Silent brain infarcts, leukoaraiosis, and long-term prognosis in young ischemic stroke patients
Silent brain infarcts, leukoaraiosis, and long-term prognosis in young ischemic stroke patients
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DOI：
10.1212/wnl.0b013e31821a44ad
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发表时间：
2011-05-01
期刊：
影响因子：
9.9
通讯作者：
Tatlisumak, T.
中科院分区：
文献类型：
--
作者：
Putaala, J.;Haapaniemi, E.;Tatlisumak, T.
目的：探讨无症状性脑梗死（SBIs）和脑白质疏松症（LA）在年轻患者缺血性stroke.Methods的预后相关性：这项观察性队列研究包括连续MRI扫描的患者，年龄在15至49岁首次缺血性中风治疗赫尔辛基大学中心医院（1994-2007年）的长期随访数据。结局指标为1）非致死性或致死性缺血性卒中，2）复合血管终点，3）全因死亡。ORG 10172在急性卒中治疗中的试验（吐司）和Bamford标准允许卒中亚型。SBI的数量分为无、单一或多个。LA分为无，轻度，或中度至重度（有效的视觉评级量表）。结果：655例患者（平均年龄40.0 +/- 8.0岁），包括随访平均8.7 +/- 3.8年（幸存者）。在86例（13.1%）发生SBI的患者中，46例为单一SBI，40例为多个SBI。在50例（7.6%）LA患者中，21例这些变化为轻度，29例为中度至重度。在考克斯回归分析中，多种SBI独立地增加了缺血性卒中复发的风险（比值比2.48; 95%置信区间1.24-4.94），调整了年龄、性别、危险因素、卒中病因和LA。在进一步校正初始卒中严重程度、吐司和Bamford亚组以及存在SBI后，中度至重度LA增加死亡风险（3.43; 1.58-7.42）。无论是SBIs还是LA与复合血管endpoint.Conclusions：MRI定义的SBIs和LA在首次缺血性卒中后的年轻人中具有诊断价值。神经病学（R）2011;76：1742-1749
Objective: To investigate prognostic relevance of silent brain infarcts (SBIs) and leukoaraiosis (LA) in young patients with ischemic stroke.Methods: This observational cohort study included consecutive MRI-scanned patients aged 15 to 49 with first-ever ischemic stroke treated at Helsinki University Central Hospital (1994-2007) with long-term follow-up data available. Outcome measures were 1) nonfatal or fatal ischemic stroke, 2) composite vascular endpoint, and 3) death from any cause. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and Bamford criteria allowed for stroke subtyping. Number of SBIs was categorized into none, single, or multiple. LA fell into groups of none, mild, or moderate to severe (validated visual rating scale).Results: The 655 patients (mean age 40.0 +/- 8.0 years) included were followed for a mean 8.7 +/- 3.8 years (survivors). Of the 86 (13.1%) patients with SBIs, 46 had single and 40 had multiple SBIs. In the 50 (7.6%) patients with LA, these changes were mild in 21 and moderate to severe in 29. In Cox regression analysis, multiple SBIs independently raised the risk for recurrent ischemic stroke (odds ratio 2.48; 95% confidence interval 1.24-4.94) adjusted for age, gender, risk factors, stroke etiology, and LA. After further adjustment for initial stroke severity, TOAST and Bamford subgroups, and presence of SBIs, moderate to severe LA increased the risk for death (3.43; 1.58-7.42). Neither SBIs nor LA associated with the composite vascular endpoint.Conclusions: MRI-defined SBIs and LA are prognostically valuable in young adults after their first-ever ischemic stroke. Neurology (R) 2011;76:1742-1749