Post-stroke blood-brain barrier disruption predicts poor outcome in patients enrolled in the ACTION study.
Post-stroke blood-brain barrier disruption predicts poor outcome in patients enrolled in the ACTION study.
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中风后血脑屏障破坏预示着参加 ACTION 研究的患者预后不佳。
DOI：
10.1111/jon.12862
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Elkins,Jacob
中科院分区：
文献类型：
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作者：
Leigh,Richard;Hitomi,Emi;Hutchison,RMatthew;Elkins,Jacob
背景和目的先前的一项研究发现卒中后血脑屏障破坏与功能结局之间存在联系。目前的研究旨在在随机临床试验中招募的一组患者中重复这一发现。方法ACTION试验是一项natalizumab在急性脑卒中患者中的应用研究。MRI -灌注加权成像（PWI）患者被纳入这项事后分析。根据PWI源图像计算血脑通透性图像（BBPI）。使用线性回归将24小时时间点的平均BBPI值与第5、30和90天评估时的修正Rankin评分（mRS）进行比较。使用逻辑回归比较功能预后良好（mRS< = 1）的平均BBPI。结果119例患者纳入分析，中位年龄为74岁，其中43%为女性。较高的平均BBPI与第5天（p= 0.002;r2= 0.078）和第30天（p= 0.036;r2= 0.039）时较差的mRS相关，但在第90天无统计学意义（p= 0.30;r2= 0.010）。当去除高值异常值时，所有结果测量都显示与平均BBPI有更强的关系。Logistic回归发现，卒中后24小时测量的平均BBPI每增加1%，在90天内获得良好功能结局的可能性降低一半（OR = 0.53; CI = 0.30:0.95;p= 0.032）。结论：如果图像质量足够高，在缺血事件发生后数天内测量的BBPI升高可预测较差的功能结果，并可作为脑卒中后炎症的生物标志物。
Background and PurposeA prior study found a link between post‐stroke blood–brain barrier disruption and functional outcomes. The current study aimed to replicate this finding in a cohort of patients recruited in the context of a randomized clinical trial.MethodsThe ACTION trial was a study of natalizumab in acute stroke patients. Patients with MRI‐perfusion weighted imaging (PWI) were included in this post‐hoc analysis. Blood‐brain permeability images (BBPI) were calculated from the PWI source images. Mean BBPI values from the 24 h time point were compared with modified Rankin scores (mRS) at 5, 30, and 90‐day assessments using linear regression. Good functional outcome (mRS< = 1) was compared with mean BBPI using logistic regression.ResultsOne hundred and nineteen patients were included in the analysis (median age = 74, 43% female). Higher mean BBPI was associated with worse mRS at 5 days (p= 0.002;r2= 0.078) and 30 days (p= 0.036;r2= 0.039) but did not reach statistical significance at 90 days (p= 0.30;r2= 0.010). When removing high‐value outliers, all outcome measures showed a stronger relationship with mean BBPI. Logistic regression found that with every 1% increase in mean BBPI measured 24 h after the stroke, the likelihood of achieving a good functional outcome at 90 days is decreased by half (OR = 0.53; CI = 0.30:0.95;p= 0.032).ConclusionsWith sufficient image quality, elevated BBPI measured in the days after an ischemic event is predictive of worse functional outcome and may serve as a biomarker for post‐stroke inflammation.