Correlation between asymmetrically prominent cortical veins on susceptibility-weighted imaging and early neurological deterioration in patients with acute ischemic stroke

Hu Zongji; Tan Qi; Liu Lin; Huang Ruxun; Li Zhe; Zhu Gangming; Peng Quan; Huang Can

doi:10.3760/cma.j.issn.1673-4165.2020.02.002

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• 临床研究 •

磁敏感加权成像不对称的显著皮质静脉与急性缺血性卒中患者早期神经功能恶化的相关性

国际脑血管病杂志, 2020,28(02) : 87-92. DOI: 10.3760/cma.j.issn.1673-4165.2020.02.002

摘要

目的

探讨磁敏感加权成像(susceptibility weighted imaging, SWI)显示的不对称的显著皮质静脉(asymmetrically prominent cortical vein, APCV)与急性缺血性卒中患者早期神经功能恶化(early neurological deterioration, END)的相关性。

方法

回顾性纳入2016年10月至2018年9月期间在中山大学附属东华医院神经内科住院并在发病3 d内完成MRI检查的急性缺血性卒中患者。应用SWI评价APCV。END定义为发病后7 d内任何时间点美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NHISS)评分较基线时增加≥2分或运动项评分较基线时增加≥1分。应用多变量logistic回归分析确定APCV与END的独立相关性。

结果

共纳入133例急性缺血性卒中患者，其中男性93例，女性40例，中位年龄57.3岁(四分位数间距：47.5～67.5岁)。基线NIHSS评分(5.9±5.0)分。51例(38.3%)患者存在APCV，38例(28.6%)患者发生END。END组与非END组APCV、同侧大血管狭窄以及入院后接受抗凝治疗的患者构成比均差异有统计学意义(P均<0.05)。多变量logistic回归分析显示，在校正年龄和性别后，APCV是急性缺血性卒中患者发生END的独立危险因素(优势比6.907，95%可信区间2.798～17.052；P<0.001)。

结论

SWI显示的APCV是急性缺血性卒中患者发生END的独立危险因素。

引用本文: 胡宗继, 谭琦, 刘琳, 等. 磁敏感加权成像不对称的显著皮质静脉与急性缺血性卒中患者早期神经功能恶化的相关性 [J] . 国际脑血管病杂志,2020,28 (02): 87-92. DOI: 10.3760/cma.j.issn.1673-4165.2020.02.002

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

急性缺血性卒中是中老年人的常见病，致残率和致死率很高，严重影响患者生活质量。研究表明，多达1/3的缺血性卒中患者会在发病数小时或数天内出现持续或阶梯式病情进展，该现象被称为早期神经功能恶化(early neurological deterioration, END)^[1]。END的判定标准尚不统一，通常定义为入院后7 d内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NHISS)评分增加≥2分或运动项目评分增加≥1分^[2]。END的发病机制及危险因素尚不完全清楚，其发病机制可能与大血管闭塞、侧支循环不良、脑水肿、动脉再闭塞、血压变异性所致脑灌注不足、出血性转化、血栓进展等有关^[3,4]，其主要危险因素包括基线血糖、NIHSS评分、梗死体积、高半胱氨酸和体温升高、主干动脉重度狭窄或闭塞病变、白细胞计数、低密度脂蛋白胆固醇和C反应蛋白较高以及高龄等^[5,6]。END常与临床转归不良相关，严重影响患者生存和生活质量，早期识别其危险因素或预测因素对卒中治疗有着重要意义，但目前尚无确切预测指标。

贡献者信息

胡宗继

中山大学附属东华医院，东莞　523110

谭琦

中山大学附属东华医院，东莞　523110

刘琳

中山大学附属东华医院，东莞　523110

黄如训

中山大学附属第一医院，广州　510080

李哲

中山大学附属东华医院，东莞　523110

朱刚明

中山大学附属东华医院，东莞　523110

彭全

中山大学附属东华医院，东莞　523110

黄灿

中山大学附属东华医院，东莞　523110

通信作者

谭琦

中山大学附属东华医院，东莞　523110

Email：tanqi1117@126.com

关键词

卒中; 脑缺血; 磁共振成像; 疾病恶化; 危险因素;

基金项目

东莞市社会科技发展（重点）项目（201750715046470）

利益冲突

利益冲突　所有作者均声明不存在利益冲突

历史

出版日期：2020-02-28

收稿日期：2019-04-01

Clinical Research

Correlation between asymmetrically prominent cortical veins on susceptibility-weighted imaging and early neurological deterioration in patients with acute ischemic stroke

Hu Zongji, Tan Qi, Liu Lin, Huang Ruxun, Li Zhe, Zhu Gangming, Peng Quan, Huang Can

Published 2020-02-28

Cite as Int J Cerebrovasc Dis, 2020,28(02): 87-92. DOI: 10.3760/cma.j.issn.1673-4165.2020.02.002

Abstract

Objective

To investigate the correlation between asymmetrically prominent cortical veins (APCV) on susceptibility-weighted imaging (SWI) and early neurological deterioration (END) in patients with acute ischemic stroke.

Methods

From October 2016 to September 2018, patients with acute ischemic stroke admitted to the Department of Neurology, Donghua Hospital Affiliated to Sun Yat-sen University were enrolled retrospectively. They completed MRI within 3 d of onset. APCV was evaluated using SWI. END was defined as the National Institutes of Health Stroke Scale (NHISS) score at any time point within 7 d after the onset increased by ≥2 or the motor function item score increased by ≥1 from baseline. Multivariate logistic regression analysis was used to determine the independent correlation between APCV and END.

Results

A total of 133 patients with acute ischemic stroke were enrolled, including 40 females and 93 males, with a median age of 57.3 years (interquartile range: 47.5-67.5 years). Baseline NIHSS score was 5.9±5.0. Fifty-one (38.3%) patients had APCV, and 38 (28.6%) had END. The proportions of APCV, ipsilateral large vessel stenosis, and patients receiving anticoagulation after admission were significantly different between the END group and the non-END group (P<0.05). Multivariate logistic regression analysis showed that after adjusting for age and gender, APCV was an independent risk factor for END in patients with acute ischemic stroke (odds ratio 6.907, 95% confidence interval 2.798-17.052; P<0.001).

Conclusions

APCV on SWI was an independent risk factor for END in patients with acute ischemic stroke.

Key words:

Stroke; Brain ischemia; Magnetic resonance imaging; Disease progression; Risk factors

Contributor Information

Hu Zongji