早期弥散加权成像预测急性孤立性穿支脑梗死后早期神经功能恶化  

Early diffusion-weighted imaging predicts early neurological deterioration after acute isolated basal ganglia infarct

作　　者：段作伟[1] 符长标[1] 陶丽红[1] 唐铁钰[1] 张帅[1] 侯红玲[1] 张新江[1] 

机构地区：[1]扬州市第一人民医院神经内科,225001i

出　　处：《国际脑血管病杂志》2015年第11期815-819,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨早期弥散加权成像（diffusion-weighted imaging，DWI）对急性孤立性穿支脑梗死后早期神经功能恶化（early neurological deterioration，END）的预测价值。方法回顾性分析在发病24h内完成头颅MRI检查的大脑中动脉穿支供血区急性孤立性脑梗死患者，病灶大小根据轴位DWI显示的病灶最大直径分为〈15mm、15～30mm和〉30mm。END定义为在入院72h内任一时刻复评美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分较基线增加≥2分或NIHSS运动项评分增加≥1分。结果共纳入336例患者，其中END患者126例（37．5％）。END组与非END组性别（P=0．044）、病灶最大直径（P=0．001）、责任动脉狭窄（P=0．006）的构成比以及基线NIHSS评分（P=0．001）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）（P=0．033）和C反应蛋白（P=0．039）水平均差异有统计学意义。多变量logistic回归分析显示，病灶最大直径15～30mm[优势比（oddsratio，OR）2．360，95％可信区间（confidence interval，CI）1．370～4．066；P=0．002]、女性（OR1．660，95％C11．024～2．691；P=0．040）以及责任大动脉狭窄（OR1．713，95％C11．036～2833；P=0．036）是患者发生END的独立危险因素，而高水平HDL-C（OR0．355，95％C10．141～0．894；P=0．028）则是发生END的独立保护因素。结论早期DWI显示的最大病灶直径可能对预测基底节区急性孤立性脑梗死END的发生具有一定的临床价值。Objective To investigate the predictive value of early diffusion-weighted imaging （DWI） for early neurological deterioration （END） after acute isolated basal ganglia infarct. Methods Patients with acute isolated basal ganglia infarct in middle cerebral artery perforators completed head MRI examination at 24 h after onset were analyzed retrospectively. According to the axial DWI revealed lesion size, the maximum diameters were divided into 〈 15 mm, 15 - 30 mm, and 〉 30 mm. END was defined as an increase in the National Institute of Health Stroke Scale （NIHSS） score ≥2 or the motor score of NIHSS ≥ 1 at any time within the first 72 h after admission compare with the baseline scores. Results A total of 336 patients were enrolled, including 126 patients （37. 5% ） with END. There were significant differences in the constituent ratios of the sex （P = 0. 044）, maximum diameter of the lesion （P = 0. 001 ）, and guilty artery stenosis （P = 0. 006）, as well as baseline NIHSS score （P = 0. 001 ）, high-density lipoprotein cholesterol （HDL-C） （P =0. 033）, and C-reactive protein （P =0. 039） between the END group and the non-END group. Multiple logistic regression showed that the maximum diameter of the lesions 15 -30 mm （odds ratio EOR] 2. 360, 95% confidence interval [ CII 1. 370 - 4. 066; P = 0. 002）, female （OR 1. 660, 95% CI 1. 024 - 2. 691; P=0. 040）, and guilty large artery stenosis （OR 1. 713, 95%CI 1. 036 -2. 833; P=0. 036） were the independent risk factors for patients occurring END, while the high HDL-C （OR O. 355, 95% CI O. 141 - 0. 894; P =0. 028） was an independent protective factor of occurring END. Conclusion Early DWI revealed that the maximum diameter of the lesions may have certain clinical value for prediction of the occurrence of END in patients with acute isolated basal ganglia infarct.

关 键 词：脑梗死 脑缺血 疾病恶化 弥散磁共振成像 磁共振血管造影术 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]