易损性血管征长度可预测大动脉闭塞性小急性缺血性卒中的早期神经功能恶化。
The length of susceptibility vessel sign predicts early neurological deterioration in minor acute ischemic stroke with large vessel occlusion.
机构信息
Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, 610021, People's Republic of China.
Department of Neurology, The Second Affiliated Hospital of Chengdu College, Nuclear Industry 416 Hospital, Chengdu, 610021, People's Republic of China.
出版信息
BMC Neurol. 2021 Oct 29;21(1):421. doi: 10.1186/s12883-021-02455-7.
BACKGROUND
Patients with acute large vessel occlusion (LVO) presenting with minor stroke are at risk of early neurological deterioration (END). The present study aimed to evaluate the frequency and potential predictors of END in patients with medical management and LVO presenting with minor stroke. The relationship between SVS length and END was also investigated.
METHODS
This was a prospective multicenter study. Consecutive patients were collected with anterior circulation. LVO presented with minor stroke [National Institutes of Health Stroke Scale (NIHSS) ≤ 4] within 24 h following onset. END was defined as a deterioration of NIHSS ≥4 within 24 h, without parenchymal hemorrhage. The length of the susceptibility vessel sign (SVS) was measured using the T2* gradient echo imaging.
RESULTS
A total of 134 consecutive patients with anterior circulation LVO presenting with minor stroke were included. A total of 27 (20.15%) patients experienced END following admission. Patients with END exhibited longer SVS and higher baseline glucose levels compared with subjects lacking END (P < 0.05). ROC curve analysis indicated that the optimal cutoff point SVS length for END was SVS ≥ 9.45 mm. Multivariable analysis indicated that longer SVS [adjusted odds ratio (aOR), 2.03; 95% confidence interval (CI), 1.45-2.84; P < 0.001] and higher baseline glucose (aOR,1.02; 95% CI, 1.01-1.03; P = 0.009) levels were associated with increased risk of END. When SVS ≥ 9.45 mm was used in the multivariate logistic regression, SVS ≥ 9.45 mm (aOR, 5.41; 95%CI, 1.00-29.27; P = 0.001) and higher baseline glucose [aOR1.01; 95%CI, 1.00-1.03; P = 0.021] were associated with increased risk of END.
CONCLUSIONS
END was frequent in the minor stroke patients with large vessel occlusion, whereas longer SVS and higher baseline glucose were associated with increased risk of END. SVS ≥ 9.45 mm was a powerful independent predictor of END.
背景
患有急性大血管闭塞（LVO）并伴有小卒中等轻微中风的患者存在早期神经功能恶化（END）的风险。本研究旨在评估接受药物治疗的 LVO 并伴有小卒中等轻微中风患者的 END 发生率及其潜在预测因素。还研究了 SVS 长度与 END 之间的关系。
方法
这是一项前瞻性多中心研究。连续收集了前循环 LVO 患者，其小卒中[美国国立卫生研究院卒中量表（NIHSS）≤4]在发病后 24 小时内发生。END 的定义为在 24 小时内 NIHSS 恶化≥4，无实质内出血。使用 T2*梯度回波成像测量易损血管征（SVS）的长度。
结果
共纳入了 134 例前循环 LVO 伴小卒中患者。共有 27 例（20.15%）患者在入院后发生 END。与未发生 END 的患者相比，发生 END 的患者的 SVS 更长，基线血糖水平更高（P<0.05）。ROC 曲线分析表明，SVS 长度的最佳截断点为 SVS≥9.45mm。多变量分析表明，较长的 SVS[调整优势比（aOR），2.03；95%置信区间（CI），1.45-2.84；P<0.001]和较高的基线血糖[aOR，1.02；95%CI，1.01-1.03；P=0.009]与 END 风险增加相关。当 SVS≥9.45mm 用于多变量逻辑回归时，SVS≥9.45mm（aOR，5.41；95%CI，1.00-29.27；P=0.001）和较高的基线血糖[aOR，1.01；95%CI，1.00-1.03；P=0.021]与 END 风险增加相关。
结论
大血管闭塞伴小卒中患者中 END 较为常见，而较长的 SVS 和较高的基线血糖与 END 风险增加相关。SVS≥9.45mm 是 END 的有力独立预测因素。
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