Postoperative Functional Outcomes and Prognostic Factors in Two Types of Adult Moyamoya Diseases
Postoperative Functional Outcomes and Prognostic Factors in Two Types of Adult Moyamoya Diseases
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两种成人烟雾病的术后功能结果和预后因素
DOI：
10.1016/j.jstrokecerebrovasdis.2020.104846
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发表时间：
2020-08-01
影响因子：
2.5
通讯作者：
Fu, Jianhui
中科院分区：
文献类型：
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作者：
Zhang, Miaoyi;Tang, Jie;Fu, Jianhui
背景资料：确定成人缺血性和出血性烟雾病（MMD）患者各阶段的功能结局，并确定预后因素。方法：本回顾性研究回顾了2012年1月至2017年6月手术治疗的连续成人MMD患者。收集围手术期临床数据，并通过电话访谈进行随访。分析功能结局和预后因素。结果：共纳入219例缺血性MMD患者（268个半球）和157例出血性MMD患者（193个半球）。中位随访时间为18个月（3-69个月）。MMD类型对出院时改良兰金量表（mRS）评分无显著影响。围手术期并发症（P = 0.004）和基线时mRS评分（P < 0.001）是两组中与短期功能结局相关的危险因素，而糖尿病（DM，P = 0.022）在缺血组中也起作用。在随访期间，两组的功能结局均明显改善，但两组良好功能结局的累积曲线呈非比例（log-rank检验，P = 0.483）。脑卒中复发（P < 0.001）和出院时mRS评分（P < 0.001）是影响两类MMD患者远期功能预后的共同因素。特别是，女性缺血性MMD患者更可能具有较高的mRS评分（P = 0.028），Suzuki分期与出血组的长期功能结局呈正相关（P = 0.044）。结论：MMD类型对预后无显著影响，而两种类型的MMD患者术后功能结局均显示出总体显著改善。不同类型的MMD患者的短期和长期功能结局具有不同的预后因素。
Background: To determine the functional outcomes in each period for adult ischemic and hemorrhagic Moyamoya disease (MMD) patients and identify prognostic factors. Methods: The current retrospective study reviewed consecutive adult MMD patients surgically treated from January 2012 to June 2017. Perioperative clinical data were collected and follow-up was conducted via telephone interviews. Functional outcomes and prognostic factors were analyzed. Results: A total of 219 ischemic MMD patients (268 hemispheres) and 157 hemorrhagic patients (193 hemispheres) were included. The median follow-up time was 18 months (3-69 months). MMD type had no significant effect on the modified Rankin Scale(mRS) score at discharge. Perioperative complications (P = 0.004) and the mRS score at baseline (P < 0.001) were risk factors correlated with the short-term functional outcomes in both groups, while diabetes mellitus (DM, P = 0.022) also played a role in the ischemic group. During the follow-up period, functional outcomes obviously improved in both groups, but two groups showed nonproportional cumulative curves for favorable functional outcomes (log-rank test, P = 0.483). Stroke recurrence (P < 0.001) and mRS at discharge (P < 0.001) were common factors related with long-term functional outcomes in two types of MMD patients. Particularly, female patients with ischemic MMD were more likely to have higher mRS scores (P = 0.028) and Suzuki stage was positively associated with long-term functional outcomes in hemorrhagic group (P = 0.044). Conclusions: MMD type had no significant effect on prognosis while both types of MMD patients showed overall significant improvements in functional outcomes after surgery. Different types of MMD patients have distinct prognostic factors for short-term and long-term functional outcomes.