责任性颅内动脉粥样硬化性狭窄致首发缺血性脑卒中解剖模式与发病机制的关系  

Relationship between topographic patterns and mechanisms in intracranial atherosclerotic stenosis related first-ever Ischemic Stroke

作　　者：王炎强[1] 孙绍洋 王玉鸽[3] 伍爱民[3] 杨渝[3] 戴永强[3] 陆正齐[3] 胡学强[3] WANG Yanqiang SUN Shaoyang WANG Yuge et al(Department of Neurology,The Affiliated Hospital of Weifang Medical University, Weifang 261031, China)

机构地区：[1]潍坊医学院附属医院神经内科,山东潍坊261031 [2]青岛大学医学院附属医院神经内科,山东青岛266000 [3]中山大学附属第三医院神经内科,广东广州510630

出　　处：《中风与神经疾病杂志》2017年第1期43-47,共5页Journal of Apoplexy and Nervous Diseases

基　　金：山东省医药卫生科技发展计划项目(No.2015WS0051)

摘　　要：目的探讨责任性颅内动脉粥样硬化性狭窄(Intracranial atherosclerotic stenosis,ICAS)致首发缺血性脑卒中(Ischemic stroke,IS)解剖模式与发病机制的关系。方法回顾性分析261例责任性ICAS致首发IS患者的临床资料。根据弥散加权成像(DWI)的影像学表现分为单发病灶(皮质-皮质下梗死、皮质梗死、皮质下梗死),弥散病灶,多发病灶(单侧前循环或后循环多发梗死);卒中机制分为动脉到动脉栓塞、原位血栓形成、穿支动脉闭塞、低灌注、多发机制等。结果单发皮质下梗死是责任性ICAS致首发IS最常见的卒中模式(41.38%,108/261);责任性ICAS致IS主要发病机制为穿支动脉闭塞(41.38%,108/261);责任性ICAS致IS的解剖模式与发病机制显著相关(r=0.384,P=0.001),穿支动脉闭塞与皮质下梗死相关(r=0.805,P=0.001),弥散梗死、单侧前循环多发梗死、后循环多发性梗死,分别与动脉到动脉栓塞(r=0.853,P=0.001;r=0.860,P=0.001;r=0.281,P=0.001)、及多发机制(r=0.792,P=0.001;r=0.883,P=0.001;r=0.213,P=0.001)相关。结论卒中解剖模式有助于明确责任性ICAS致缺血性脑卒中的发病机制,有利于指导其临床诊治及预防措施的拟定。Objective To evaluate the relationship between topographic patterns and mechanism in ischemic stroke with intracranial atherosclerotic stenosis（ ICAS）. Methods We retrospectively investigated 261 patients who had ICAS with ischemic stroke. The patients＇ characteristics were reviewed,ischemic patterns were divided into single（ corticosubcortical,cortical,subcortical lesion）,scattered,multiple lesions. Stroke mechanisms were categorized as artery to artery embolism（ A-A）,in situ thrombotic occlusion（ STO）,local branch occlusion（ LBO）,hemodynamic impairment（ HI）,and multiple mechanisms. Results In all of the patients who had ICAS with ischemic stroke,single subcortical（ 41. 4） lesions were most commonly seen in all the lesion patterns,the most frequent lesion mechanism was LBO（ 66. 3）. There was a statistically significant association between topographic patterns on DWI and different stroke mechanisms（ r = 0. 384,P =0. 001）. LBO was related with subcortical lesions（ r = 0. 805,P = 0. 001）,scattered,multiple lesions in unilateral anterior circulation,multiple lesions in posterior circulation were especially association with A-A（ r = 0. 853,P = 0. 001; r = 0. 860,P = 0. 001; r = 0. 281,P = 0. 001） and multiple mechanisms（ r = 0. 792,P = 0. 001; r = 0. 883,P = 0. 001; r = 0. 213,P =0. 001）. Conclusion Topographical patterns were helpful to verify etiology mechanism in ICAS with ischemic stroke.

关 键 词：缺血性脑卒中 颅内动脉粥样硬化性狭窄 解剖模式 发病机制 弥散加权成像 

分 类 号：R743[医药卫生—神经病学与精神病学]