预先存在的脑小血管病限制了急性腔隙性梗死患者的早期恢复。

Pre-Existing Cerebral Small Vessel Disease Limits Early Recovery in Patients with Acute Lacunar Infarct.

机构信息

Hospital de Sant Joan Despí Moisés Broggi, Sant Joan Despí, Spain.

出版信息

J Stroke Cerebrovasc Dis. 2019 Nov;28(11):104312. doi: 10.1016/j.jstrokecerebrovasdis.2019.104312. Epub 2019 Aug 5.

DOI:10.1016/j.jstrokecerebrovasdis.2019.104312

PMID:31395422

Abstract

BACKGROUND AND PURPOSE

To assess whether neuroimaging markers of chronic cerebral small vessel disease (cSVDm) influence early recovery after acute ischemic stroke (AIS).

METHODS

Retrospective analysis of patients diagnosed with AIS and included in the Spanish Neurological Society Stroke Database.

INCLUSION CRITERIA

(1) Brain MRI performed after acute stroke and (2) Premorbid modified Rankin scale (mRS) = 0.

EXCLUSION CRITERIA

(1) Uncommon stroke etiologies, (2) AIS not confirmed on neuroimaging, or (3) Old territorial infarcts on neuroimaging. Patients scored from 0 to 2 according to the amount of cSVDm. Patients were divided into lacunar ischemic stroke (LIS) and nonlacunar ischemic stroke (NLIS) groups according to TOAST classification.

PRIMARY OUTCOME

Distribution of mRS at discharge.

SECONDARY OUTCOMES

NIHSS improvement more than or equal to 3 at 24 hours and at discharge, NIHSS worsening more than or equal to 3 points at 24 hours.

RESULTS

We studied 4424 patients (3457 NLIS, 967 LIS). The presence of cSVDm increased the risk of worsening 1 category on the mRS at discharge in the LIS group ([1] cSVDm: OR 1.89 CI 95% 1.29-2.75, P = .001. [2] cSVDm: OR 1.87, CI 95% 1.37-2.56 P = .001) and was an independent factor for not achieving an improvement more than or equal to 3 points on the NIHSS at discharge for all the patients and the LIS group (all stroke patients: [1] cSVDm: OR 0.81 CI 95% .68-.97 P = .022. [2] cSVD: OR 0.58 CI95% .45-.77, P = .001./LIS: [1] cSVDm: OR 0.64, CI 95% .41-.98, P = .038. [2] cSVDm: OR 0.43, CI 95% .24-.75 P = .003).

CONCLUSIONS

Pre-existing SVD limits early functional and neurological recovery after AIS, especially in LIS patients.

摘要

背景与目的

评估慢性脑小血管病（cSVDm）的神经影像学标志物是否会影响急性缺血性脑卒中（AIS）后的早期恢复。

方法

回顾性分析了被诊断为 AIS 并被纳入西班牙神经病学学会卒中数据库的患者。

纳入标准

（1）急性卒后行脑 MRI 检查，（2）发病前改良 Rankin 量表（mRS）= 0。

排除标准

（1）不常见的卒中病因，（2）神经影像学不证实为 AIS，（3）神经影像学显示陈旧性区域性梗死。根据 cSVDm 的数量，患者评分为 0-2 分。根据 TOAST 分类，患者分为腔隙性脑梗死（LIS）和非腔隙性脑梗死（NLIS）组。

主要结局

出院时 mRS 分布。

次要结局

24 小时和出院时 NIHSS 改善≥3 分，24 小时 NIHSS 恶化≥3 分。

结果

我们研究了 4424 例患者（3457 例 NLIS，967 例 LIS）。LIS 组中，cSVDm 的存在增加了出院时 mRS 恶化 1 个等级的风险（[1] cSVDm：OR 1.89，95%CI 1.29-2.75，P=0.001。[2] cSVDm：OR 1.87，95%CI 1.37-2.56，P=0.001），并且是所有患者和 LIS 组出院时 NIHSS 改善≥3 分的独立因素（所有卒中患者：[1] cSVDm：OR 0.81，95%CI 0.68-0.97，P=0.022。[2] cSVD：OR 0.58，95%CI 0.45-0.77，P=0.001。/LIS：[1] cSVDm：OR 0.64，95%CI 0.41-0.98，P=0.038。[2] cSVDm：OR 0.43，95%CI 0.24-0.75，P=0.003）。