Li Junying, Yang Dan, Song Rui, Wang Jian, He Lanying
Department of Neurology, The Second People's Hospital of Chengdu, No. 10, Qingyun South Street, Jinjiang District, Chengdu City, 610021, Sichuan Province, People's Republic of China.
J Neurol. 2024 Dec 18;272(1):81. doi: 10.1007/s00415-024-12755-w.
This study aimed to explore the impact of white matter hyperintensities (WMH) on the short-term outcomes of reperfusion therapy in acute ischemic stroke (AIS) patients.
We prospectively collected data on AIS patients undergoing reperfusion therapies at Chengdu Second People's Hospital from January 2020 and January 2024. WMH severity was graded as 0-3 (none to moderate) or 4-6 (severe) by the Fazekas scale. We analyzed National Institutes of Health Stroke Scale (NIHSS) scores, good functional outcomes (modified Rankin Scale, mRS 0-2) at 7 days and discharge, and safety outcomes like in-hospital mortality and intracranial hemorrhage.
During the study period, 669 patients were included, with 345 having none to moderate WMH and 324 with severe WMH. Patients with severe WMH exhibited significantly higher NIHSS and mRS at 7 days and discharge, with a decrease in good outcomes (mRS 0-2: 40.43% vs. 75.65%), and an increase in intracranial hemorrhage (16.4% vs. 5.8%) and in-hospital mortality (11.7% vs. 2.0%) compared with none to moderate WMH patients. After matching the baseline data, none to moderate WMH was associated with higher likelihood of good outcomes at discharge [adjusted odds ratio (aOR), 2.142; 95% confidence interval (CI), 1.380-3.304; P < 0.001] and a lower rate of any intracranial hemorrhage (aOR, 0.348; 95% CI 0.180-0.673; P < 0.001), with no significant difference in in-hospital mortality between the groups.
Severe WMH could reduce the benefits of reperfusion therapy in AIS, with increased risk of hemorrhagic complications, warranting further research into treatment strategies for these patients.
本研究旨在探讨脑白质高信号（WMH）对急性缺血性卒中（AIS）患者再灌注治疗短期预后的影响。
我们前瞻性收集了2020年1月至2024年1月在成都第二人民医院接受再灌注治疗的AIS患者的数据。根据 Fazekas量表，WMH严重程度分为0 - 3级（无至中度）或4 - 6级（重度）。我们分析了美国国立卫生研究院卒中量表（NIHSS）评分、7天和出院时的良好功能预后（改良Rankin量表，mRS 0 - 2）以及院内死亡率和颅内出血等安全性预后指标。
在研究期间，共纳入669例患者，其中345例无至中度WMH，324例有重度WMH。与无至中度WMH患者相比，重度WMH患者在7天和出院时的NIHSS和mRS显著更高，良好预后（mRS 0 - 2）比例降低（40.43%对75.65%），颅内出血（16.4%对5.8%）和院内死亡率（11.7%对2.0%）增加。在匹配基线数据后，无至中度WMH与出院时良好预后的可能性更高[调整优势比（aOR），2.142；95%置信区间（CI），1.380 - 3.304；P < 0.001]以及任何颅内出血发生率更低（aOR，0.348；95% CI 0.180 - 0.673；P < 0.001）相关，两组间院内死亡率无显著差异。
重度WMH可能会降低AIS患者再灌注治疗的获益，出血性并发症风险增加，需要对这些患者的治疗策略进行进一步研究。
