Tane Neuro-Rehabilitation Hospital, Osaka, Japan.
Department of Neurology, Tane General Hospital, Osaka, Japan.
Restor Neurol Neurosci. 2021;39(2):139-147. doi: 10.3233/RNN-211163.
Functional recoveries after rehabilitation of patients with branch atheromatous disease (BAD) have not been well investigated, however, clinical category of cerebral infarction including BAD itself could be a potential predictive factor for functional outcome.
To describe characteristics of functional recoveries of patients with BAD through comparison with other types of cerebral infarction.
We retrospectively compared outcomes of patients with BAD (N = 222), cardioembolic cerebral infarction (CE: N = 177) and atherothrombotic cerebral infarction (AT: N = 219) by using functional independence measure (FIM) and FIM effectiveness (the proportion of potential for improvement achieved).
Univariate analysis showed that FIM on discharge was comparable among three types of cerebral infarction, but that FIM effectiveness in patients with BAD was significantly higher than those with CE or AT. Stratified analysis revealed higher FIM effectiveness in patients with BAD compared to patients with CE or AT, if they were male, younger (≤72 years) or had supratentorial brain lesions. Multiple regression analysis demonstrated that location of the brain lesion (supratentorial vs infratentorial) and gender (male vs female) were significantly associated with FIM on discharge, and that cognitive function on admission as well as gender were significantly associated with FIM effectiveness in patients with BAD, but not in patients with CE or AT.
Outcomes after rehabilitation of patients with BAD may be characterized by better functional improvement, especially if patients are male, relatively younger or with supratentorial lesions. The impact and the type of factors related to functional recoveries of patients with BAD may be different from other types of stroke. The present study suggested that clinical category of stroke should be taken into consideration in prediction of outcomes and planning of rehabilitation management.
尽管对接受康复治疗的分支动脉粥样硬化性疾病（BAD）患者的功能恢复情况研究甚少，但包括 BAD 在内的脑梗死临床类型可能是功能结局的潜在预测因素。
通过与其他类型脑梗死的比较，描述 BAD 患者的功能恢复特征。
我们回顾性比较了 BAD（N=222）、心源性脑梗死（CE：N=177）和动脉粥样硬化血栓性脑梗死（AT：N=219）患者的功能独立性测量（FIM）和 FIM 效果（潜在改善程度的比例）。
单因素分析显示，三种类型脑梗死患者出院时 FIM 无差异，但 BAD 患者的 FIM 效果明显高于 CE 或 AT 患者。分层分析显示，如果 BAD 患者为男性、年龄≤72 岁或有幕上脑病变，则其 FIM 效果明显高于 CE 或 AT 患者。多因素回归分析表明，脑病变部位（幕上 vs 幕下）和性别（男 vs 女）与 BAD 患者出院时的 FIM 显著相关，而入院时的认知功能以及性别与 BAD 患者的 FIM 效果显著相关，但与 CE 或 AT 患者无关。
BAD 患者康复后的结局可能表现为更好的功能改善，尤其是男性、相对年轻或有幕上病变的患者。与其他类型的卒中相比，BAD 患者功能恢复相关因素的影响和类型可能不同。本研究表明，在预测结局和规划康复管理时，应考虑卒中的临床类型。
