摘要
目的探讨老年患者脑小血管病(cerebral small vessel disease,CSVD)总负荷与穿支动脉粥样硬化病(branch atheromatous disease,BAD)预后不良的相关性。方法选取2021年1月至2023年3月于上海市第八人民医院就诊的BAD患者114例,根据发病90 d时改良的Rankin量表(modified Rankin scale,mRS)评分分为预后良好组67例(mRS评分≤2分)和预后不良组47例(mRS评分>2分)。分析所有患者的临床和影像学特征,采用logistic回归分析CSVD总负荷与BAD临床预后的关系。通过ROC曲线确定CSVD总负荷预测不良结局的临界值,并评估其敏感性和特异性。结果预后良好组年龄、糖尿病、收缩压、入院时美国国立卫生研究院卒中量表(NIHSS)评分、脑白质疏松、脑微出血比例较预后不良组明显降低,差异有统计学意义(P<0.05,P<0.01)。2组CSVD总负荷评分比较,差异有统计学意义(P<0.01)。二元logistic回归分析显示,CSVD总负荷评分和入院时NIHSS评分是BAD患者不良预后的独立预测因素(OR=3.350,95%CI:1.439~7.798,P=0.005;OR=2.814,95%CI:1.586~4.993,P=0.001)。ROC曲线分析显示,CSVD总负荷评分临界值为1.5分,预测BAD患者预后不良的敏感性为63.8%,特异性为86.6%。结论CSVD总负荷是BAD不良预后的独立预测因素。
Objective To explore the correlation between the total burden of cerebral small vessel disease and poor prognosis of branch atheromatous disease(BAD)in elderly patients.Methods A total of 114 BAD patients admitted to Shanghai Eighth People's Hospital between January 2021 and March 2023 were enrolled,and according to mRS score at 90 d after onset,they were divided into a good prognosis group(mRS score≤2,67 cases)and a poor prognosis group(mRS score>2,47 cases).The clinical and imaging characteristics were analyzed,and the relationship between total cerebral small vessel disease burden and clinical prognosis of BAD was investigated using logistic regression analysis.ROC curve analysis was used to determine the threshold of the total cere-bral small vessel disease burden for predicting adverse outcomes and to evaluate its sensitivity and specificity.Results The good prognosis group had younger age,smaller proportion of diabetes,lower SBP,NIHSS score at admission and white matter hyperintensities,and reduced ratio of cerebral microbleeds than the poor prognosis group(P<0.05,P<0.01).Statistical difference was observed in the total cerebral small vessel disease burden between the two groups(P<0.01).Binary logistic regression analysis showed that the total cerebral small vessel disease burden score and NIHSS score at admission were independent predicators of poor prognosis in BAD patients(OR=3.350,95%CI:1.439-7.798,P=0.005;OR=2.814,95%CI:1.586-4.993,P=0.001).ROC curve analysis indicated that the total cerebral small vessel disease burden had a cut-off value of 1.5,and the sensitivity and specificity for predicting poor prognosis was 63.8%and 86.6%,respectively,for BAD patients.Conclusion The total cerebral small vessel disease burden is an independent predictor for poor prognosis of BAD patients.
作者
路秋云
李强
曹立梅
彭晨
陈旭
Lu Qiuyun;Li Qiang;Cao Limei;Peng Chen;Chen Xu(Department of Neurology,Shanghai Eighth People's Hospital,Shanghai 200235,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2024年第1期46-49,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
国家自然科学基金(81870920)
上海市科技计划项目(21YF1433500)
上海市徐汇区医学科研项目(SHXH202034)。
关键词
大脑小血管疾病
颅内动脉硬化
预后
大脑小血管疾病总负荷
cerebral small vessel diseases
intracranial arteriosclerosis
prognosis
total burden of cerebral small vessel disease
