梗死位置预测大脑中动脉区脑梗死进展性运动神经功能损伤  

Infarction location for predicting cerebral infarction progressive motor nerve function deficits in middle cerebral artery area

作　　者：朱筱琦[1] 陆学胜[1] 张允[1] 许敏[1] 严乾峰 丁冀[1] 

机构地区：[1]上海交通大学医学院附属同仁医院神经内科,上海200336

出　　处：《重庆医学》2018年第6期763-766,共4页Chongqing medicine

基　　金：上海市长宁区科学技术委员会项目(CNKW2015Y04)

摘　　要：目的探讨脑梗死位置与进展性运动神经功能损伤(PMD)发生的相关性。方法纳入发病24h内、未行溶栓治疗的大脑中动脉区梗死患者,以发病7d内美国国立卫生研究院卒中量表(NIHSS)评分运动项目较基线升高大于或等于2分作为PMD的诊断标准,比较PMD组与非PMD组的临床、实验室资料及梗死位置的差异。多因素Logistic回归分析预测PMD发生的危险因素。结果共纳入大脑中动脉区急性脑梗死患者121例,分为PMD组(45例)与非PMD组(76例)。PMD组内分水岭梗死的发生率高于非PMD组(26.7%vs.5.3%,P=0.001)。穿支动脉区梗死的发生率在PMD组与非PMD组之间差异无统计学意义(42.2%vs.35.5%,P=0.463),进一步将穿支动脉区梗死分为穿支动脉粥样硬化性疾病(BAD)及脂质玻璃样变(LD)后。PMD组中BAD的发生率高于非PMD组,差异有统计学意义(28.9%vs.9.2%,P=0.005)。逐步Logistic回归显示内分水岭梗死(OR=9.750,95%CI:2.828~33.612,P=0.000)与BAD病变(OR=6.036,95%CI:2.119~17.190,P=0.001)是PMD的独立危险因素。结论内分水岭梗死、BAD病变可以预测PMD的发生。梗死位置有助于发现脑梗死进展的高危人群。Objective To investigate the correlation between the infarction location and progressive motor deficits （PMD） occurrence. Methods The patients with middle cerebral artery（MCA） infarction within 24 h of onset without thrombolytic therapy were included. The National Institutes of Health Stroke Scale（NIHSS） motor item score increase ≥2 points of the base line within 7 d after stroke onset served as the PMD diagnostm criteria. The differences in clinical and laboratory data, and infarction location were compared between the PMD group and non-PMD group. The multivariate Logistic regression analysis predicted the risk fac- tors of PMD occurrence. Results A total 121 patients with MCA acute cerebral infarction were included in the study and divided into the PMD group （45 cases） and non-PMD group （76 cases）. The internal watershed infarction occurrence rate in the PMD group was higher than that in the non-PMD group （26.7% vs. 5.3M ,P=0. 001）. The occurrence rate of penetrating arterial infarction （PAD had no statistical difference between thePMD group and non-PMD group（42. 2% vs. 35. 5%, P=0. 463）. PAI was further divided into perforating branch atheromatous disease （BAD） and lipohyalinitic degeneration （LD）. The occurrence rate of BAD in the PMD group was significantly higher than that in the non-PMD group （28. 9% vs. 9.2%. P=0. 005）. The stepwise Logistic regression analysis indicated that watershed infarction [odds ratio（OR） ： 9. 750,95% confidence interval（CI） ： 2. 828-33. 612, P=0. 000% and BAD lesion （OR： 6. 036,95% CI： 2. 119-17. 190, P=0. 001 ） were the independent risk factors contributing to PMD. Conclusion Internal watershed infarction and BAD lesion may predict the PMD occurrence. The infarct location is conducive to find the high risk population of cerebral infarction progress.

关 键 词：大脑中动脉区脑梗死 进展性运动神经功能损伤 内分水岭梗死 穿支动脉粥样硬化性疾病 

分 类 号：R743.3[医药卫生—神经病学与精神病学]