Long-term prognosis of Chinese patients with a lacunar infarct associated with small vessel disease: a five-year longitudinal study
Long-term prognosis of Chinese patients with a lacunar infarct associated with small vessel disease: a five-year longitudinal study
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DOI：
10.1111/j.1747-4949.2009.00262.x
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发表时间：
2009-04-01
影响因子：
6.7
通讯作者：
Wong, Lawrence K. S.
中科院分区：
文献类型：
--
作者：
Mok, Vincent C. T.;Lau, Alexander Y. L.;Wong, Lawrence K. S.
腔隙性脑梗塞合并小血管病变是中国患者常见的卒中亚型，近期预后良好。关于其在中国患者中的远期预后资料尚不多见。我们的目的是研究其远期预后和预后不良的预测因素。我们对75例连续5年的腔隙性脑梗塞患者进行了随访。关于死亡率和复发中风的临床结果被记录下来。我们使用COX回归分析评估了基线临床和影像对此类预后的预测因素。16名患者(21.3%)死亡，12名患者(16%)在随访期间复发中风。21名患者(28%)有死亡和/或复发中风的综合事件。单因素COX回归分析显示，年龄、文化程度、美国国立卫生研究院卒中评分、卒中/短暂性脑缺血发作和脑白质病变体积预测存活，而年龄、美国国立卫生研究院卒中评分、收缩压、高同型半胱氨酸血症、无症状腔隙、少量出血和脑白质病变体积预测卒中复发。多因素COX回归分析显示，美国国立卫生研究院卒中评分(HR 1.25，95%CI 1.05~1.48)和脑白质病变体积(HR 1.46，95%CI 1.11~1.92)预测年龄调整后死亡和/或再发卒中的综合事件。约1/4的患者在腔隙梗死后5年内死亡和/或复发。年龄、卒中严重程度和脑白质病变体积预示着不良的长期预后。
Lacunar infarct associated with small vessel disease is a common stroke subtype in China and has a favorable short-term prognosis. Data on its long-term prognosis among Chinese patients are lacking.We aimed to study its long-term prognosis and predictors for poor outcomes.We followed up to 75 consecutive Chinese stroke patients who had a lacunar infarct for a period of 5 years. Clinical outcomes with respect to mortality and recurrent stroke were noted. We evaluated baseline clinical and imaging predictors for such outcomes using the Cox regression analysis.Sixteen (21.3%) patients died and 12 (16%) patients had recurrent stroke during follow-up. Twenty-one (28%) patients had combined events of either death and/or recurrent stroke. Univariate Cox regression analysis showed that age, literacy, National Institute of Health Stroke Scale, incident stroke/transient ischemic attack, and white matter lesion volume predicted survival, while, age, National Institute of Health Stroke Scale, systolic blood pressure, hyperhomocysteinemia, silent lacunes, microbleeds, and white matter lesion volume predicted recurrent stroke. Multivariate Cox regression analysis showed that National Institute of Health Stroke Scale (HR 1.25, 95% CI 1.05-1.48) and white matter lesion volume (HR 1.46, 95% CI 1.11-1.92) predicted combined events of mortality and/or recurrent stroke after age adjustment.Approximately one in four patients either died and/or had recurrent stroke within 5 years after a lacunar infarct. Age, stroke severity, and volume of white matter lesion predict a poor long-term prognosis.