Extent of white matter lesions is related to acute subcortical infarcts and predicts further stroke risk in patients with first ever ischaemic stroke
Extent of white matter lesions is related to acute subcortical infarcts and predicts further stroke risk in patients with first ever ischaemic stroke
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DOI：
10.1136/jnnp.2003.032771
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发表时间：
2005-06-01
影响因子：
11
通讯作者：
Wong, KS
中科院分区：
文献类型：
--
作者：
Fu, JH;Lu, CZ;Wong, KS
目的：探讨脑白质病变(WML)在液体衰减反转恢复(FLAIR)MRI序列上的范围是否是再发卒中的独立危险因素，并利用弥散加权成像(DWI)记录不同程度WML患者的急性脑梗塞类型。方法：采用前瞻性队列研究，对1999年至2001年在某社区医院住院的228例脑卒中患者进行研究。WML的严重程度根据FLAIR表现分为0(无WML)、1(轻度)、2(中度)或3(重度)。结果：WML0级31例，1级69例，2级59例，3级69例。Logistic回归分析显示年龄是影响WML的独立因素(p=0.0001)。白质深部的急性脑梗塞与WML的严重程度相关。中位随访23.0个月，生命表分析显示再发卒中与白细胞性白血病的严重程度有关(0级复发率7.8%，1级复发率9.3%，2级复发率17.7%，3级复发率43.7%；p=0.0001)。重度白细胞性白血病患者的存活率降低(p=0.0068)。COX比例风险模型显示白质疏松对再发卒中有预测作用(p=0.000，危险比=4.177(95%可信区间，2.038~8.564))，对生存也有预测作用(p=0.040，危险比=2.021(1.032~3.960))。结论：严重脑白质疏松症患者发生皮质下深层卒中的风险增加，再发卒中的风险也更高。
Objective: To investigate whether the extent of white matter lesions (WML) on fluid attenuated inversion recovery ( FLAIR) MRI sequences is an independent risk factor for recurrent stroke, and to document the pattern of acute cerebral infarcts using diffusion weighted imaging (DWI) in patients with different severities of WML.Methods: In a prospective cohort study, 228 consecutive stroke patients were studied between 1999 and 2001 in a community hospital. The severity of WML was graded as 0 ( no WML), 1 ( mild), 2 ( moderate), or 3 ( severe) according to the FLAIR appearances. DWI was used to document the location and size of the infarct.Results: 31 patients had grade 0 WML, 69 had grade 1, 59 had grade 2, and 69 had grade 3. Age was independently associated with WML on logistic regression analysis ( p = 0.0001). Acute cerebral infarcts in deep white matter were correlated with increasing severity of WML. On a median follow up of 23.0 months, life table analysis showed that recurrent stroke was related to the severity of WML ( recurrence rate 7.8% in grade 0, 9.3% in grade 1, 17.7% in grade 2, 43.7% in grade 3; p = 0.0001). Survival was reduced in patients with severe WML ( p = 0.0068). A Cox proportional hazards model showed WML to be predictive of recurrent stroke ( p = 0.000, hazard ratio = 4.177 ( 95% confidence interval, 2.038 to 8.564)) and also for survival ( p = 0.040, hazard ratio = 2.021 ( 1.032 to 3.960)).Conclusions: Patients with severe leukoaraiosis have increased risk of deep subcortical stroke and a higher risk of recurrent stroke.