Radiology:脑白质疏松症对大血管闭塞性卒中患者的预后有何影响?

2022-08-09 shaosai MedSci原创

脑白质疏松症或白质增生(WMH)是脑部MRI上慢性脑小血管疾病的一个常见的神经影像学特征,特别是在有血管危险因素的老年个体中尤为常见。

血管内血栓切除术(EVT)的引入彻底改变了临床对卒中治疗,使许多患者在大血管闭塞性卒中后获得了临床意义上的神经系统恢复。由于再灌注损伤和出血性并发症的存在,急性缺血组织的再灌注对于部分患者来说并无益处甚至会产生相反的效果。鉴于符合EVT条件的患者越来越多,了解预先存在的脑损伤迹象与早期症状性颅内出血(sICH)和不良预后的风险之间的关系至关重要。

白质疏松症或白质增生(WMH)是脑部MRI上慢性脑小血管疾病的一个常见的神经影像学特征,特别是在有血管危险因素的老年个体中尤为常见。推测血管源性的WMH与认知功能障碍、抑郁症、卒中风险增加、残疾率较高和卒中后死亡有关,表明WMH负担是应对缺血性损伤能力受损的神经影像学标志之一。然而,WMH负荷与静脉注射组织凝血酶原激活剂溶栓后卒中患者发生sICH和不良预后的潜在联系仍有争议。

近日,发表在Radiology杂志的一项研究在接受EVT的急性缺血性卒中患者中评估了治疗前的WMH负荷与sICH风险的增加和不良预后结局之间的关系,为临床对早期卒中患者的风险分层及预后评估提供了参考依据。

项回顾性研究纳入并分析了在综合卒中中心接受EVT治疗前循环急性缺血性卒中的连续患者(2015年1月-2017年12月)。WMH体积是由对临床数据保密的读者在流体衰减反转恢复MRI序列使用半自动体积分析法进行评估的,同时评估了WMH负荷与sICH和3个月功能预后(改良的Rankin量表[mRS]评分)的关联。

共纳入366名患者(平均年龄,69岁±19[SD];188名女性[51%])。WMH总体积的中位数为3.61立方厘米(IQR,1.10-10.83立方厘米)。在调整了患者和临床变量后,患者的MRS评分随着WMH体积的增加而升高(几率比[OR],每增加1.0立方厘米,MRS积分增加1.020[95%CI:1.003,1.037];P=0.018)。WMH严重程度与90天死亡率(OR,1.007 [95% CI: 0.990, 1.024]; P = .40)或sICH发生率(OR,1.001 [95% CI: 0.978, 1.024]; P = .94)之间没有明显的相关性


图 图中显示了90天时根据白质增生(WMH)的总体积,在(A)所有患者(n = 366)和(B)成功再灌注的患者(n = 289)中修正的Rankin量表(mRS)得分。虚线表示根据WMH体积,各组间mRS类别(mRS评分为022和326以及死亡率)的差异。mRS的分数范围是0到6,分数越高表示功能障碍越严重

本项脑部MRI定量研究表明,急性缺血性卒中患者在接受血管内血栓切除术后,白质高浓度(WMH)负荷的增加与3个月内功能预后不良的风险有关。然而,WMH负荷与颅内出血或死亡没有明显的相关性。WMH的量化可能为临床优化诊断及个性化护理提供了途径,并能为临床提供更准确地功能恢复评估。

 

原文出处:

Imad Derraz,Mohamed Abdelrady,Raed Ahmed,et al.Impact of White Matter Hyperintensity Burden on Outcome in Large-Vessel Occlusion Stroke.DOI:10.1148/radiol.210419

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    2022-11-26 kkunny
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