Lin Bomiao, Leong Yuh Yang, Mohamad Mazlyfarina
Center for Diagnostic, Therapeutic and Investigative Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia Jalan Raja Muda Abdul Aziz, Wilayah Persekutuan Kuala Lumpur 50300, Malaysia.
Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre Jalan Yaacob Latif Bandar Tun Razak Cheras, Kuala Lumpur 56000, Malaysia.
Am J Transl Res. 2025 Jun 15;17(6):4306-4314. doi: 10.62347/ANQP2661. eCollection 2025.
To evaluate glymphatic system (GS) dysfunction in patients with cerebral infarction using diffusion tensor imaging - along the perivascular space (DTI-ALPS), and to investigate factors associated with glymphatic function impairment following stroke.
A retrospective study was conducted on 82 patients diagnosed with cerebral infarction at Zhujiang Hospital of Southern Medical University between July 2019 and June 2022. Based on 90-day modified Rankin Scale (mRS) scores, patients were categorized into a good prognosis group (n = 40) and a poor prognosis group (n = 42). Clinical data, National Institutes of Health Stroke Scale (NIHSS) scores, DTI-ALPS indices (L-ALPS, R-ALPS, mean-ALPS), 90-day mRS scores, and infarct location were compared between groups.
At admission, the L-ALPS, R-ALPS, and mean-ALPS values were significantly higher in the good prognosis group compared to the poor prognosis group (all P < 0.05). At 90 days post-onset, Hamilton Depression (HAMD) and Anxiety (HAMA) scores were significantly lower than baseline in the good prognosis group, indicating better psychological recovery compared to the poor prognosis group (both P < 0.05). Additionally, NIHSS scores were lower, while Glasgow Coma Scale (GCS) and activities of daily living (ADL) scores were higher in the good prognosis group (both P < 0.05). Logistic regression analysis identified L-ALPS, R-ALPS, mean-ALPS, 90-day mRS, ADL, and GCS scores as independent predictors of poor prognosis. Furthermore, ADL, 90-day mRS, and GCS scores were independently associated with GS dysfunction.
Patients with poor prognosis after cerebral infarction exhibit significant GS dysfunction. This dysfunction correlates with the severity of neurological impairment, suggesting that glymphatic impairment is both a marker and a potential contributor to stroke outcomes.
利用沿血管周围间隙的扩散张量成像（DTI-ALPS）评估脑梗死患者的脑淋巴系统（GS）功能障碍，并研究卒中后与脑淋巴功能损害相关的因素。
对2019年7月至2022年6月在南方医科大学珠江医院确诊为脑梗死的82例患者进行回顾性研究。根据90天改良Rankin量表（mRS）评分，将患者分为预后良好组（n = 40）和预后不良组（n = 42）。比较两组之间的临床资料、美国国立卫生研究院卒中量表（NIHSS）评分、DTI-ALPS指数（L-ALPS、R-ALPS、mean-ALPS）、90天mRS评分和梗死部位。
入院时，预后良好组的L-ALPS、R-ALPS和mean-ALPS值显著高于预后不良组（均P < 0.05）。发病90天时，预后良好组的汉密尔顿抑郁量表（HAMD）和焦虑量表（HAMA）评分显著低于基线水平，表明与预后不良组相比心理恢复更好（均P < 0.05）。此外，预后良好组的NIHSS评分较低，而格拉斯哥昏迷量表（GCS）和日常生活活动（ADL）评分较高（均P < 0.05）。Logistic回归分析确定L-ALPS、R-ALPS、mean-ALPS、90天mRS、ADL和GCS评分是预后不良的独立预测因素。此外，ADL、90天mRS和GCS评分与GS功能障碍独立相关。
脑梗死预后不良的患者表现出明显的GS功能障碍。这种功能障碍与神经功能损害的严重程度相关，提示脑淋巴损害既是卒中预后的一个标志物，也是一个潜在的影响因素。
