Liu Haiyan, Pu Yuehua, Wang Yilong, Zou Xinying, Pan Yuesong, Zhang Changqing, Soo Yannie O Y, Leung Thomas W H, Zhao Xingquan, Wong Ka Sing Lawrence, Wang Yongjun, Liu Liping
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Front Neurol. 2020 Dec 21;11:609607. doi: 10.3389/fneur.2020.609607. eCollection 2020.
This study aimed to assess the effect of baseline white matter hyperintensities (WMH) on 1-year stroke recurrence and the functional outcome for patients with intracranial atherosclerosis (ICAS). We analyzed 2,076 patients who were enrolled in the Chinese IntraCranial AtheroSclerosis (CICAS) study. ICAS and WMH were diagnosed by baseline magnetic resonance angiography. The primary outcomes were stroke recurrence and unfavorable functional outcome (modified Rankin Scale score 3-6) at 1 year. Of the 2,076 patients included in this study, 1,370 (65.99%) were men, and the mean age was 61.70 years. In total, 224 (10.79%) patients had no WMH and no ICAS, 922 (44.41%) patients had WMH and no ICAS, 157 (7.56%) patients had ICAS and no WMH, and 773 (37.24%) had both WMH and ICAS. During the follow-up period, 87 patients had a recurrent stroke and 333 had unfavorable outcomes at 1 year. Compared to WMH (-) ICAS (-) group, the adjusted odd ratios and 95% confidence interval for unfavorable functional outcome were 0.791 (0.470-1.332; = 0.3779) in the WMH (+) ICAS (-) group, 1.920 (1.024-3.600; = 0.0421) in the WMH (-) ICAS (+) group, and 2.046 (1.230-3.403; = 0.0058) in the WMH (+) ICAS (+) group. There was no significant difference in stroke recurrence risk among the four groups. ICAS coexisting with WMH may predict an unfavorable functional outcome at 1 year, but not stroke recurrence.
本研究旨在评估基线脑白质高信号（WMH）对颅内动脉粥样硬化（ICAS）患者1年卒中复发及功能转归的影响。我们分析了纳入中国颅内动脉粥样硬化（CICAS）研究的2076例患者。ICAS和WMH通过基线磁共振血管造影诊断。主要结局为1年时的卒中复发及不良功能转归（改良Rankin量表评分3 - 6分）。本研究纳入的2076例患者中，1370例（65.99%）为男性，平均年龄为61.70岁。共有224例（10.79%）患者无WMH且无ICAS，922例（44.41%）患者有WMH但无ICAS，157例（7.56%）患者有ICAS但无WMH，773例（37.24%）患者既有WMH又有ICAS。在随访期间，87例患者发生复发性卒中，333例患者在1年时出现不良结局。与WMH（-）ICAS（-）组相比，WMH（+）ICAS（-）组不良功能转归的校正比值比及95%置信区间为0.791（0.470 - 1.332；P = 0.3779），WMH（-）ICAS（+）组为1.920（1.024 - 3.600；P = 0.0421），WMH（+）ICAS（+）组为2.046（1.230 - 3.403；P = 0.0058）。四组之间的卒中复发风险无显著差异。ICAS与WMH共存可能预示1年时不良功能转归，但不能预示卒中复发。
