[1]秦雅鑫 任占云 李杰 许冬华 叶沈早 陈蒋楠.Willis环完整性和脑白质变化对急性缺血性脑卒中患者神经功能缺损及预后的影响[J].卒中与神经疾病杂志,2023,30(03):259-264.[doi:10.3969/j.issn.1007-0478.2023.03.005]
　Qin Yaxin,Ren Zhanyun,Li Jie,et al.Effects of Willis ring integrity and white matter changes on neurological deficit and prognosis in patients with acute ischemic stroke[J].Stroke and Nervous Diseases,2023,30(03):259-264.[doi:10.3969/j.issn.1007-0478.2023.03.005]
点击复制

Willis环完整性和脑白质变化对急性缺血性脑卒中患者神经功能缺损及预后的影响()
分享到：

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第30卷
期数:
2023年03期
页码:
259-264
栏目:
论著
出版日期:
2023-06-20

文章信息/Info

Title:
Effects of Willis ring integrity and white matter changes on neurological deficit and prognosis in patients with acute ischemic stroke
文章编号:
1007-0478(2023)03-0259-06
作者:
秦雅鑫 任占云 李杰 许冬华 叶沈早 陈蒋楠
214200 江苏省宜兴市人民医院(江苏大学附属宜兴医院)康复医学科(秦雅鑫 任占云 李杰 叶沈早 陈蒋楠),神经内科[许冬华(通信作者)]
Author(s):
Qin Yaxin;  Ren Zhanyun;  Li Jie;  et al.
Department of Rehabilitation Medicine, Yixing People's Hospital, Yixing Jiangsu 214200
关键词:
急性缺血性脑卒中; 脑白质; Willis环完整性; 神经功能; 预后
Keywords:
Acute ischemic stroke; White matter; Willis ring integrity; Neurological function; Prognosis
分类号:
R743.3
DOI:
10.3969/j.issn.1007-0478.2023.03.005
文献标志码:
A
摘要:
目的 探讨Willis环完整性和脑白质变化对急性缺血性脑卒中患者神经功能缺损及预后的影响。方法 选取本院2018年8月-2021年2月收治的急性缺血性脑卒中患者172例,根据患者美国国立卫生院卒中量表(National institute of health stroke scale,NIHSS)评分分为轻度组(n=48)、中度组(n=74)和重度组(n=50),分析不同组别患者Willis环完整性和脑白质评分变化; 所有患者均随访12个月,分析患者预后情况与Willis环完整性和脑白质评分的关系; 采用Spearman分析Willis环完整性、脑白质评分与NIHSS评分、改良Rankin量表(Modified Rankin scale,mRS)评分的关系; 绘制受试者工作特征曲线(Receiver operating characteristic curve,ROC)分析相关指标对急性缺血性脑卒中不良预后的预测效能。结果 经12个月随访,172例患者共有13例失访,随访成功率为92.44%(159/172); 重度组Willis环完整性评分均低于轻度组、中度组(P<0.05); 重度组脑室周围白质评分、深部脑白质评分均高于轻度组、中度组(P<0.05); 预后不良组Willis环完整性评分低于预后良好组(P<0.05); 预后不良组脑室周围白质评分、深部脑白质评分均高于预后良好组(P<0.05); 经Spearman分析发现,Willis环完整性评分与NIHSS评分、mRS评分呈负相关(r=-0.492、-0.417,P=0.000); 脑室周围白质评分、深部脑白质评分均与NIHSS评分和mRS评分呈正相关(r=0.513、0.450、0.508、0.427,P<0.05); ROC分析发现,三者联合预测患者预后的曲线下面积(Area under the curve,AUC)为0.922(0.853～0.991),分别高于Willis环完整性评分(AUC=0.671)、脑室周围白质评分(AUC=0.780)、深部脑白质评分(AUC=0.808)单独预测患者预后的AUC(P<0.05)。结论 急性缺血性脑卒中患者Willis环完整性和脑白质变化与神经功能缺损及预后密切相关,可作为预后效果的预测指标。
Abstract:
ObjectiveTo investigate the effects of Willis ring integrity and white matter changes on neurological deficits and prognosis in patients with acute ischemic stroke.Methods A total of 172 patients with acute ischemic stroke treated in our hospital from August 2018 to February 2021 were selected and divided into mild group(n=48), moderate group(n=74)and severe group(n=50)according to the NIHSS score. The changes in Willis ring integrity and brain white matter score in different NIHSS score groups were analyzed. All patients were followed up for 12 months. The relationship between prognosis and Willis ring integrity and brain white matter score was analyzed. Spearman's correlation was used to analyze the relationship between Willis ring integrity, brain white matter score, NIHSS score and mRS score. The ROC curve was drawn to analyze the predictive efficacy of relevant indicators on the adverse prognosis of acute ischemic stroke.Results After 12 months of follow-up, 13 of 172 patients were lost to follow-up. The success rate of follow-up was 92.44%(159/172). The Willis ring integrity score in the severe group was lower than that in the mild and moderate group(P<0.05). The scores of periventricular white matter and deep white matter in the severe group were higher than those in the mild group and moderate group(P<0.05). The Willis ring integrity score in the poor prognosis group was lower than that in the good prognosis group(P<0.05). The periventricular white matter score and deep brain white matter score in the poor prognosis group were higher than those in the good prognosis group(P<0.05). Spearman analysis showed that the Willis ring integrity score was negatively correlated with the NIHSS score and mRS score(r=-0.492, -0.417, P=0.000). The periventricular white matter score and deep brain white matter score were positively correlated with the NIHSS score and mRS score(r=0.513, 0.450, 0.508, 0.427, P<0.05). ROC curve analysis showed that the AUC of prognosis predicted by the combination of the three was 0.922(0.853～0.991), which was higher than that predicted by the Willis ring integrity score(AUC=0.671), periventricular white matter score(AUC=0.780)and deep brain white matter score(AUC=0.808)(P<0.05).Conclusion The integrity of Willis ring integrity and white matter changes in patients with acute ischemic stroke were closely related to neurological deficits and short-term prognosis and could be used as predictors of short-term prognosis.

参考文献/References:

[1] 黄梁江,张苏明.急性缺血性卒中血管内治疗的发展历程及展望[J].神经损伤与功能重建,2020,15(2):73-74.
[2] 李娜,吴芬香,李涛,等.老年急性缺血性脑卒中患者静脉溶栓后早期神经功能恶化的相关因素分析[J].中华老年医学杂志,2021,40(8):1005-1009.
[3] 覃奇雄,梁志坚.急性缺血性脑卒中患者静脉溶栓后血压变异性与预后相关性的研究进展[J].中国全科医学,2021,24(3):376-380.
[4] Iqbal S.A comprehensive study of the anatomical variations of the circle of willis in adult human brains[J].J Clin Diagn Res,2013,7(11):2423-2427.
[5] Li ZK,Huo XY,Zhang SY,et al.Selection of genes associated with variations in the Circle of Willis in gerbils using suppression subtractive hybridization[J].PLoS One,2015,10(5):e0127355.
[6] 徐永立,赵小华,郝金华,等.慢性酒精中毒性脑病患者脑白质损伤的MRI特点[J].中国中西医结合影像学杂志,2019,17(4):345-347, 350.
[7] 张萍,刘新爱,王同明.MRI联合SWI在急性脑梗死患者脑白质病变评估中的应用[J].中国实用医刊,2021,48(5):18-21.
[8] 陈萍,周和平,朱亚男,等.46例CO中毒脑病病例脑部MRI影像特征及ADC值分析[J].中国CT和MRI杂志,2017,15(10):24-26.
[9] Ryan DJ,Byrne S,Dunne R,et al.White matter disease and an incomplete circle of Willis[J].Int J Stroke,2015:547-552.
[10] van Seeters T,Hendrikse J,Biessels GJ,et al.Completeness of the circle of Willis and risk of ischemic stroke in patients without cerebrovascular disease[J].Neuroradiology,2015,57(12):1247-1251.
[11] 中华医学会神经病学分会.中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志,2018,51(9):666-682.
[12] 芦亚楠,孔辉,丁勇,等.颈内动脉闭塞患者Willis环完整性与神经功能缺损程度的关系[J].安徽医学,2021,42(6):654-656.
[13] 熊义林,彭长秀,兰永树,等.MSCT分析Willis环完整性与环上动脉瘤的关系[J].中国介入影像与治疗学,2018,15(3):167-170.
[14] 宁珑,孙航,冯晋,等.急性缺血性脑卒中防治策略研究进展[J].医学综述,2022,28(1):94-99.
[15] 郭春宣,钟纯正,李琦,等.老年急性缺血性脑卒中患者血清微小RNA-24和微小RNA-29b表达及神经功能预后评估价值[J].中华危重病急救医学,2020,32(1):78-82.
[16] 高靖,王秀艳,杨红梅,等.急性缺血性脑卒中患者血清SDF-1、UCH-L1水平变化及其与病情程度和预后的关系[J].山东医药,2021,61(25):46-48.
[17] Sánchez van Kammen M,Moomaw CJ,van der Schaaf IC,et al.Heritability of circle of Willis variations in families with intracranial aneurysms[J].PLoS One,2018,13(1):e0191974.
[18] Warnert EAH,Rodrigues JCL,Burchell AE,et al.Is high blood pressure self-protection for the brain?[J].Circ Res,2016,119(12):e140-e151.
[19] Arjal RK,Zhu TT,Zhou YC.The study of fetal-type posterior cerebral circulation on multislice CT angiography and its influence on cerebral ischemic strokes[J].Clin Imaging,2014,38(3):221-225.
[20] Charidimou A,Pasi M,Fiorelli M,et al.Leukoaraiosis, cerebral hemorrhage, and outcome after intravenous thrombolysis for acute ischemic stroke: a Meta-Analysis(v1)[J].Stroke,2016,47(9):2364-2372.
[21] Kannikar,Kongbunkiat,Duncan,et al.Leukoaraiosis,intracerebral hemorrhage,and functional outcome after acute stroke thrombolysis[J].Neurology,2017,88(7):638-645.
[22] Goyal M,Menon BK,van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723-1731.
[23] Henninger N,Lin E,Baker SP,et al.Leukoaraiosis predicts poor 90-day outcome after acute large cerebral artery occlusion[J].Cerebrovasc Dis,2012,33(6):525-531.

相似文献/References:

[1]白文婷,杨丽荣,吕利英,等.多个危险因素聚集与急性缺血性脑卒中患者出院结局不良的关系[J].卒中与神经疾病杂志,2015,22(02):71.
[2]陈翠荣,赵振国,周媛,等.轻中度急性脑梗死MRI指导下超时间窗静脉溶栓治疗的研究[J].卒中与神经疾病杂志,2014,21(06):330.
[3]但毕堂,彭小祥,陈小奇,等.急性缺血性脑卒中时间窗内的动静脉溶栓分层治疗的对比研究[J].卒中与神经疾病杂志,2014,21(06):334.
[4]宗彦武,蔡柳燕,张岩.神经介入联合阿加曲班对急性缺血性脑卒中患者血清FIB,D-D表达水平的影响[J].卒中与神经疾病杂志,2022,29(04):365.[doi:10.3969/j.issn.1007-0478.2022.04.012]
[5]李海峰,李振华,刘丽娟.急性缺血性脑卒中患者血清Survivin,Hepc25水平变化及其临床意义[J].卒中与神经疾病杂志,2022,29(05):432.[doi:10.3969/j.issn.1007-0478.2022.05.007]
　Li Haifeng*,Li Zhenhua,Liu Lijuan*..Changes in serum Survivin and Hepc25 levels in patients with acute ischemic stroke and their clinical significance[J].Stroke and Nervous Diseases,2022,29(03):432.[doi:10.3969/j.issn.1007-0478.2022.05.007]
[6]顾亮亮 王建锋 乔鑫 张保朝 傅国惠.急性缺血性脑卒中患者静脉溶栓前后SCUBE1水平的变化及其与预后不良的相关性分析[J].卒中与神经疾病杂志,2023,30(03):265.[doi:10.3969/j.issn.1007-0478.2023.03.006]
　Gu Liangliang*,Wang Jianfeng,Qiao Xin*,et al.Changes of SCUBE1 levels after thrombolytic therapy in patients with acute ischemic stroke and its correlation with prognosis[J].Stroke and Nervous Diseases,2023,30(03):265.[doi:10.3969/j.issn.1007-0478.2023.03.006]
[7]孙光文 徐仕皓 王媛媛 毛瑞 杨文琼.PTX3联合LP-PLA2水平与急性缺血性脑卒中合并颈动脉狭窄的关系[J].卒中与神经疾病杂志,2023,30(03):273.[doi:10.3969/j.issn.1007-0478.2023.03.008]
　Sun Guangwen*,Xu Shihao,Wang Ruanruan,et al.Correlation analysis of PTX3 combined with LP-PLA2 in carotid stenosis in acute ischemic stroke[J].Stroke and Nervous Diseases,2023,30(03):273.[doi:10.3969/j.issn.1007-0478.2023.03.008]
[8]龚汉贤,庄泽微,李述桃,等.球囊导引导管在老年急性缺血性脑卒中患者取栓治疗中的作用[J].卒中与神经疾病杂志,2024,31(01):73.[doi:10.3969/j.issn.1007-0478.2024.01.012]

备注/Memo

备注/Memo:
基金项目:无锡市“双百”中青年医疗卫生拔尖人才项目(BJ2020108)
更新日期/Last Update: 2023-06-20