The association of white matter hyperintensities with stroke outcomes and antiplatelet therapy in minor stroke patients
The association of white matter hyperintensities with stroke outcomes and antiplatelet therapy in minor stroke patients
复制标题
轻度脑卒中患者白质高信号与脑卒中结局及抗血小板治疗的关系
DOI：
10.21037/atm.2020.02.137
复制
发表时间：
2020-03
影响因子：
--
通讯作者：
Wang Yong-Jun
中科院分区：
文献类型：
--
作者：
Xu Yu-Yuan;Zong Li-Xia;Zhang Chang-Qing;Pan Yue-Song;Jing Jing;Meng Xia;Li Hao;Zhao Xing-Quan;Liu Li-Ping;Wang David;Wang Yi-Long;Wang Yong-Jun
背景描述白色高信号（WMH）的严重程度和分布，并评估WMH与初始卒中严重程度、3个月功能结局、卒中复发和抗血小板治疗反应的关系。方法在氯吡格雷高危急性非致残性脑血管事件患者（CHANCE）试验中，纳入787例有基线MRI信息的轻度脑卒中患者。使用Fazekas量表对深部和心室周围WMH（DWMH和PVWMH）进行评级，并将其分为轻度（0-2级）、中度（3-4级）和重度（5-6级）。采用多变量logistic回归分析WMH严重程度与结局之间的关系，包括采用美国国立卫生研究院卒中量表（NIHSS）评分的初始卒中严重程度、采用改良兰金量表（mRS）评分的3个月功能结局和卒中复发。使用考克斯比例风险模型评估治疗与亚组的相互作用效应。结果在本次分析的787例患者中，432例（54.9%）患有中度或重度WMH（3-6）。与轻度WMH相比，重度WMH的NIHSS升高风险的校正比值比（OR）为2.10，95%可信区间（CI）为1.26-3.48（P=0.004）。SDWMH（OR 1.66; 95% CI，1.15-2.40; P=0.007）和PVWMH（OR 1.47; 95% CI，1.02-2.10; P=0.04）的严重程度均与较高的NIHSS评分相关。WMH与3个月功能结局和卒中复发之间无统计学显著相关性。WMH和抗血小板治疗之间没有显著的相互作用。结论在轻度脑卒中患者中，SDWMH和PVWMH均可能与初始脑卒中严重程度相关。未检测到WMH严重程度与抗血小板治疗之间的相互作用。试验注册ClinicalTrials.gov标识符：NCT 00979589。注册日期：2009年9月18日。
Background To characterize the severity and distribution of white matter hyperintensities (WMHs) and to assess the relationship of WMHs with initial stroke severity, 3-month functional outcome, stroke recurrence and response to antiplatelet therapies. Methods In Clopidogrel High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial, 787 minor stroke patients with baseline magnetic resonance imaging (MRI) information were included in this analysis. Deep and periventricular WMHs (DWMHs and PVWMHs) were rated using the Fazekas scale and categorized into mild (grades 0–2), moderate (grades 3–4) and severe (grades 5–6). Multivariable logistic regression was used to examine the associations between WMHs severities and outcomes, including initial stroke severity by the National Institutes of Health Stroke Scale (NIHSS) scores, 3-month functional outcome by modified Rankin Scale (mRS), and stroke recurrence. Cox proportional hazards model was used to assess the treatment-by-subgroup interaction effect. Results Among the 787 patients in this analysis, 432 (54.9%) had moderate or severe WMHs (3-6). Compared with mild WMHs, the adjusted odds ratio (OR) of severe WMHs for risk of higher NIHSS was 2.10, 95% confidence interval (CI), 1.26–3.48 (P=0.004). Both severities of SDWMHs (OR 1.66; 95% CI, 1.15–2.40; P=0.007) and PVWMHs (OR 1.47; 95% CI, 1.02–2.10; P=0.04) were associated with higher NIHSS scores. There were no statistically significant associations of WMHs with 3-month functional outcome and stroke recurrence. There were no significant interactions between WMHs and antiplatelet therapy. Conclusions In patients with minor stroke, both SDWMHs and PVWMHs might related with initial stroke severity. No interaction was detected between the severity of WMHs and antiplatelet treatment. Trial registration ClinicalTrials.gov identifier: NCT00979589. Date of registration: Sep 18, 2009.
登录
查看更多内容
影响因子：
11
作者：
Fu, JH;Lu, CZ;Wong, KS
通讯作者：
Wong, KS
影响因子：
8.3
作者：
Helenius, Johanna;Goddeau, Richard P., Jr.;Henninger, Nils
通讯作者：
Henninger, Nils
影响因子：
11.2
作者：
J. Killestein;H. Schrijver;J. Crusius;C. Pérez;B. Uitdehaag;A. Peña;C. Polman
通讯作者：
J. Killestein;H. Schrijver;J. Crusius;C. Pérez;B. Uitdehaag;A. Peña;C. Polman
影响因子：
168.9
作者：
Johnston, S. Claiborne;Rothwell, Peter M.;Sidney, Stephen
通讯作者：
Sidney, Stephen
影响因子：
8.3
作者：
Helenius, Johanna;Henninger, Nils
通讯作者：
Henninger, Nils