颅内动脉粥样硬化负荷对缺血性卒中预后的影响

目的 了解颅内动脉粥样硬化负荷（intracranial atherosclerosis burden，ICASB）对缺血性卒中1年复发的影响。方法 入组中国22家医院共计2864例发病7 d内的缺血性卒中患者。所有入组患者均进行MRA检查，并根据颅内血管狭窄程度和数量计算ICASB，根据不同的ICASB将患者分为<4分组、4～5分组和>5分组。比较不同ICASB组间基线数据的差异，并分析1年卒中复发的危险因素。结果 ICASB<4分组、4～5分组和>5分组分别有2491例、214例和159例。不同ICASB组责任血管狭窄程度的分布不同，差异有统计学意义（P <0.0001）。多变量分析显示，ICASB 4～5分（HR 2.28，95%CI 1.41～3.71，P =0.0008）、卒中家族史（HR 2.06，95%CI 1.27～3.33，P =0.0033）、缺血性卒中病史（HR 2.12，95%CI 1.29～3.50，P =0.0030）、以前和现在吸烟史（HR 0.54，95%CI 0.35～0.85，P =0.0075）及入院时NIHSS评分（HR 1.05，95%CI 1.00～1.09，P =0.028）是1年卒中复发的独立危险因素。Kapl an-Meier生存曲线分析显示，ICASB 4～5分组1年卒中复发率（10.28%）较<4分组（3.89%）和>5分组（6.91%）增高（均P <0.0001）。结论 ICASB 4～5分是缺血性卒中患者1年卒中复发的独立危险因素。

Effect of Intracranial Atherosclerosis Burden on the Prognosis of Ischemic Stroke

Objective To analyze the effect of intracranial atherosclerosis burden (ICASB) on 1-year recurrent
stroke in patients with ischemic stroke.
Methods A total of 2864 consecutive patients with acute ischemic stroke within 7 days after
stroke onset from 22 hospitals across China were included in this analysis. All patients underwent
magnetic resonance angiography, and the ICASB was calculated based on the degree and number
of intracranial atherosclerotic stenosis. The patients were divided into three groups according to
the scores of ICASB: <4, 4-5 and >5 points. Difference in baseline characteristics among the three
groups were compared, and the risk factors for recurrent stroke within 1 year were analyzed.
Results There were 2491, 214 and 159 cases in ICASB <4 points group, 4-5 points group and >5
points group, respectively. The degrees of culprit artery stenosis were different among the three groups
(P <0.0001). The multivariate logistic analysis showed that ICASB 4-5 points (HR 2.28, 95%CI 1.41-
3.71, P =0.0008), family history of stroke (HR 2.06, 95%CI 1.27-3.33, P =0.0033), history of ischemic
stroke (HR 2.12, 95%CI 1.29-3.50, P =0.0030), current and prior smoking (HR 0.54, 95%CI 0.35-0.85,
P =0.0075) and NIHSS score at admission (HR 1.05, 95%CI 1.00-1.09, P =0.028) were independentrisk factors for recurrent stroke within 1 year. Kaplan–Meier curve analysis showed that the rate of
recurrent stroke at 1 year was higher in ICASB 4-5 points groups (10.28%) than that in ICASB <4
points group (3.89%) and >5 points group (6.91%) (both P <0.0001).
Conclusions The ICASB score 4-5 points was an independent risk factor for recurrent stroke
within 1 year in atherosclerotic ischemic stroke.