血管源性腔隙灶对急性缺血性卒中患者生命健康状况的动态影响OA

Objective To explore the correlation between lacunes of presumed vascular origin and health status in patients with acute ischemic stroke after onset,and to dynamically observe their effects on the recovery speed of health status,thereby providing a reference for the accurate assessment of health status after acute ischemic stroke. Methods Acute ischemic stroke patients hospitalized at the Sixth People's Hospital of Nanhai District from July 2021 to July 2024 were prospectively and consecutively included.The lacunes of presumed vascular origin and other imaging indicators were recorded according to the results of brain MRI.At the same time,baseline data such as age,previous medical history,admission NIHSS score,and laboratory test results were also recorded.The patients' health status was evaluated at 90 and 180 days after onset via telephone or outpatient follow-up using the European five-dimension five-level questionnaire(EQ-5D-5L),which evaluates five dimensions:mobility,self-care,usual activities,pain/discomfort,and anxiety/depression.Univariate and multivariate logistic regression analyses were used to analyze the correlation between lacunes of presumed vascular origin(and other baseline indicators)and poor health status(defined as an EQ-5D-5L score ≤0.5)at 90 days after onset.The recovery speed of health status at 180 days after onset was dynamically observed.Univariate and multivariate logistic regression analyses were also used to determine the correlation between lacunes of presumed vascular origin(and other baseline indicators)and slow recovery of health status(defined as the 180-day EQ-5D-5L score minus the 90-day EQ-5D-5L score ≤ 0).Subgroup analysis was conducted to compare the incidence of poor health status at 90 days and the recovery speed of health status at 180 days among patients with mild versus severe lacunes of presumed vascular origin. Results A total of 682 acute ischemic stroke patients were enrolled,including 354 patients with lacunes of presumed vascular origin and 328 patients without.Among the patients,376 had good health status at 90 days after onset,and 306 had poor health status.Multivariate logistic regression analysis showed that lacunes of presumed vascular origin were independent risk factors for poor health status at 90 days after onset(OR 1.632,95％CI 1.107-2.406,P=0.013).Compared to the status at 90 days after onset,241 patients(35.3％)showed slow recovery at 180 days after onset,including 144 patients with and 97 patients without lacunes of presumed vascular origin.Multivariate logistic regression analysis showed that lacunes of presumed vascular origin were independent risk factors for slow recovery of health status in patients with acute ischemic stroke(OR 1.324,95％CI 1.035-1.696,P=0.026).Subgroup analysis revealed that at 90 days,the incidence of poor health status was higher in the severe lacunes of presumed vascular origin group than in the mild group(78.2％vs.36.7％,P＜0.001).At 180 days,the proportion of patients with slow recovery of health status was also higher in the severe group than in the mild group(51.0％vs.33.3％,P=0.001). Conclusions Lacunes of presumed vascular origin are independent risk factors for poor health status and slow recovery in patients with acute ischemic stroke after onset.The more severe the lacunes of presumed vascular origin,the higher the incidence of poor health status after stroke,and the slower the recovery of their health status.