Dohle Esmee, Lewis Benjamin, Agarwal Smriti, Warburton Elizabeth A, Evans Nicholas R
Department of Clinical Neurosciences, University of Cambridge, R3 Clinical Neurosciences (Box 83) Addenbrooke's Hospital Hills Road, Cambridge CB2 0QQ, UK.
Age Ageing. 2024 Nov 28;53(12). doi: 10.1093/ageing/afae266.
Frailty-the loss of physiological reserve to withstand a stressor event-is associated with poorer outcomes following acute stroke reperfusion therapies. However, the mechanisms underlying this relationship are poorly understood. This study investigated the association between frailty and penumbral volumes in hyperacute ischemic stroke.
Total ischemic lesion volumes (comprising infarct core and penumbral volumes) were measured using computed tomography (CT) perfusion imaging to give the penumbral fraction within the ischemic lesion. Pre-stroke frailty was measured using a validated frailty index. The relationship between frailty and penumbral fraction was adjusted for age, onset-to-CT interval, collateral scores, small vessel disease burden and vascular comorbidities. Stroke severity was measured using the National Institutes of Health Stroke Scale at baseline and after 24 h.
In 55 individuals receiving thrombolysis for ischemic stroke, increasing frailty was associated with a reduction in penumbral fraction (rs = -0.36, P < 0.01). This remained significant after adjustment for age, onset-to-imaging time and collateral score (beta = -1.16, P < 0.001). Correspondingly, frailty was independently negatively associated with proportional improvement in stroke severity following treatment (beta = -2.00, P < 0.01). C-reactive protein (CRP) on presentation was associated with frailty index (rs = 0.38, P < 0.01) and penumbral fraction (rs = -0.30, P = 0.02).
A reduction in salvageable penumbra in frailty may explain the treatment-attenuating effects of frailty on reperfusion therapies. The association with CRP motivates further research into a possible inflammatory component of this relationship.
Frailty is independently associated with reduced penumbra and poorer neurological recovery in acute stroke. These findings may explain the attenuated response to stroke reperfusion therapies seen in frailer individuals.
衰弱——即生理储备丧失以致无法承受应激源事件——与急性中风再灌注治疗后较差的预后相关。然而，这种关系背后的机制尚不清楚。本研究调查了超急性缺血性中风中衰弱与半暗带体积之间的关联。
使用计算机断层扫描（CT）灌注成像测量总的缺血性病变体积（包括梗死核心和半暗带体积），以得出缺血性病变内的半暗带分数。使用经过验证的衰弱指数测量中风前的衰弱情况。针对年龄、发病至CT检查的间隔时间、侧支循环评分、小血管疾病负担和血管合并症对衰弱与半暗带分数之间的关系进行了校正。在基线和24小时后使用美国国立卫生研究院卒中量表测量中风严重程度。
在55例接受缺血性中风溶栓治疗的个体中，衰弱程度增加与半暗带分数降低相关（rs = -0.36，P < 0.01）。在对年龄、发病至成像时间和侧支循环评分进行校正后，这一关联仍然显著（β = -1.16，P < 0.001）。相应地，衰弱与治疗后中风严重程度的比例改善独立呈负相关（β = -2.00，P < 0.01）。就诊时的C反应蛋白（CRP）与衰弱指数相关（rs = 0.38，P < 0.01），也与半暗带分数相关（rs = -0.30，P = 0.02）。
衰弱状态下可挽救的半暗带减少可能解释了衰弱对再灌注治疗的疗效减弱作用。与CRP的关联促使人们进一步研究这种关系中可能存在的炎症成分。
衰弱与急性中风中半暗带减少及神经功能恢复较差独立相关。这些发现可能解释了在较衰弱个体中观察到的对中风再灌注治疗反应减弱的现象。
