Clinical Characteristics And Risk Factors Of Small Artery Occlusion Stroke Patients With White Matter Hyperintensity

Objective:To investigate the clinical characteristics and risk factors of small artery occlusion stroke patients with different degrees of white matter hyperintensity.Methods:Patients with small artery occlusion（SAO）stroke admitted to the Department of Neurology of the Second People’s Hospital of Changzhou from November 2020 to October 2022 were included.Periventricular white matter hyperintensity（PVWMH）and deep white matter hyperintensity（DWMH）were scored according to the Fazekas scale.According to the total score,patients were divided into none-mild WMH group（0-2 points）,moderate WMH group（3-4 points）and severe WMH group（5-6 points）.Collect patients relevant test indicators and estimated glomerular filtration rate（e GFR）.NIHSS score at admission and m RS score at 90 days were assessed.Carotid plaque properties were assessed and cerebral infarct volume was calculated.The clinical characteristics of SAO stroke patients with different degrees of WMH were analyzed,and the risk factors of WMH were analyzed by ordinal logistic regression.Results:（1）A total of 162 patients were included in this study,including none-mild WMH（n=70）,moderate WMH（n=53）and severe WMH（n=39）.The cerebral infarct volume,incidence of pulmonary infection and NIHSS score were higher in patients with moderate and severe WMH,and the proportion of poor prognosis after 90 days was increased.Univariate analysis found that age,e GFR,history of hypertension,history of stroke and unstable plaques were statistically significant among different degrees of WMH（P<0.05）.An ordinal regression analysis model was established.It was found that age（OR=1.050,95%CI:1.015-1.086,P=0.005）,e GFR（OR=0.985,95%CI:0.970-0.999,P=0.040）,unstable plaque（OR=2.502,95%CI:1.122-5.577,P=0.025）and history of stroke（OR=3.737,95%CI:1.654-8.444,P=0.002）were independent risk factors for WMH severity.（2）Correlation analysis showed that there was a rank correlation between cerebral infarct volume and NIHSS score（r_s=0.340,P<0.001）;There was a correlation between cerebral infarct volume and NIHSS score in patients with no-mild WMH(r_s1=0.339,P=0.004),but no correlation was found in patients with moderate and severe WMH(r_s2=0.161,P=0.250;r_s3=0.257,P=0.114).（3）The patients were divided into PVWMH group and DWMH group according to the Fazekas scale,and the influencing factors of WMH at different areas were investigated:1)There were none-mild PVWMH（n=74）,moderate PVWMH（n=51）,and severe PVWMH（n=37）.Statistically significant differences were found in age,albumin,e GFR,history of hypertension,unstable plaque,and history of stroke among different groups（P<0.05）.The ordinal logistic regression analysis model was constructed with the severity of PVWMH as the dependent variable.It was found that age（OR=1.047,95%CI:1.011-1.083,P=0.010）,e GFR（OR=0.983,95%CI:0.968-0.999,P=0.033）,unstable plaque（OR=2.557,95%CI:1.124-5.815,P=0.025）,and history of stroke（OR=3.333,95%CI:1.499-7.414,P=0.003）were independent risk factors for PVWMH severity.2)There were none-mild DWMH（n=106）,moderate DWMH（n=43）,and severe DWMH（n=13）.Statistically significant differences were found in age,e GFR,unstable plaque,and the history of stroke in patients with different degrees of DWMH（P<0.05）.The ordinal logistic regression analysis model was constructed with the severity of DWMH as the dependent variable.It was found that unstable plaque（OR=3.378,95%CI:1.200-9.508,P=0.021）and history of stroke（OR=3.730,95%CI:1.624-8.571,P=0.002）were independent risk factors for DWMH severity.Conclusions:1.Moderate and severe WMH significantly affected infarct volume,incidence of pulmonary infection,NIHSS score at admission and 90-day prognosis of SAO stroke patients,and modulated the association between NIHSS score and infarct volume.2.Age,e GFR,unstable plaque,and history of stroke were associated with WMH severity in SAO stroke patients.Patients with severe WMH,especially those with severe PVWMH,usually had older age,lower e GFR,higher discovery rate of stroke history and unstable plaque.