脑缺血相关的白质疏松对脑梗死后意识障碍的影响  

The effect of ischemia-related leukoaraiosis on the conscious disturbance after stroke

作　　者：方燕南[1] 张爱武[1] 李花 任丽[1] 李现亮[1] 

机构地区：[1]中山大学第一附属医院神经内科,广州510080 [2]广州市三九脑科医院神经内科

出　　处：《中华流行病学杂志》2007年第9期906-909,共4页Chinese Journal of Epidemiology

基　　金：国家自然科学基金(30572459)

摘　　要：目的探讨脑白质疏松对脑梗死后意识障碍的影响。方法采用Glasgow昏迷量表评分、英国OCSP分型追踪观察了138例脑梗死患者,其中自质疏松组78例,非白质疏松组60例。结果经logistic回归发现白质疏松(OR=5.294,95%CI:1.451～19.318)和OCSP分型中的全前循环梗死(TACI)和后循环梗死(POCI)类型(OR=14.489,95%CI:4.121～50.934)是影响意识障碍的独立危险因素。结论研究发现OCSP分型中的TACI和POCI类型及白质疏松均是意识障碍的独立危险因素,脑梗死发病时白质疏松组的意识障碍发生率低于非白质疏松组,但意识障碍程度则较非白质疏松组严重且恢复慢,提示白质疏松对意识障碍的影响是双重的。因白质疏松的慢性脑缺血耐受,故脑梗死时发生意识障碍例数少;但对脑梗死发病3个月以内的意识状态的改善则有消极作用。脑梗死后意识障碍的发生OCSP分型可能起主导作用,白质疏松只起次要作用。Objective To explore the effect of leukoaraiosis on conscious disturbance in patients with acute cerebral infarction. Methods A follow-up study including 138 patients with acute cerebral infarction matched with the diagnostic criteria of the Forth Cerebrovascular Disease Conference, were carried out. Patients were divided into two groups, using MRI to estimate the white substance process around cerebral ventricle, including 78 of them with leukoaraiosis and 60 without leukoaraiosis were followed up using Glasgow coma scale scores and England OCSP classification in 1 month, 3 month and 6 month after onset. Results The independent factors of conscious disturbance included leukoaraiosis （ OR = 5. 294, 95 % CI ： 1.451-19.318）, and OCSP classification （TACI and POCI especially） （ OR = 14.489, 95% CI：4. 121- 50. 934）. At the initial, the first month and the third month of the stroke episodes, significant difference （P 〈 0.05） was noticed when using Glasgow coma scales, and the scales in leukoaraiosis group was lower than the control. Conclusion TACI and POCI in OCSP classification were independent risk factors of conscious disturbance, and leukoaraiosis was also the independent factor. The incidence of conscious disturbance after stroke in patients with leukoaraiosis were lower than in that without leukoaraiosis. On the other hand, the degree of conscious disturbance was more serious and slower than those without leukoaraiosis, suggesting that the effect of leukoaraiosis was duplicate for conscious disturbance. Because patients with leukoraiosis had tolerance of chronic cerebral ischemia. The number of patients with conscious disturbance after stroke was fewer relatively. Leukoaraiosis had inactive effect for amelioration of conscious disturbance after three months of the episode. The grouping of OCSP played a primary while leukoaraiosis playing a secondary role, despite the patients with or without conscious disturbance after stroke.

关 键 词：脑梗死 白质疏松 意识障碍 

分 类 号：R743[医药卫生—神经病学与精神病学] R749.1[医药卫生—临床医学]