Huo Ying-Chao, Li Qi, Zhang Wen-Yu, Zou Ning, Li Rui, Huang Si-Yuan, Wang Hui-Qi, Song Kai-Yi, Zhang Rong-Rong, Qin Xin-Yue
Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Division of Life Sciences and Medicine, Department of Neurology, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China.
Front Neurol. 2019 Aug 6;10:808. doi: 10.3389/fneur.2019.00808. eCollection 2019.
Cerebral small vessel disease (SVD) is generally considered as a cause of stroke, disability, gait disturbances, vascular cognitive impairment, and dementia. The aim of this study was to investigate whether the total SVD burden can be used to predict functional outcome in patients with acute ischemic stroke. From April 2017 to January 2018, consecutive patients with acute ischemic stroke who underwent baseline MRI scan were evaluated. The functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days and defined as i) excellent outcome (mRS ≤ 1) and ii) good outcome (mRS ≤ 2). Brain MRI was performed and assessed for lacunes, white matter hyperintensities (WMH), and enlarged perivascular spaces (EPVS). The total SVD burden was calculated based on lacunes, WMH, and EPVS and then summed up to generate an ordinal "total SVD burden" (range 0-3). Bivariate logistic regression models were used to identify the association between SVD and functional outcome. A total of 416 patients were included in the final analysis; 44.0, 33.4, 19.2, and 3.4% of the patients had 0, 1, 2, and 3 features of SVD, respectively. In regard to individual SVD feature, lacunes (OR: 0.48, 95% CI: 0.32-0.71; OR: 0.49, 95% CI: 0.31-0.77) and WMH (OR: 0.53, 95% CI: 0.34-0.82; OR: 0.53, 95% CI: 0.33-0.85) were negatively associated with excellent outcome and good outcome. As to the total burden of SVD, three SVD features had strongest negative associations with functional outcomes (excellent outcome, OR: 0.13, 95% CI: 0.03-0.48; good outcome, OR: 0.18, 95% CI: 0.06-0.54). After adjustment for potential confounders, a high SVD burden (3 features, OR: 0.07, 95% CI: 0.01-0.41) and the score of total SVD burden (OR: 0.64, 95% CI: 0.44-0.93) remained negatively associated with excellent outcome. Total SVD burden negatively associated with functional outcome at 3 months in patients with acute ischemic stroke and is superior to individual SVD feature in prediction of functional outcome. MRI-based assessment of total SVD burden is highly valuable in clinical management of stroke victims and could help guide the allocation of resources to improve outcome.
脑小血管病（SVD）通常被认为是中风、残疾、步态障碍、血管性认知障碍和痴呆的一个病因。本研究的目的是调查SVD总负担是否可用于预测急性缺血性中风患者的功能结局。2017年4月至2018年1月，对连续接受基线MRI扫描的急性缺血性中风患者进行了评估。在90天时使用改良Rankin量表（mRS）评估功能结局，并将其定义为：i）良好结局（mRS≤1）和ii）较好结局（mRS≤2）。进行脑部MRI检查并评估腔隙、白质高信号（WMH）和血管周围间隙扩大（EPVS）。根据腔隙、WMH和EPVS计算SVD总负担，然后将其相加得出一个有序的“SVD总负担”（范围0 - 3）。使用二元逻辑回归模型确定SVD与功能结局之间的关联。最终分析共纳入416例患者；分别有44.0%、33.4%、19.2%和3.4%的患者具有0、1、2和3个SVD特征。就单个SVD特征而言，腔隙（比值比：0.48，95%置信区间：0.32 - 0.71；比值比：0.49，95%置信区间：0.31 - 0.77）和WMH（比值比：0.53，95%置信区间：0.34 - 0.82；比值比：0.53，95%置信区间：0.33 - 0.85）与良好结局和较好结局呈负相关。至于SVD总负担，三个SVD特征与功能结局的负相关性最强（良好结局，比值比：0.13，95%置信区间：0.03 - 0.48；较好结局，比值比：0.18，95%置信区间：0.06 - 0.54）。在对潜在混杂因素进行调整后，高SVD负担（3个特征，比值比：0.07，95%置信区间：0.01 - 0.41）和SVD总负担评分（比值比：0.64，95%置信区间：0.44 - 0.93）与良好结局仍呈负相关。SVD总负担与急性缺血性中风患者3个月时的功能结局呈负相关，并且在预测功能结局方面优于单个SVD特征。基于MRI的SVD总负担评估在中风患者的临床管理中具有很高的价值，并且有助于指导资源分配以改善结局。
