不同类型腔隙性脑梗死发病机制的探讨  

Pathogenesis of different lacunar infarction subtypes

作　　者：陈兰兰[1] 徐耀[1] 马灿灿[1] 于海龙[1] 李晓波[1] 徐俊[1] 

机构地区：[1]江苏省苏北人民医院神经内科,扬州225001

出　　处：《中华老年心脑血管病杂志》2016年第9期961-965,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的通过比较不同类型腔隙性脑梗死（lacunar infarction,LI）与非LI的危险因素,推测其发病机制。方法回顾性分析2008年8月1日~2014年12月13日入住我院的急性颈内动脉系统脑梗死患者的临床资料,根据临床表现及影像学结果筛选出符合入选标准的患者LI 148例和非LI 148例。根据头颅MRI弥散加权成像上病灶数目及位置分为单发LI 113例,多发LI 35例;单发非LI 97例,多发非LI 51例。采用logistic回归分析IL的危险因素。结果单发LI的心房颤动及同侧颈动脉狭窄≥50%的发生率较多发LI（0.88%vs 11.43%,P=0.013;1.77%vs 17.14%,P=0.002）、单发非LI（0.88%vs 11.34%,P=0.001;1.77%vs 16.49%,P=0.000）、多发非LI（0.88%vs 9.80%,P=0.018;1.77%vs 17.65%,P=0.000）明显低。与单发LI比较,心房颤动及同侧颈动脉狭窄≥50%为多发LI（OR=26.353,95%CI：2.778~250.007,P=0.011;OR=11.483,95%CI：2.202~59.891,P=0.011）、单发非IL及多发非IL的独立危险因素。多发LI与单发非IL和多发非LI心房颤动及同侧动脉狭窄≥50%等危险因素无差异（P〉0.05）。结论单发LI与多发LI具有不同的发病机制,推测动脉粥样硬化病变及心源性栓塞为多发性LI的重要发病机制,但参与单发LI发病过程的概率相对较少。Objective To study the pathogenesis of different lacunar infarction（LI）subtypes by comparing the risk factors for LI and non-LI.Methods Clinical data of acute ischemic stroke patients（148LI patients and 148non-LI patients）admitted to our hospital were retrospectively analyzed.The patients were divided into single LI group（n=113）,multiple LI group（n=35）,single non-LI group（n=97）and multiple non-LI group（n=51）according to their MRI.Risk factors for LI were analyzed by logistic regression analysis.Results The incidence of AF and ipsilateral carotid stenosis≥50% was significantly lower in single LI group than in single non-LI group,multiple LI group and multiple non-LI group（0.88%vs 11.43%,P=0.013;1.77%vs 17.14%,P=0.002;0.88%vs 11.34%,P=0.001;1.77%vs 16.49%,P=0.000;0.88%vs 9.80%,P=0.018;1.77%vs 17.65%,P=0.000）.AF and ipsilateral carotid stenosis ≥50% were the independent risk factors for multiple LI（OR=26.353,95%CI：2.778-250.007,P=0.011;OR=11.483,95%CI：2.202-59.891,P=0.011）.No significant difference was found in risk factors for multiple LI and non-LI（P〈0.05）.Conclusion The pathogenesis of single LI and multiple LI is different.Atherosclerotic lesion and cardiogenic embolism are the important mechanism for multiple LI and are seldom involved in single LI.

关 键 词：脑梗死 动脉粥样硬化 心房颤动 颈动脉狭窄 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]