进展性神经功能恶化与脑分水岭梗死早期预后的相关性分析  

Correlation analysis of early prognosis of progressive neurological deterioration and cerebral watershed infarction: a clinical study

作　　者：谢怡[1,2] 张晓浩[1,2] 邱忠明[1,2] 张君[1,2] 杨恋[1,2] 谢霞[1,2] 马楠[1,2] 刘新峰[1,2] 

机构地区：[1]南京大学医学院附属金陵医院 [2]南京军区南京总医院神经内科,210002

出　　处：《中国脑血管病杂志》2014年第10期505-510,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(31171016)

摘　　要：目的探讨脑分水岭梗死进展性神经功能恶化（PND）对早期预后的影响。方法回顾性连续纳入2009年3月—2014年3月于南京军区南京总医院神经内科住院，且经影像学检查证实为脑分水岭梗死患者。确定并分析内分水岭梗死、外分水岭梗死及混合分水岭梗死的临床特点、实验室指标及影像学特征。采用美国国立卫生研究院卒中量表（NIHSS）对神经功能缺损进行评分，采用改良Rankin量表（mRS）对患者预后进行评分。应用单因素分析比较组间差异，同时进行多因素Logistic回归分析PND与脑分水岭梗死90d预后不良的相关性。结果共纳入89例脑分水岭梗死患者，其中外分水岭梗死患者43例，内分水岭梗死36例，混合分水岭梗死10例。单因素分析显示，内分水岭梗死及混合分水岭梗死PND发生率明显高于外分水岭梗死[分别为36．1％（13例）、50．0％（5例）、16．3％（7例）]，组间差异有统计学意义（P=0．018）。28例（31．5％）患者90d预后不良，90dmRS为（3．4±1．0）分。预后不良患者梗死类型与预后良好患者间差异有统计学意义（P〈0．05），预后不良患者中，以内分水岭梗死患者较多，占50．0％（14例），而预后良好患者中，以外分水岭患者较多，占57．4％（35／61）。预后不良患者PND发生率明显高于预后良好患者[57．1％（16／28）比14．8％（9／61）]，组间差异有统计学意义（P〈0．05）。多因素Logistic回归分析结果显示，经过校正混杂因素后，PND与脑分水岭梗死90d预后不良独立相关（OR=6．969，95％CI：2．451～19．869；P〈0．01）。结论相比于脑外分水岭梗死，梗死部位累及内分水岭的患者较易发生PND，且PND与90d预后不良独立相关.Objective To investigate the effect of progressive neurological deterioration （PND） of cerebral watershed infarction on early prognosis. Methods The consecutive patients with cerebral watershed infarction admitted in the Department of Neurology, Jinling Hospital, Nanjing University School of Medicine and their cerebral watershed infarctions confirmed by the imaging examination from March 2009 to March 2014 were enrolled. The clinical features, laboratory indicators and imaging features of internal watershed infarction, cortical-type watershed infarction, and mixed watershed infarction were identified and analyzed. The National Institutes of Health Stroke Scale was used to score neurological deficit. The modified Rankin scale （mRS） was used to score the prognosis of patients. Single factor analysis was used to compare the differences between the groups. At the same time, the correlation between PND and poor prognosis of cerebral watershed infarction at day 90 was analyzed by multivariable Logistic regression analysis. Results A total of 89 patients with cerebral watershed infarction were enrolled, including 43 cortical-type watershed infarctions, 36 internal watershed infarctions, and 10 mixed watershed infarctions. Single factor analysis indicated that the incidences of PND of internal watershed infarction and mixed watershed infarction were significantly higher than the cortical-type watershed infarction （36.1% [ n = 13 ] ,50.0% [ n = 5 ], and 16.3% [ n = 7 ] , respectively; P = 0. 018 ）. At day 90,28 patients had poor prognosis, and mRS was （3.4± 1.0 ） scores at day 90. There was significant difference in the types of infarction between the patients with poor prognosis and patients with good prognosis （P 〈 0.05 ）. In patients with poor prognosis, most of them were internal watershed infarctions, accounting for 50.0% （ 14/28 ） , while in patients with good prognosis, most of them were cortical-type watershed infarctions（57.4% [ 35/61 ] ）. The incidence of PND in patients with poor

关 键 词：脑梗死 脑分水岭梗死 进展性神经功能恶化 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]