Wei Cunsheng, Shen Tingwen, Tang Xuelian, Gao Yuanyuan, Yu Xiaorong, Chen Xuemei
Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China.
The Health Promotion Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Front Neurol. 2022 Aug 11;13:969637. doi: 10.3389/fneur.2022.969637. eCollection 2022.
Besides cerebral collaterals, few studies have examined other additional factors affecting the prognosis of patients with large artery atherosclerotic (LAA) stroke. Our study aims to explore the effect of the cerebral small vessel disease (SVD) and the effects of its interaction with cerebral collaterals on the prognosis of patients with acute LAA stroke.
Patients aged 18 years or older with LAA stroke within 24 h after stroke onset were consecutively enrolled. The functional outcome was determined using the modified Rankin Scale (mRS) at 3 months after stroke onset. Logistic multivariate analyses were used to identify the risk factors for stroke prognosis. Receiver operating characteristic (ROC) curves were constructed to compare the effects of cerebral collaterals and SVD on predicting the prognosis.
Of the 274 enrolled patients, 174 (63.50%) were identified as having a favorable prognosis, and 100 (36.50%) were identified as having an unfavorable prognosis. After adjusting for covariates, the logistic regression analysis identified that unfavorable prognosis was related to the total SVD score (Model 1, adjusted odds ratio = 1.73, 95% CI: 1.15-2.61, < 0.01; Model 2, adjusted odds ratio = 1.85, 95% CI: 1.23-2.79, < 0.01) and Tan score (Model 1, adjusted odds ratio = 0.38, 95% CI: 0.23-0.64, < 0.01; Model 2, adjusted odds ratio = 0.52, 95% CI: 0.33-0.82, < 0.01). Compared with cerebral collaterals (AUC = 0.59; 95% CI: 0.52-0.67; < 0.01) or SVD (AUC = 0.62; 95% CI: 0.56-0.69; < 0.01) alone, the combination of collaterals and SVD (AUC = 0.66; 95% CI: 0.59-0.73; < 0.01) had higher diagnostic value for an unfavorable prognosis, and the optimal sensitivity and specificity were 77.01 and 53.00%, respectively.
The total SVD burden was related to the prognosis of patients with LAA stroke. Compared with cerebral collaterals or SVD alone, cerebral collaterals combined with total SVD burden are better at predicting the prognosis of patients with acute LAA stroke.
除脑侧支循环外，很少有研究探讨影响大动脉粥样硬化（LAA）性卒中患者预后的其他因素。我们的研究旨在探讨脑小血管病（SVD）的影响及其与脑侧支循环的相互作用对急性LAA性卒中患者预后的影响。
连续纳入卒中发病后24小时内年龄在18岁及以上的LAA性卒中患者。在卒中发病后3个月使用改良Rankin量表（mRS）确定功能结局。采用多因素logistic分析确定卒中预后的危险因素。绘制受试者工作特征（ROC）曲线，比较脑侧支循环和SVD对预测预后的影响。
在纳入的274例患者中，174例（63.50%）预后良好，100例（36.50%）预后不良。在调整协变量后，logistic回归分析确定不良预后与SVD总分（模型1，调整比值比=1.73，95%CI：1.15-2.61，P<0.01；模型2，调整比值比=1.85，95%CI：1.23-2.79，P<0.01）和Tan评分（模型1，调整比值比=0.38，95%CI：0.23-0.64，P<0.01；模型2，调整比值比=0.52，95%CI：0.33-0.82，P<0.01）有关。与单独的脑侧支循环（AUC=0.59；95%CI：-0.52-0.67；P<0.01）或SVD（AUC=0.62；95%CI：0.56-0.69；P<0.01）相比，脑侧支循环与SVD的联合（AUC=0.66；95%CI：0.59-0.73；P<0.01）对不良预后具有更高的诊断价值，最佳敏感性和特异性分别为77.01%和53.00%。
SVD总负担与LAA性卒中患者的预后有关。与单独的脑侧支循环或SVD相比，脑侧支循环与SVD总负担相结合在预测急性LAA性卒中患者的预后方面表现更佳。
