大脑中动脉深穿支单发小梗死病灶形态与早期功能预后的关系  

Relation between morpholy of SSI in perforating territory of middle cerebral artery and early prognosis of neurological function

作　　者：邱忠明[1] 段作伟[2] 桑红菲 杜鹃[1] 张晓浩[3] 马楠[3] 谢霞[2] 樊新颖[3] 刘新峰[1] 徐格林[1] 

机构地区：[1]第二军医大学南京临床医学院(南京军区南京总医院)神经内科,210002 [2]南方医科大学南京临床医学院神经内科 [3]南京大学医学院附属金陵医院神经内科

出　　处：《中华老年心脑血管病杂志》2015年第1期57-60,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81301017);江苏省临床医学科技专项基金(BL2013025)

摘　　要：目的 探讨大脑中动脉深穿支单发小梗死的病灶形态与早期神经功能恶化（END）及30 d功能预后的关系.方法 连续收集因大脑中动脉深穿支单发小梗死住院患者1 45例,根据病灶在MRI弥散加权成像上的形态特征,分为规则病灶组95例和不规则病灶组50例.采用美国国立卫生研究院卒中量表（NIHSS）评估患者的神经功能缺损情况;以30 d的改良Rankin量表（mRS）评估患者早期的临床功能预后.结果 与不规则病灶组比较,规则病灶组END、基线收缩压、基线NIHSS评分明显降低,病灶直径明显缩小（P＜0.05,P＜0.01）;其中END 27例（18.6％）,脑卒中30 d后预后不良31例（21.4％）.与预后不良比较,预后良好患者不规则病灶、END、基线收缩压、基线NIHSS评分明显降低,病灶直径明显缩小（P＜0.05,P＜0.01）.logistic回归分析显示,不规则病灶（OR-3.949,95％CI：1.331～11.716,P=0.013）是END的独立危险因素,基线NIHSS评分（OR=2.211,95％CI：1.473～3.319,P=0.007）和END（OR=6.136,95％CI：3.043～12.428,P=0.001）是30 d预后不良的独立危险因素.结论 穿支供血区病灶不规则的单发小梗死患者住院期间易发生END,并且短期功能预后表现较差.Objective To study the relation of the morphology of SSI in perforating territory of middle cerebral artery with early neurological deterioration （END） and prognosis of neurological function.Methods One hundred and forty-five patients with SSI in perforating territory of middle cerebral artery were divided into regular SSI group （n=95） and irregular SSI group （n=50） according to the morphology of SSI on diffusion-weighted MRI.Their neurological function dificits were assessed according to the NIHSS and the prognosis of their neurological function was assessed according to the mRS.Results The END was significantly worse,the baseline SBP and NIHSS score were significantly lower,the diameter of SSI was significantly shorter in regular SSI group than in irregular SSI group （P〈0.05,P〈0.01）.END and poor prognosis were observed in 27 （18.6%） and 31 （21.4%） out of the 145 patients.Logistic regression analysis showed that irregular SSI was the independent risk factor for END （OR=3.949,95%CI：1.331-11.716,P=0.013） while baseline NIHSS score and END were the independent risk factors for the poor prognosis of neurological function （OR =2.211,95% CI：1.473-3.319,P =0.007; OR =6.136,95% CI：3.043-12.428,P=0.001）.Conclusion END is easy to occur in patients with irregular SSI in the perforating territory of middle cerebral artery with a poor prognosis of neurological function.

关 键 词：梗死 大脑中动脉 磁共振成像 危险因素 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]