Research On Correlation Between White Matter Hyperintensites And Functional Prognosis Of Patients With Cryptogenic Stroke

Objective: At present,it is unclear whether white matter hyperintensities(WMH)affects the prognosis of patients with cryptogenic stroke(CS).The purpose of this study is to explore the relationship between WMH and functional prognosis of CS patients,and to analyze the risk factors affecting WMH load in CS patients,so as to provide theoretical basis for the predictive value of WMH on functional prognosis of CS patients.Methods: 1.Participants: Sixty-five patients who met the diagnostic criteria of cryptogenic stroke according to TOAST classification from December 2018 to December 2020 in the Department of Neurology,Shaanxi Provincial People’s Hospital were included retrospectively,including 43 males and 22 females.2.research method:(1)Data collection: including demographic characteristics,clinical related data,laboratory related test results,imaging examination,etc.(2)Scoring: NIHSS score was used to score neurological deficit at admission,and the patients were followed up by telephone or outpatient service 3 months after discharge.The patients were scored according to m RS score: m RS score < 3 is defined as good functional prognosis,and MRS score ≥ 3 is defined as poor functional prognosis.(3)Grouping: according to Fazakes classification,WMH degree was divided into mild group(Fazekas score< 3)and moderate and severe group(Fazekas score ≥3);According to m RS score,they were divided into good prognosis group and poor prognosis group.3.Statistical Methods: Statistical software SPSS26.0 was used to analyze the data.Results: 1.Compared severe WMH with mild WMH group,there were significant differences in age(P < 0.001),history of hypertension(P=0.004),mixed atherosclerosis(P=0.01)and NIHSS score(P=0.001).2.Through Logistic regression analysis of influencing factors of WMH,it is found that age(OR:1.183,95%CI:1.015~1.379,P=0.031),hypertension(OR:11.585,95%CI:1.207~111.167,P=0.034),mixed atherosclerosis(OR:9.09,95%CI:1.384~59.689,P=0.022)and the severity of WMH were statistically significant.3.Compared CS patients with good prognosis group and poor prognosis group,the differences in mixed atherosclerosis(P=0.006),NIHSS score on admission(P < 0.001),and severe WMH(P < 0.001)were statistically significant.4.Multivariate Logistic regression analysis showed that NIHSS score on admission(OR=3.236,95%CI:1.539~6.803,P=0.002),severe WMH(OR:5.213,95%CI:1.108~24.518,P=0.037)and 3-month functional prognosis of CS patients were statistically significant.5.The logistic regression model of CS prognosis was evaluated by ROC curve.the results showed that the area under ROC curve,that is,AUC=0.886,was significantly lower than that of the random model with an area of 0.5(P < 0.01),indicating that the logistic regression model of prognosis had higher predictive value.Conclusion: 1.Age(advanced age),hypertension and mixed intracranial and extracranial atherosclerosis are the risk factors of WMH load in CS patients.2.Severe WMH is a risk factor for 3-month prognosis of patients with CS.Attention should be paid and active intervention should be given to patients with CS complicated with severe WMH.3.WMH load has certain predictive value and guiding significance for functional prognosis of CS patients after 3 months.