JAHA:卒中、短暂性脑缺血发作和疑似卒中患者慢性隐匿性脑梗死和白质高信号的临床价值

2022-01-19 MedSci原创 MedSci原创

CBI和WMH在疑似卒中患者和TIA/缺血性卒中患者之间存在差异,并且与已确定的复发风险评分密切相关。

近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,该研究旨在比较慢性脑梗死(CBI)和白质高信号(WMH)的发生频率,以及它们与短暂性脑缺血发作(TIA)和脑卒中疑似患者与缺血性脑卒中患者早期复发风险评分之间的关系。

该单中心队列研究纳入了2015年1月至2017年12月期间连续就诊的TIA、卒中疑似和急性缺血性卒中患者,他们均接受了磁共振成像检查。盲法评估者根据既定定义判定受试者的WMH(年龄相关白质变化评分)和CBI。

该研究共有2112名患者(中位[Q1-Q3]年龄为71[59-80]岁,43%为女性,美国国立卫生研究院卒中量表评分为2[1-7],80%缺血性卒中,18%TIA,2%疑似卒中患者)被纳入研究。虽然只有10%的疑似卒中患者存在CBI,但在28%的TIA和38%的缺血性卒中患者中检测到了CBI(P<0.001)。WMH在疑似卒中患者中不太明显(0,0-1),但TIA(1,1-2)和缺血性卒中(0,1-2)患者之间没有差异。

CBI(调整后的比值比为0.3;95%CI为0.1-0.9)与较低的疑似卒中作为最终诊断相关,而WMH则不然(调整后的比值比为1.3;95%CI为0.7-2.2)。根据ABCD3-I评分,WMH(每分的β为0.4;95%CI为0.3-0.6)和存在CBI(β为0.6;95%CI为0.3-0.9)与较高的心血管风险相关。在脑成像、年龄和性别的基础上,高危TIA的预测准确性良好(受试者工作特征曲线下交叉验证面积为0.89;95%CI为0.79-0.93)。

由此可见,CBI和WMH在疑似卒中患者和TIA/缺血性卒中患者之间存在差异,并且与已确定的复发风险评分密切相关。

原始出处:

Alessandra Epstein.et al.Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic.JAHA.2022.https://www.ahajournals.org/doi/10.1161/JAHA.121.024191

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  5. 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  6. 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  7. 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12:35:36 CST 2022, time=2022-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268733, encodeId=1efd1268e332f, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Jan 21 14:35:36 CST 2022, time=2022-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289265, encodeId=734f128926573, content=<a href='/topic/show?id=cd268500578' target=_blank style='color:#2F92EE;'>#脑缺血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85005, encryptionId=cd268500578, topicName=脑缺血)], attachment=null, 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  8. [GetPortalCommentsPageByObjectIdResponse(id=1765943, encodeId=d8251e65943a9, content=<a href='/topic/show?id=252ae1803a3' target=_blank style='color:#2F92EE;'>#白质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71803, encryptionId=252ae1803a3, topicName=白质)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Mon Nov 21 07:35:36 CST 2022, time=2022-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1764558, encodeId=675f1e64558b9, content=<a href='/topic/show?id=1612e319263' target=_blank style='color:#2F92EE;'>#短暂性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73192, encryptionId=1612e319263, topicName=短暂性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1b6237741961, 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encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Wed Nov 23 14:35:36 CST 2022, time=2022-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1993552, encodeId=1a7d1993552c1, content=<a href='/topic/show?id=440a226e6c4' target=_blank style='color:#2F92EE;'>#临床价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22676, encryptionId=440a226e6c4, topicName=临床价值)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/vLodSSFTQLpHtfwJicWJibSWH7pbiauxvpCMvQIv0N9Oes8vHkDkCIW2HNDkt7icUq3RCZiaDcHR9Rap17fFySRbiaFg/132, createdBy=9f202500205, createdName=ms3297076796458174, createdTime=Sat Feb 19 16:35:36 CST 2022, time=2022-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1800856, 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12:35:36 CST 2022, time=2022-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268733, encodeId=1efd1268e332f, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Jan 21 14:35:36 CST 2022, time=2022-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289265, encodeId=734f128926573, content=<a href='/topic/show?id=cd268500578' target=_blank style='color:#2F92EE;'>#脑缺血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85005, encryptionId=cd268500578, topicName=脑缺血)], attachment=null, 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    2022-01-21 zhaohui6731
  9. 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  10. 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