分支动脉粥样硬化病和小动脉闭塞的临床差异  

The Differences of Clinical Features and Outcomes Between BAD and SAO

作　　者：段振鹏[1] 代成波[2] 张玉虎[2] 张雄[2] 王硕[2] 马桂贤[2] 刘新通[2] 龙隆[2] 李昌茂[2] 王丽娟[2] 

机构地区：[1]南方医科大学,广东广州510515 [2]广东省人民医院(广东省医学科学院)神经内科,广东省神经科学研究所,广东广州510080

出　　处：《中风与神经疾病杂志》2015年第3期196-200,共5页Journal of Apoplexy and Nervous Diseases

基　　金：国家自然科学基金(No.81371401);广东省科技计划项目(No.2012B031800410);广东省科技计划项目(No.2011B080701087);广州市科技计划项目(No.2013J4100068);广东省自然科学基金(No.S2013010014033)

摘　　要：目的比较分析分支动脉粥样硬化病(branch atheromatous disease,BAD)和小动脉闭塞(small artery occlusion,SAO)性梗死患者临床及影像学特点的差异,并探讨两者早期神经功能恶化和短期预后的情况。方法连续收集210例皮质下小卒中(small subcortical stroke,S3)患者的临床资料(年龄、性别、高血压、糖尿病、吸烟、同型半胱氨酸、脑白质疏松和静息性腔隙性梗死等),采用美国国立卫生院神经功能评分(NIHSS)标准对所有患者入院当天、发病5 d、10 d进行神经功能评分。根据头部DWI的梗死灶的位置、形态等将其分为SAO组(n=83)和BAD组(n=127),比较分析两组患者临床、影像学特点的差异及治疗期间早期神经功能恶化(early neurological deterioration,END)和神经功能改善情况。结果 SAO组和BAD组相比,脑白质疏松比例、脑白质疏松分数、静息性腔隙性梗死比例、静息性腔隙性梗死数目有统计学意义(均P<0.05)。BAD组比SAO组患者入院当天NIHSS评分更高,比较有统计学意义(P<0.001);BAD组患者END发生率高于SAO组,两组比较有统计学意义(P=0.030);发病10 d神经功能改善程度和神经功能改善率比较无统计学差异(均P>0.05)。结论 SAO组患者脑白质疏松和静息性腔隙性梗死比例更高且程度更严重,BAD组患者入院时神经功能缺损更严重,且END发生率更高,但两者短期神经功能恢复无差异。Objective To compare the differences of clinical features between small artery occlusion（ SAO） and branch atheromatous disease（ BAD） in patients with small subcortical stroke,aimed to explore the pathogenesis of these 2different pathologies. At the same time,we analysis incidence of early neurological deterioration（ END）,the short-term prognosis between SAO and BAD. Methods A total of 210 patients with small subcortical stroke were recruited consecutively in this study. They were divided into SAO group and BAD group. Clinic data such as vascular risk factors,laboratory parameters,the presence of leukoaraiosis and silent lacunar infarcts were recorded during hospital stay,clinical neurological assessments were performed in line with national institutes of health stroke scale（ NIHSS） on the day of admission and day5,day 10 of hospital stay. We evaluated and compared the clinical features and outcomes between the two groups. Results The incidence of leukoaraiosis and silent infarction as well as severity of leukoaraiosis and silent lacunar infarcts were significantly different between the SAO and BAD groups（ all P〈0. 05）. Initial NIHSS（ P〈0. 001） and incidence of early neurological deterioration（ P = 0. 030） were significantly higher in BAD than SAO,but there were no differences in functional outcome of 10 days after ictus between the SAO and BAD（ all P〉0. 05）. Conclusion SAO had a higher incidence and severity of leukoaraiosis and silent lacunar infarcts than BAD. The patients with BAD had higher severity of motor deficits on the day of admission and incidence of early neurological deterioration but there were no differences in short-term prognosis between SAO and BAD.

关 键 词：皮质下小卒中 小动脉闭塞 分支动脉粥样硬化病 脑白质疏松 静息性腔隙性梗死 早期神经功能恶化 短期预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]