stroke recurrence, and this association is stronger for hemorrhagic than for ischemic stroke, although the absolute risk of ischemic recurrence remains higher. These data should be helpful to practitioners seeking to find the optimal preventive/treatment regimen for poststroke patients and to individualize risk-benefit ratios.
目的
确定在缺血性卒中患者中，脑白质高信号（WMH）负荷与复发性卒中和卒中后死亡率相关的作用和风险。
方法
在一个大学医院网络中，共对 7101 例出现缺血性卒中的患者进行了为期 1 年的随访。采用多变量 Cox 比例风险模型和竞争风险分析来研究 WMH 负荷四分位数与 1 年内卒中复发和死亡率的独立相关性。
结果
1 年内总体复发性卒中风险为 6.7%/年，其中 5.6%/年为复发性缺血性卒中，0.5%/年为复发性出血性卒中。按 quartile 分层，WMH 体积与复发性出血性卒中的相关性更强（风险比[HR]分别为 7.32、14.12 和 33.52），而与复发性缺血性卒中的相关性较弱（HR 分别为 1.03、1.37 和 1.61），但 quartile 分层的缺血性复发绝对发生率更高（3.8%/年、4.5%/年、6.3%/年和 8.2%/年），而复发性出血性卒中的发生率较低（0.1%/年、0.4%/年、0.6%/年和 1.3%/年）。全因死亡率（10.5%）与 WMH 体积明显相关（HR 分别为 1.06、1.46 和 1.60），但这归因于非血管性而非血管性原因。
结论
WMH 体积负荷与卒中复发之间存在关联，并且这种关联在出血性卒中比缺血性卒中更强，尽管缺血性复发的绝对风险仍然更高。这些数据应该有助于寻求为卒中后患者找到最佳预防/治疗方案的临床医生，并对风险效益比进行个体化评估。
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