穿支动脉疾病型脑梗死的临床特点与预后分析  

Study on clinical characteristics and prognosis on 44 patients with penetrating artery disease type ischemic stroke

作　　者：于海芙[1] 付建辉[2,3] 张斌[1] 余波 

机构地区：[1]上海交通大学附属第六人民医院南院神经内科,上海201400 [2]上海复旦大学附属华山医院 [3]上海市浦东医院神经内科 [4]上海市浦东医院血管外科

出　　处：《中国神经精神疾病杂志》2014年第6期353-356,共4页Chinese Journal of Nervous and Mental Diseases

基　　金：上海浦东新区卫计委资助项目(编号:PW2013D-13)

摘　　要：目的探讨穿支动脉疾病(penetrating artery disease,PAD)型脑梗死的临床特点、影像特点及其转归。方法经头颅MRI和头颈CTA、颈部大动脉彩超或DSA证实,将前瞻性收集的脑梗死病例100例,分为PAD组44例与对照组即大动脉粥样硬化(large artery atherosclerosis,LAA)型脑梗死组56例,两组通过比较,分析PAD型脑梗死的临床特点、影像特点及其转归。观察发病早期(7 d内)出现进展性运动障碍(progressive motordeficits,PMD)的发生率。结果根据2011年中国脑梗死分型(Chinese ischemic stroke subclassification,CISS)诊断标准,100例脑梗死患者中,PAD型44例(44%),LAA型56例(56%)。与LAA型相比,PAD型吸烟及饮酒的患者更少(P值分别为0.021及0.023),且有短暂性脑缺血发作(transient ischemic attack,TIA)史者也更低(P=0.025)。PAD型出现PMD的现象较LAA型更常见(56.82%vs.30.36%,P=0.008);PAD型发病部位多位于侧脑室旁,与LAA型比较有显著差异(52.27%vs.21.43%,P=0.001)。随访两组患者发病3个月改良Rankin量表(modifiedRankin Scale,mRS)评分无统计学差异(1.43±1.17 vs.1.43±1.45,P=0.99)。结论 PAD型脑梗死早期多出现PMD,但发病3个月预后良好。Objective To investigate the imaging characteristics, clinical features and outcomes of penetrating ar-tery disease （PAD） cerebral infarction. Methods One hundred cases of cerebral infarction were divided into 44 cases of PAD group and 56 cases of LAA （large artery atherosclerosis ） group by brain MRI and neck CTA, or DSA neck artery ultrasound. The clinical features, imaging characteristics, outcome and progressive motor deficits（PMD） were compared between PAD cerebral infarction and large artery atherosclerosis （LAA） cerebral infarction. Results There were For-ty-four （44%） cases of PAD cerebral infarction, 56 （56%） cases of LAA cerebral infarction according to 2011 Chinese ischemic stroke subclassification （CISS）. The smoking, drinking and TIA histories was significantly less in PAD group （27.27%） than in LAA group （50%） （P=0.021,0.023 and 0.025 respectively,）;compared with LAA group, PMD occured in PAD group more frequently. （56.82% vs. 30.36%, P=0.008）; lesions were located in the lateral ventricles in most PAD group which was significantly different from LAA group （52.27% vs. 21.43%, P=0.001）. Modified Rankin Scale,＆amp;nbsp;（mRS） was not significantly different between two groups （1.43 ＆#177; 1.17 vs. 1.43 ＆#177; 1.45, P=0.99） at 3 months. Conclu-sions Patients with PAD cerebral infarction have PMD at early stage but have good prognosis at three months.

关 键 词：穿支动脉疾病 脑梗死 进展性运动障碍 侧脑室 

分 类 号：R743.3[医药卫生—神经病学与精神病学]