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目的:探讨脑白质高信号(white matter hyperintensities, WMHs)部位对前循环急性缺血性卒中(acute ischemic stroke, AIS)静脉溶栓患者临床转归的影响。方法:回顾性纳入2015年2月至2020年2月在徐州市中心医院接受阿替普酶静脉溶栓治疗的前循环AIS患者。根据Fazekas量表评估脑室周围WMHs(periventricular WMHs, PWMHs)和深部WMHs(deep WMHs, DWMHs)严重程度。根据发病后90 d时改良Rankin量表评分分为转归良好组(0～2分)和转归不良组(3～6分)。比较两组患者的人口统计学和临床资料，采用多变量n logistic回归分析探讨WMHs部位对AIS静脉溶栓患者临床转归的影响。n 结果:共纳入408例前循环AIS静脉溶栓患者，其中男性272例(66.7%)，女性136例(33.3%)；年龄(64.1±12.1)岁(范围40～92岁)。基线中位美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分为6分(四分位数间距：4～16分)。转归良好组314例(77.0%)，转归不良组94例(23.0%)。两组在年龄、心房颤动、糖尿病、基线NIHSS评分、溶栓前血糖水平、卒中病因学分型、PWMHs、DWMHs、出血性转化、早期神经功能恶化和卒中复发差异有统计学意义(n P均<0.05)。多变量n logistic回归分析显示，中重度PWMHs与前循环AIS静脉溶栓患者发病后90 d转归不良显著独立相关(优势比2.357，95%置信区间1.086～5.115；n P＝0.030)，其他独立相关因素还包括年龄、基线NIHSS评分、卒中病因学分型(大动脉粥样硬化和心源性栓塞)、早期神经功能恶化、出血性转化和卒中复发。n 结论:中重度PWMHs是前循环AIS静脉溶栓患者发病后90 d时转归不良的独立危险因素。“,”Objective:To investigate the effect of white matter hyperintensities (WMHs) location on the clinical outcomes in patients with anterior circulation acute ischemic stroke (AIS) after intravenous thrombolysis.Methods:Patients with anterior circulation AIS treated with alteplase intravenous thrombolysis in Xuzhou Central Hospital from February 2015 to February 2020 were enrolled retrospectively. The severity of periventricular WMHs (PWMHs) and deep WMHs (DWMHs) was assessed by Fazekas scale. According to the score of the modified Rankin Scale at 90 d after onset, the patients were divided into good outcome group (0-2) and poor outcome group (3-6). The demographic and clinical data were compared between the two groups. Multivariate n logistic regression analysis was used to investigate the effect of WMHs location on the clinical outcome in AIS patients treated with intravenous thrombolysis.n Results:A total of 408 patients with anterior circulation AIS were enrolled in the study, including 272 males (66.7%) and 136 females (33.3%). Their age was 64.1±12.1 years (range, 40-92years). The baseline median National Institutes of Health Stroke Scale (NIHSS) score was 6 (interquartile range, 4-16). Three hundred and fourteen patients (77.0%) were in the good outcome group and 94 (23.0%) were in the poor outcome group. There were significant differences in age, atrial fibrillation, diabetes mellitus, baseline NIHSS score, blood glucose level before thrombolysis, etiological classification of stroke, PWMHs, DWMHs, hemorrhagic transformation, early neurological deterioration and stroke recurrence between the two groups (all n P<0.05). Multivariaten logistic regression analysis showed that moderate to severe PWMHs were significantly and independently associated with the poor outcomes in patients with anterior circulation AIS treated with intravenous thrombolysis at 90 d after onset (odds ratio 2.357, 95% confidence interval 1.086-5.115; n P=0.030). Other independent related factors included age, baseline NIHSS score, etiological classification of stroke (large artery atherosclerosis and cardiogenic embolism), early neurological deterioration, hemorrhagic transformation, and stroke recurrence.n Conclusion:Moderate to severe PWMHs is an independent risk factor for poor outcomes at 90 d after onset in patients with anterior circulation AIS treated with intravenous thrombolysis.