急性多发性脑梗死形态与其供血动脉狭窄的关系  

THE RELATIONSHIP BETWEEN INFARCTION MODALITY AND STENOSIS OF FEEDING ARTERIES IN ACUTE MUTIPLE BRAIN INFARCTION

作　　者：唐敏[1] 滕继军[1] 王敏[1] 孙晓敏[1] 张晨[1] 

机构地区：[1]青岛大学医学院附属医院神经内科,山东青岛266003

出　　处：《齐鲁医学杂志》2014年第2期109-111,114,共4页Medical Journal of Qilu

摘　　要：目的探讨大脑中动脉(MCA)供血区急性多发性脑梗死(AMBI)梗死形态与血管病变或心源性栓塞(CE)的关系及其可能的发病机制。方法回顾性分析经颅脑磁共振成像(MRI)DWI序列诊断、发病48h内、病灶位于单侧大脑半球MCA供血区的急性脑梗死病人126例,所有病人均行头颈部CT血管造影(CTA)或颅脑磁共振血管造影(MRA)加颈部血管B超、超声心动图及12导联心电图检查。根据血管检查结果将病人分为颈内动脉(ICA)病变组、MCA病变组、MCA+ICA病变组及血管检查阴性(NE)组。将梗死按照部位分为软脑膜动脉供血区梗死(CI)、纹状体内囊梗死(SCI)、表面穿支动脉供血区梗死(SPI)和分水岭梗死(BI)。结果 AMBI病人56例,MCA供血区AMBI的梗死形态可分为10种;不同血管病变所致脑卒中的梗死形态差异有显著意义(χ2=29.270,P<0.05)。单纯ICA病变9例(12.5%),MCA+ICA病变20例(35.7%),单纯MCA病变22例(39.3%),单纯MCA病变者及MCA+ICA病变者均多于单纯ICA病变者(χ2=7.538、5.630,P<0.05)。MCA+ICA病变组多见CI+BI类型的梗死(χ2=5.678,P<0.05);MCA病变多发CI类型的梗死多见(χ2=7.623,P<0.05)。结论 MCA供血区AMBI血管病变以MCA和MCA+ICA病变多见,且不同的血管病变导致的梗死形态及其发病机制均有差异。Objective To investigate the relationship between infarction modality of acute multiple brain infarction （AMBI） in middle cerebral artery （MCA） blood-supply territory and vasculopathy or cardio-embolism, as well as its possible mechanism. Methods A retrospective analysis was done in 126 patients with AMBI, who were diagnosed using MRI within 48 h after the onset, located in unilateral cerebral hemisphere of MCA blood-supply zone. All the patients underwent CTA or MRA plus ultrasonography, echocardiography and 12-lead electrocardiography. The patients were divided into internal carotid artery （ICA）, MCA＋ICA, and negative groups according to the results of blood-vessel examinations. The infarction pattern in MCA territory was divided into CI, SCI, SPI and BI. Results AMBI was observed in 56 patients, there were 10 types of the lesions, the differences of the lesions caused by different vasculopathy were significant （χ2=29.270,P〈0.05）. Simple ICA lesion was noted in nine cases （12.5%）, MCA complicated with ICA in 20（35.7%）, simple MCA 22 （39.3%）.The incidence of simple MCA lesion and MCA plus ICA lesion was higher than simple ICA （χ2=7.538,5.630;P〈0.05）. In MCA＋ICA group, CI plus BI was more commonly seen （χ2=5.678,P〈0.05）, and in MCA group, multiple CI was common （χ2=7.623,P〈0.05）. Conclusion AMBI in the MCA blood-supply area, MCA disease and MCA plus ICA disease are more common and different types of artery disease may lead to different infarction pattern and its mechanism is also different

关 键 词：梗塞 大脑中动脉 颈动脉狭窄 磁共振成像 弥散 

分 类 号：R743[医药卫生—神经病学与精神病学]