心房纤颤患者急性分水岭区脑梗死的临床与影像学特点  

Clinical and Diffusion- weighted Imaging Features of Acute Border- zone Infarction in the Patients with Atrial Fibrillation

作　　者：乔利云[1] 徐秀芝[1] 

机构地区：[1]内蒙古包头市第四医院,中国包头014030

出　　处：《国际老年医学杂志》2015年第3期99-102,105,共5页International Journal of Geriatrics

摘　　要：目的：心房纤颤（Atrial fibrillation，AF）是急性脑梗死的一种重要危险因素。急性分水岭区脑梗死（acute border—zone infarcts，ABZI）的发病机制目前尚不明确。我们通过弥散加权成像（diffusion—weighted imaging，DWI）探讨AF患者ABZI的病理生理学从而对其进行分类。方法：我们选择103名ABZI同时合并存在AF的患者进行研究。在患者脑梗死症状出现24h之内进行DWI检查。根据动脉支配区特点把ABZI患者分为内侧BZI（Interal border—zone infarcts，IBZI）与皮层BZI（Cortical border—zone infarcts，CBZI）两组，并分别比较两组患者的基本信息、危险因素、临床特点和影像学特点。结果：IBZI组有27名患者，CBZI组有76名患者。与IBZI组相比，CBZI组患者年龄较大，女性患者所占比例偏高。IBZI组患者入院时美国国立卫生院神经功能缺损（National Institutes of Health Stroke Scale，NIHSS）评分与出院时改良Rankin量表（modified Rankin Scale，mRS）评分皆高于对照组。而IBZI组大脑中动脉（middle cerebral artery，MCA）的严重狭窄率或闭塞率比率较高，DWI上其梗死灶通常为串珠样（P〈0．01），CBZI组较多表现为皮层小梗死病变（P〈0．01）。结论：IBZI的病因可能主要为脑动脉血流动力学障碍所致，而栓塞机制是CBZI的主要发病机制。我们的研究结果提示房颤患者不同类型ABZI的治疗方案是有蒡异的。OBJECTIVE： To investigate the pathophysiology of ABZI and to identify its categories. METHODS： 103 atrial fibril- lation （AF） patients with ABZI were selected. DWI was performed within 24 hours of stroke onset for the patients. These patients were divided into interal border - zone infarcts （IBZI） group （ n = 27） and cortical border - zone infarcts （CBZI） group （ n = 76） based on vascular territories. Their demographic characteristics, cerebrovascular risk factors, clinical and neuroradiological data were compared in two groups. RESULTS： Patients with IBZI were associated with higher National Institutes of Health Stroke Scale （NIH- SS） scores on admission and higher modified Rankin Scale （mRS） at discharge. Compared with the CBZI patients, IBZI patients had a higher degree of stenosis or occlusion in middle cerebral artery （MCA） and exhibited a rosary - like pattern of infarction more fre- quently （P 〈 0.01）. In contrast, concomitant small cortical infarcts were observed more frequently in CBZI patients （P 〈 0. 01 ）. CONCLUSIONS： IBZI are caused mainly by hemodynamic compromise and CBZI by embolic pathogenesis. The studies suggest that different therapeutic approaches may be required in AF patients with different types of ABZI.

关 键 词：心房纤颤 分水岭区脑梗死 弥散加权成像 发病机制 血流动力学障碍 栓塞 

分 类 号：R743.33[医药卫生—神经病学与精神病学]