急性双侧脑梗死的病因分型及发病机制分析  

Etiological subtypes and pathogenesis of acute bilateral ischemic stroke

作　　者：王佳楠[1] 张雄伟[1] 王翠玉[1] 黄玲[1] 尹世敏[1] 李秋俐[1] 王磊[1] 

机构地区：[1]第二炮兵总医院神经内科,北京100088

出　　处：《中华老年心脑血管病杂志》2015年第8期826-829,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨急性双侧脑梗死的病因分型及发病机制。方法选择经磁共振弥散加权成像(DWI)证实为急性双侧脑梗死的患者55例,根据梗死灶分布进行分组,双侧前循环梗死12例(前循环组),双侧后循环梗死28例(后循环组),一侧前循环合并对侧后循环梗死15例(合并组)。按照TOAST分型标准,分析不同病因及发病机制在各组的分布差异。结果 55例患者中,病因分型依次为大动脉粥样硬化42例,心源性栓塞9例,小动脉闭塞1例,其他和不明原因型3例。与后循环组比较,前循环组和合并组大动脉粥样硬化(21.4%、23.8%vs 54.8%)、心源性栓塞(33.3%、22.2%vs 44.4%)显著降低,差异有统计学意义(P<0.05)。发病机制依次为动脉-动脉栓塞20例,低灌注/栓子清除障碍15例,心源性栓塞9例,血栓形成4例,血管变异合并动脉-动脉栓塞4例,机制不明3例。与后循环组比较,前循环组和合并组动脉-动脉栓塞(10.0%、15.0%vs 75.0%),心源性栓塞(33.3%、22.2%vs44.4%)明显降低,而低灌注/栓子清除障碍(40.0%、46.7%vs 13.3%)明显升高,差异有统计学意义(P<0.05)。结论急性双侧脑梗死患者主要病因分型为大动脉粥样硬化和心源性栓塞,主要发病机制为动脉-动脉栓塞、心源性栓塞和低灌注。Objective To study the etiological subtypes and pathogenesis of acute bilateral ischemic stroke （ABIS）. Methods Fifty-five ABIS patients were divided into anterior circulation group （n = 12）, posterior circulation group （n= 28）, and combined circulation group （ n = 15 ）. The etio- logical subtypes and pathogenesis of ABIS were analyzed according to the TOAST criteria. Results Of the 55 ABIS patients, 42 were diagnosed with large artery atherosclerosis, 9 with cardiogenic stroke, 1 with small artery occlusion, 3 with other unknown etiological subtypes of ABIS. The in- cidence of large artery atherosclerosis was significantly higher in posterior circulation group than in anterior circulation group and combined circulation group （54. 8% vs 21. 4%, 54. 8% vs 23.8% ,P〈0. 05）. Arterial embolism was detected in 20 patients,hypo-perfusion in 15 patients, cardiac embolism in 3 patients,atherothrombosis in 4 patients,vascular variation and arterial em- bolism in 4 patients,unknown eiolgical subtypes in 3 patients. The incidence of arterial embolism and cardiac embolism was significantly higher while that of hypoperfusion and emboli was signifi- cantly lower in posterior circulation group than in anterior circulation group and combined circula- tion group （75.0% vs 10.0%,75.0% vs 15.0%,P〈0.05;13.3% vs 40.0%,13.3% vs 46.7%, P〈0.05）. Conclusion Large artery atherosclerosis and cardiogenic stroke are the main etiologi- cal subtypes of ABIS, and arterial embolism, cardiac embolism and hypoperfusion are the main pathogenesis of ABIS.

关 键 词：脑梗死 动脉粥样硬化 栓塞 胆固醇 发病率 磁共振成像 弥散 

分 类 号：R743.3[医药卫生—神经病学与精神病学]