梗死部位预测大脑中动脉穿支动脉区梗死患者进展性运动功能缺损  

Infarct location predicts progressive motor deficits in patients with infarct hi the perforator territory of the middle cerebral artery

作　　者：于永鹏[1,2] 谭兰[3] 鞠卫萍[1] 

机构地区：[1]威海市中心医院,潍坊医学院附属威海中心医院神经内科,264400 [2]青岛大学医学院,266021 [3]青岛大学医学院附属青岛市立医院神经内科,266071

出　　处：《国际脑血管病杂志》2015年第8期602-606,共5页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金项目（81400957）

摘　　要：目的探讨大脑中动脉（middle cerebral artery，MCA）穿支动脉供血区梗死患者弥散加权成像上梗死分布模式与进展性运动功能缺损（progressive motor deficits，PMD）的相关性。方法对新发MCA穿支动脉供血区梗死患者进行回顾性分析，PMD定义为发病5d内美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）运动项目评分增加〉2分且持续〉24h。比较PMD组和非PMD组人口统计学特征、危险因素、临床表现和梗死分布特点。结果共纳入64例患者，男性26例，女性38例，年龄（67．5±10．8）岁；PMD组28例，非PMD组36例。PMD组梗死位于后部侧脑室旁的比例（67．8％对25．0％；χ^2=11．5，P〈0．05）和基线NIHSS评分[（6．9±1．8）分对（4．3±1．2）分；t=2．42，P〈0．05）]均显著高于非PMD组。多变量logistic回归分析显示，梗死呈后部侧脑室旁分布与PMD呈显著独立相关（优势比6．3，95％可信区间2．20～18．0；P〈0．001）。结论梗死呈后部侧脑室旁分布模式可作为预测MCA穿支动脉供血区梗死患者PMD的神经影像学标记物。Objective To investigate the relationship between the pattern of infarct distribution on diffusion-weight imaging （DWI） and progressive movement deficits （PMD） in patients with infarct in the perforator territory of the middle cerebral artery （MCA）. Methods The patients with new infarction in the perforator territory of MCA were analyzed retrospectively. PMD was defined as an increase of at least 2 points on the motor item of the National Institutes of Health Stroke Scale （NIHSS） score persisting for at least 24 hours within 5 days of stroke onset. The demographic characteristics, risk factors, clinical presentation, and distribution characteristics of the infarcts in the PMD and non-PMD groups were compared. Results A total of 64 patients were enrolled in the study, including 38 females and 26 males, aged 67. 5 ± 10. 8 years. There were 28 patients in the PMD group and 36 in the non-PMD group. The proportion of the infarcts located in the posterior paraventricular region （67. 8% vs. 25.0% ; χ^2 = 11.5, P 〈 0. 05） of the PMD group and the mean baseline NIHSS score （6. 9 ± 1.8 vs. 4. 3 ± 1.2; t =2. 42, P〈0. 05） were significantly higher than those of the non-PMD group. Multiple logistic regression analysis showed that the posterior paraventricular type infarcts had significantly independently correlation with PMD （odds ratio 6. 31, 95% confidence interval 2.20 - 18.0; P 〈0. 001 ）. Conclusions The posterior paraventricular type infarcts on DWI can be used as a neuroimaging marker for predicting PMD in patients with infarction in the perforator artery territory of MCA.

关 键 词：脑梗死 疾病恶化 运动障碍 磁共振成像 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]