中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2022, Vol. 17 ›› Issue (4): 819-823.doi: 10.4103/1673-5374.322469

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

脑白质疏松与轻度脑出血患者入院时临床症状严重程度、神经功能预后不良和卒中复发有关：多中心前瞻性队列研究

  

  • 出版日期:2022-04-15 发布日期:2021-10-18

Leukoaraiosis is associated with clinical symptom severity, poor neurological function prognosis and stroke recurrence in mild intracerebral hemorrhage: a prospective multi-center cohort study

Tian-Qi Xu1, #, Wei-Zhi Lin2, #, Yu-Lan Feng3, Fan-Xia Shen1, 4, Jie Chen1, Wei-Wen Wu5, Xiao-Dong Zhu6, Lin Gu7, *, Yi Fu1, *   

  1. 1Department of Neurology, Ruijin Hospital/Luwan Branch, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; 2The Third Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China; 3Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China; 4Department of Neurology, Ruijin North Hospital, Shanghai, China; 5Department of Neurology, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, China; 6Department of Neurology, The First Hospital of Jiaxing, Jiaxing, Zhejiang Province, China; 7Department of Rehabilitation, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
  • Online:2022-04-15 Published:2021-10-18
  • Contact: i Fu, MD, fuyiki@sina.com; Lin Gu, MS, gulin365@126.com.
  • Supported by:
    The study was supported by the National Natural Science Foundation of China, Nos. 81771281 (to FXS), 81471177 (to FXS); and the Natural Science Foundation of Shanghai of China, No. 20ZR1434200 (to YF).

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摘要：

脑白质疏松被认为是脑小血管缺血性损伤的结果，其原因可能是脑内血管密度降低、脑内血管新生减少，脑血流量减少以及脑内微循环受损。在这项研究中，我们在中国的4个临床中心纳入了357例轻度脑出血患者，分析了脑白质疏松对轻度脑出血患者入院时临床症状严重程度、3个月神经功能预后以及1年内卒中复发的影响。将患者按照Fazekas量表评分分为无脑白质疏松（n=83）、轻度脑白质疏松（n=64）、中度脑白质疏松（n=98）和重度脑白质疏松（n=112）。结果显示，患者脑白质疏松严重程度越高、血肿体积越大和入院时血糖越高，其入院时神经功能缺损成功越严重。脑白质疏松严重程度越高、年龄越大、血肿体积越大，则3个月神经功能预后越差。此外，中重度脑白质疏松、入院时甘油三酯和无症状脑梗死与1年内卒中复发有关。提示脑白质疏松可作为个体大脑血管脆弱性的一个有用标记，以体现伴有严重脑白质疏松的轻度脑出血患者对大脑的出血性损伤具有相对较差的耐受能力和恢复能力。同时轻度脑出血患者的脑白质疏松严重程度进行评估可能有助于神经医师优化治疗方案。试验于2011年3月10日经上海交通大学附属瑞金医院伦理委员会批准（批准号12）。

https://orcid.org/0000-0001-8073-6330 (Tian-Qi Xu); https://orcid.org/0000-0001-9489-4786 (Wei-Zhi Lin); https://orcid.org/0000-0001-8717-1571 (Yi Fu); https://orcid.org/0000-0003-4099-7426 (Yu-Lan Feng); https://orcid.org/0000-0003-1759-2439 (Lin Gu); https://orcid.org/0000-0003-4232-9544 (Xiao-Dong Zhu); https://orcid.org/0000-0002-2774-6350 (Fan-Xia Shen); https://orcid.org/0000-0001-5063-9476 (Wei-Wen Wu); https://orcid.org/0000-0002-4890-4127 (Jie Chen)

关键词: 脑出血, 脑白质疏松, 美国国立卫生研究院卒中量表, 功能依赖性, 卒中复发, 脑白质高信号, 改良Rankin量表, 临床症状严重程度, 预后

Abstract: Leukoaraiosis (LA) results from ischemic injury in small cerebral vessels, which may be attributable to decreased vascular density, reduced cerebrovascular angiogenesis, decreased cerebral blood flow, or microcirculatory dysfunction in the brain. In this study, we enrolled 357 patients with mild intracerebral hemorrhage (ICH) from five hospitals in China and analyzed the relationships between LA and clinical symptom severity at admission, neurological function prognosis at 3 months, and 1-year stroke recurrence. Patients were divided into groups based on Fazekas scale scores: no LA (n = 83), mild LA (n = 64), moderate LA (n = 98) and severe LA (n = 112). More severe LA, larger hematoma volume, and higher blood glucose level at admission were associated with more severe neurological deficit. More severe LA, older age and larger hematoma volume were associated with worse neurological function prognosis at 3 months. In addition, moderate-to-severe LA, admission glucose and symptom-free cerebral infarction were associated with 1-year stroke recurrence. These findings suggest that LA severity may be a potential marker of individual ICH vulnerability, which can be characterized by poor tolerance to intracerebral attack or poor recovery ability after ICH. Evaluating LA severity in patients with mild ICH may help neurologists to optimize treatment protocols. This study was approved by the Ethics Committee of Ruijin Hospital Affiliated to Shanghai Jiao Tong University (approval No. 12) on March 10, 2011. 

Key words: clinical symptom severity, functional dependence, intracerebral hemorrhage, leukoaraiosis, modified Rankin scale, National Institute Health of Stroke Scale, prognosis, stroke recurrence, white matter hyperintensities

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