颞前动脉的存在与急性动脉粥样硬化性大脑中动脉闭塞患者梗死模式及临床预后的相关性研究  

Correlation between anterior temporal artery and infarction model as well as clinical prognosis in patients with acute atherosclerotic middle cerebral artery occlusion

作　　者：朱明月[1] 刘德志[1] 施伟[1] 陈万红[1] 资文杰[1] 刘新峰[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)神经内科,南京医学硕士210002

出　　处：《医学研究生学报》2016年第11期1125-1130,共6页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81220108008;81400993)

摘　　要：目的颞前动脉是大脑中动脉第一个主要分支血管.在急性大脑中动脉（ nuddle cerebml artery,MCA） 闭塞患者中,其可提供潜在血流,继而改变脑组织坏死进程.文中旨在探讨通过分析急性动脉粥样硬化性M CA的M l段（ imddle cerebralartery-Ml segment, MCA-M1） 闭塞后颜前动脉存在与梗死模式及梗死体积的改变, 并探讨其对患者临床预后的影响.方法选取南京卒中注册系统中2 0 0 7年1 月至2 0 1 3年1 2月,因首发缺血性卒中且影像学检查提示为动脉粥样硬化性MCA闭塞的患者116例.同时依据有无颞前动脉分为2 组55例患者存在颞前动脉（颞前动脉存在组）,61例患者颞前动脉缺失（颞前动脉缺失组）.于人院期间均完成头颅M RI及血管学检查.对2 组进行临床基础资料的比较,采用A lberta卒中项目早期C T 评分方式分析组间病灶面积的差异,并采用改良R ankin量表（modified rankinscale, mRS）评估患者3 个月功能预后.最后采用多因素LoglSt1C 回归分析3 个月预后良好（mRS≤2 ）的独立预测因素.结果颞前动脉存在组人院国立卫生院神经功能评分（ National Institute of Health aroke Scale, NIHSS）、出院NIHSS评分较颞前动脉缺失组显著降低,且ASPECTS评分≥7分、m R S评分〈 2 分例数显著升高（P 〈0.05）.颞前动脉存在组多区域病灶梗死、穿通支动脉区域梗死的发生率明显低于颞前动脉缺失组（34.6% 53.1%,38.5% 57.8%,P 〈0.05） ;m R S评分≤2 发生率明显高于颞前动脉缺失组（73.1% 35.9%,P 〈0.001）.5 5 例（47.4%）患者3 个月功能预后良好,多因素logistic回归分析显示颞前动脉存在（0 R = 0.188,9 5 % C I：0.062-0.572）、人院NIHSS评分（0 R = 1.578,9 5 % C I：1.326- 1.878）是患者3 个月预后良好的独立预测因素.结论颞前动脉存在能够减小急性动脉粥样硬化性MCA-M1 段闭塞患者梗死体积,改善患者临床功能预后.Objective Anterior temporal artery( ATA) is the first major branch of middle cerebral artery( MCA) which provides blood flow to the ischemic tissue and prevents the development of neurologic deterioration. The study aimed to investigate the correlation between ATA and infarction pattern,infarct volume as well as clinical prognosis in patients with acute atherosclerotic M1 MCA occlusion( MCAO). Methods 116 patients with first ischemicstroke who were indicated with atherosclerotic MCAO by imaging examination were selected from Nanjing Stroke Registry Program( NSRP) between January 2007 and December 2013. The patients were divided into two groups according to ATA presence,55 cases with ATA and 61 cases without ATA. All patients underwent MRI and vascular examination before hospitalization. Comparison was made in the baseline characteristics between two groups. Alberta Stroke Program Early CT Score( ASPECTS) was used to analyze the difference of lesion sizes between groups. Modified Rankin Scale( mRS) was adopted to evaluate functional prognosis at 3 months. Multivariate logistic regression analysis was applied to investigate the independent predictor of good prognosis( mRS≤2) at 3 months.Results Patients in ATA group were found to have significantly lower admission and discharge National Institutes of Health Stroke Scale( NIHSS) scores in comparison with the other group and the number of cases with ASPECTS≥7 and mRS score≤2 increased remarkably( P<0.05). In ATA group,there were less infarcts in multiple lesions and perforating artery territory( 34.6% vs 53.1%,38.5% vs 57.8%,P<0.05),and more cases of mRS≤2( 73.1% vs 35.9%,P<0.001). At 3 months,55 patients( 47.4%) had good functional prognosis.Multivariate logistic regression analysis showed ATA presence( OR = 0.188,95% CI: 0.062-0.572) and admission NIHHS score( OR =1.578,95% CI: 1.326-1.878) were independent predictors of good prognosis. Conclusion The presence of ATA can change infarct volumes in the ischemic territory of M1 MCA and improve functional progn

关 键 词：卒中预后 颞前动脉 梗死模式 大脑中动脉闭塞 

分 类 号：R743.3[医药卫生—神经病学与精神病学]