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目的探讨合并的小血管病(SVD)对颅内大血管动脉粥样硬化(ILAA)性卒中患者的远期预后影响。方法前瞻性随访293例症状性ILAA患者,将之分为4组(组1为单个ILAA不伴SVD;组2为多个ILAA不伴SVD;组3为单个ILAA伴SVD;组4为多个ILAA伴SVD),观察随访期的卒中复发率和死亡率。结果 4组患者3年的累积卒中复发风险分别为18%、38%、21%和34%;3年累积死亡风险分别6%、7%、21%和22%。与组1相比,组2和组4的卒中复发率显著增高(P分别为0.05和0.014),组4的死亡率显著增高(P=0.002)。Cox回归分析提示伴SVD是多发ILAA患者卒中复发和死亡的预示因子。结论 SVD常与ILAA合并且与不良预后相关。
Objective To investigate the long-term prognosis of patients with cerebral vascular atherosclerosis (ILAA) stroke complicated with small vessel disease (SVD). Methods A total of 293 patients with symptomatic ILAA were prospectively enrolled and divided into 4 groups (group 1 with single ILAA without SVD; group 2 with multiple ILAA without SVD; group 3 with single ILAA with SVD; group 4 with multiple ILAA with SVD), to observe the follow-up of stroke recurrence rate and mortality. Results The 3-year cumulative risk of stroke recurrence in the 4 groups was 18%, 38%, 21% and 34%, respectively. The 3-year cumulative risk of death was 6%, 7%, 21% and 22%, respectively. Stroke recurrence was significantly higher in groups 2 and 4 compared with group 1 (P 0.05 and 0.014, respectively) and was significantly higher in group 4 (P 0.002). Cox regression analysis suggested that SVD was a predictor of stroke recurrence and death in multiple ILAA patients. Conclusions SVD is often associated with ILAA and is associated with poor prognosis.