脑白质高信号, 大脑中动脉, 动脉狭窄, 闭塞, 临床预后, white matter hyperintensity, middle cerebral artery, stenosis, occlusion, clinical prognosis, Neurology. Diseases of the nervous system, RC346-429

目的 探讨脑白质高信号（white matter hyperintensity，WMH）与孤立大脑中动脉（middle cerebral artery，MCA）重度狭窄或闭塞患者临床预后的关系。 方法 前瞻性连续纳入就诊于新乡医学院第一附属医院神经内科，发病在72 h内的孤立MCA M1段重度狭窄或闭塞的急性缺血性卒中患者。收集患者的临床资料，入院时采用NIHSS评估卒中严重程度，采用Fazekas评估WMH严重程度。本研究的主要结局为发病90 d和1年时的神经功能结局，根据mRS将患者分为预后良好（mRS 0～2分）和预后不良（mRS>2分）组，单因素分析比较2组的基线指标、WMH等脑小血管病影像学指标、侧支循环评级等因素；采用多因素分析判断预后不良的独立危险因素。本研究的次要结局包括卒中进展、发病90 d和1年卒中复发，采用单因素logistic回归分析评估WMH与发病3 d内卒中进展、随访90 d和1年卒中复发的关系。 结果 最终纳入117例患者，男性74例（63.2%），平均60.6±9.9岁。90 d随访时，60例患者预后良好，57例患者预后不良，多因素logistic回归分析显示Fazekas总分（OR 1.612，95%CI 1.245～2.087，P2 as poor outcome. The secondary outcomes were stroke progression with 3 days of onset, stroke recurrence within 90 days and 1 year. Multivariate logistic regression analysis was used to identify independent risk factors for 90-day and 1-year clinical outcome. Results A total of 117 patients were included, with an average age of 60.61±9.92 years and 74 males (63.2%). At 90-day follow-up, 60 patients had a good prognosis and 57 patients had a poor prognosis. Multivariate logistic regression analysis showed that the total Fazekas score (OR 1.612, 95%CI 1.245-2.087, P