Severe Lesions Involving Cortical Cholinergic Pathways Predict Poorer Functional Outcome in Acute Ischemic Stroke
Severe Lesions Involving Cortical Cholinergic Pathways Predict Poorer Functional Outcome in Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.118.023196
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发表时间：
2018-12-01
期刊：
影响因子：
8.3
通讯作者：
Yin, Han-Peng
中科院分区：
文献类型：
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作者：
Qu, Jian-Feng;Chen, Yang-Kun;Yin, Han-Peng
背景和目的-本研究的目的是评估急性缺血性卒中患者皮质胆碱能通路病变严重程度对功能结局的影响。方法-本研究样本包括214名男性（70.9%）和88名女性（29.1%）急性缺血性卒中患者。我们使用胆碱能通路高信号量表（CHIPS）来评估大脑磁共振成像中皮质胆碱能通路病变的严重程度。其他磁共振成像参数包括梗死、白色病变和内侧颞叶萎缩。在指数卒中后3个月和6个月，使用Lawton日常生活活动（ADL）量表评估功能结局。我们还评估了残疾状态，使用修改后的兰金Scale.Results-Univariate分析显示，功能预后差的患者年龄较大，更有可能是男性，有较高的国立卫生研究院卒中量表（NIHSS）评分入院，并有更频繁的历史，以前的中风和感染并发症。他们也有更频繁的皮质梗死，左皮质下梗死，更大的梗死体积，更严重的内侧颞叶萎缩，脑室周围高信号，和更高的CHIPS评分。在多元回归分析中，模型1显示年龄和入院时的NIHSS评分是3个月时ADL较差的显著预测因素，拟合模型的R-2为45.4%。年龄、入院时NIHSS评分和卒中亚型也是6个月时ADL较差的重要预测因素，R-2为37.9%，符合模型。在模型2中，性别、既往卒中史、入院时NIHSS评分、右侧皮质梗死、左侧皮质下梗死和CHIPS评分是3个月时ADL较差的显著预测因素，R-2为53.5%。入院时NIHSS评分、卒中亚型和CHIPS评分是6个月时ADL较差的显著预测因素，R-2为40.2%。在调整混杂因素后，CHIPS评分也是3个月和6个月时改良兰金量表不良的重要预测因素。即使去除中度至重度白色病变的患者后，较高的CHIPS评分仍与较差的ADL和改良兰金量表在3和6 months. Conclusions，在急性缺血性卒中患者中，皮质胆碱能通路受损是常见的，皮质胆碱能通路病变的严重程度可显著预测较差的功能结局。
Background and Purpose-The aim of the study was to assess the effect of lesion severity in cortical cholinergic pathways in acute ischemic stroke patients on functional outcomes.Methods-The study sample consisted of 214 men (70.9%) and 88 women (29.1%) with acute ischemic stroke. We used the Cholinergic Pathways Hyperintensities Scale (CHIPS) to assess the severity of lesions in cortical cholinergic pathways using brain magnetic resonance imaging. The other magnetic resonance imaging parameters included infarction, white matter lesions, and medial temporal lobe atrophy. Functional outcome was assessed using the Lawton activities of daily living (ADL) scale at 3 and 6 months after the index stroke. We also assessed disability status using the modified Rankin Scale.Results-Univariate analysis showed that patients with poor functional outcomes were older, more likely to be men, had a higher National Institutes of Health Stroke Scale (NIHSS) score on admission, and had more frequent histories of previous stroke and infection complications. They also had significantly more frequent cortical infarcts, left subcortical infarcts, a larger infarct volume, more severe medial temporal lobe atrophy, and periventricular hyperintensities, and higher CHIPS scores. In the multiple regression analysis, model 1 showed that age and NIHSS score on admission were significant predictors of poor ADL at 3 months, with an R-2 of 45.4% fitting the model. Age, NIHSS score on admission and stroke subtype were also significant predictors of poor ADL at 6 months, with an R-2 of 37.9% fitting the model. In model 2, sex, previous stroke, NIHSS score on admission, right cortical infarcts, left subcortical infarcts and CHIPS score were significant predictors for poor ADL at 3 months, with an R-2 of 53.5%. NIHSS score on admission, stroke subtype, and CHIPS score were significant predictors for poor ADL at 6 months, with an R-2 of 40.2%. After adjustment for confounders, CHIPS score was also a significant predictor for poor modified Rankin Scale, both at 3 and 6 months. Even after removing patients with moderate-to-severe white matter lesions, higher CHIPS scores still correlated with poorer ADL and modified Rankin Scale both at both 3 and 6 months.Conclusions-In patients with acute ischemic stroke, cortical cholinergic pathways impairment is common, and the severity of lesions in the cortical cholinergic pathways may significantly predict a poorer functional outcome.