皮层分水岭脑梗死与内分水岭脑梗死患者的临床特征及病因分析  

Analysis of etiology and clinical features for cortical and internal watershed infarction

作　　者：邱石[1] 赵静[1] 罗彬[1] 吴涛[1] 李继来[1] 杜继臣[1] 

机构地区：[1]航天中心医院北京大学航天临床医学院,北京100049

出　　处：《山东医药》2014年第36期8-10,共3页Shandong Medical Journal

基　　金：中国航天科工集团第二研究院青年创新基金项目(2013年12号)

摘　　要：目的：探讨皮层分水岭脑梗死（ CWSI ）与内分水岭脑梗死（ IWSI ）的临床特征及发病机制。方法2012年10月～2014年5月连续收集入住航天中心医院（北京大学航天临床医学院）神经内科的分水岭脑梗死（ WSI ）患者，根据动脉支配特点分为CWSI组和IWSI组，比较两组患者的临床资料及影像学特点。结果本研究共纳入43例CWSI及31例IWSI患者。与IWSI组相比，CWSI组患者心房纤颤发生比例更高（P＝0．033），伴随皮质小梗死更为多见（P＝0．028）。而在IWSI组中，患者大脑中动脉狭窄程度≥50％或闭塞的比例更高，且梗死灶多呈串珠状或条索状（ P＝0．022、0．003）；IWSI组患者出院时NIHSS评分更高、住院时间更长（ P＝0．027、0．031）。两组Willis环血流代偿无明显差异（ P＞0．05）。结论 CWSI的主要发病机制是栓塞机制，而血流动力学障碍可能是IWSI的主要发病机制；IWSI患者的短期临床预后较CWSI患者更差。Objective To investigate the etiology and clinical features for cortical watershed infarction （ CWSI ） and internal watershed infarction （IWSI）.Methods Patients with cerebral watershed infarction （WSI） were recruited from October 2012 to May 2014 in the department of neurology of Aerospace Center Hospital （ Aerospace Clinical Medical Col-lege Affiliated to Peking University）, who were divided into CWSI group （n=43） and IWSI group （n=31） based on vas-cular teritories.Clinical and demographic features and neuroradiological features were compared between two groups .Re-sults Compared with the IWSI group , CWSI group had a higher incidence of atrial fibrillation and more frequently con-comitant small cortical infarcts （P=0.033 and P=0.028, respectively）.In contrast, IWSI group had a higher degree of stenosis or occlusion in the middle cerebral artery （P=0.022） and exhibited a rosary-like pattern of infarction more fre-quently （P=0.003）.Patients in IWSI group had higher NIHSS scores before discharge and longer hospital stay than CWSI group （P=0.027 and P=0.031, respectively）.No significance was found between two groups in the colleteral ability of Willis circle （P〉0.05）.Conclusions CWSI are caused mainly by embolic pathogenesis , whereas hemodynamic com-promise appears to contribute greatly to the genesis of IWSI .Patients with IWSI show poor early clinical courses .

关 键 词：分水岭脑梗死 影像学 血流动力学障碍 栓塞 病因 

分 类 号：R743[医药卫生—神经病学与精神病学]