大脑中动脉供血区皮层下单个脑梗死的临床研究  

A clinical study of single subcortical cerebral infarction of middle cerebral artery territory

作　　者：杨磊[1] 于玲[2] 秦伟[1] 张小雨[1] 李悦[1] 徐霁华[1] 胡秀朝[1] 袁俊亮[1] 顾华[3] 胡文立[1] 

机构地区：[1]首都医科大学附属北京朝阳医院神经内科,100020 [2]首都医科大学附属北京朝阳医院内分泌科,100020 [3]首都医科大学附属北京朝阳医院放射科,100020

出　　处：《中华内科杂志》2016年第10期759-763,共5页Chinese Journal of Internal Medicine

摘　　要：目的 探讨大脑中动脉供血区皮层下单个脑梗死的临床特征及可能的发病机制.方法 回顾性分析344例大脑中动脉供血区皮层下单个脑梗死患者资料.根据大脑中动脉是否存在狭窄分为载体动脉疾病（PAD）组和载体动脉正常组（non-PAD组）,分别为32例和312例.non-PAD组再根据头部MRI显示的病灶与大脑中动脉的关系分为脑小血管病（SVD）亚组（129例）及分支动脉粥样硬化疾病（BAD）亚组（183例）.比较各组间临床特征的差异.结果 与non-PAD组相比,PAD组患者有更高的颅内动脉粥样硬化患病率[93.8％（30/32）比57.1％ （178/312）,P＜0.001],BAD发病率更高,但差异尚无统计学意义[75.0％ （24/32）比58.7％ （183/312）,P=0.072].在大脑中动脉正常的患者（non-PAD组）中,与BAD亚组相比,SVD亚组患者的年龄更大[（64.7±11.2）岁比（61.7±12.2）,P=0.031],高血压患病率更高[65.9％（85/129）比53.0％ （97/183）,P=0.027],有吸烟史的比率更低[41.9％ （54/129）比57.9％ （106/183）,P=0.006],脑白质疏松的程度更重.结论 大脑中动脉供血区皮层下单个脑梗死存在不同的病因和发病机制.对于BAD患者要积极寻找系统性动脉粥样硬化的证据.Objective To explore the clinical characteristics of single subcortical cerebral infarction of middle cerebral artery （MCA） territory and the possible pathogenesis.Methods A total of 344 cases diagnosed as single subcortical cerebral infarction of MCA territory were enrolled in the study and divided into the parent artery disease （PAD） group and the non-PAD group according to whether the MCA stenosis was presented or not.A total of 312 cases diagnosed as single subcortical cerebral infarction of MCA territory were divided into the BAD group and the SVD group according to the relationship between the lesion sites and MCA.Differences in the clinical and imaging feature were compared between different groups.Results A total of 32 patients were in the PAD group.Compared with the non-PAD group,patients in the PAD group were found with higher prevalence of asymptomatic cerebral arterial atherosclerosis [93.8% （30/32） vs 57.1% （178/312）,P 〈 0.001],higher prevalence of branch atheromatous disease [75.0% （24/32） vs 58.7% （183/312）,P =0.072].A total of 183 patients were in the BAD group.Compared with the BAD group,patients in the SVD group were older[（64.7 ± 11.2） years vs （61.7 ± 12.2） years,P =0.031],more with hypertension [65.9% （85/129） vs 53.0% （97/183）,P =0.027] and smoking [41.9% （54/129） vs 57.9% （106/183）,P =0.006] and more severe leukoaraiosis.Conclusions Single subcortical cerebral infarction of MCA territory has different etiology and pathogenesis.Evidence of systemic atherosclerosis should be carefully searched in patients with branch atheromatous disease.

关 键 词：卒中 大脑中动脉 分支动脉粥样硬化疾病 

分 类 号：R743.3[医药卫生—神经病学与精神病学]