大脑中动脉深穿支孤立性梗死进展性运动功能缺损的危险因素分析  

Analysis of risk factors for progressive motor function defect in isolated infarction with deep penetrating branch of middle cerebral artery

作　　者：侯明月 赵子慧 宋贵军[1] HOU Mingyue;ZHAO Zihui;SONG Guijun(Department of Neurology,The Second Hospital of Dalian Medical University,Dalian 116021,China)

机构地区：[1]大连医科大学附属二院神经内科,辽宁大连116021 [2]赤峰学院附属医院神经内科,内蒙古赤峰024000

出　　处：《中风与神经疾病杂志》2019年第12期1090-1096,共7页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨大脑中动脉深穿支孤立性梗死的临床特点、生化指标及影像学特征等与进展性运动功能缺损(PMD)之间的相关性。方法连续纳入发病72 h内、经头部磁共振证实为大脑中动脉深穿支供血区孤立性梗死的患者,以发病后5 d内,NIHSS评分中运动项目评分增加≥2分,且持续时间至少24 h为PMD诊断标准,将患者分为PMD组和非PMD组,比较两组患者一般临床资料、实验室生化指标及影像学特征,采用多变量Logistic回归模型分析大脑中动脉深穿支孤立性梗死后PMD的独立预测因素。结果185例患者中PMD组53例,非PMD组132例。女性,既往脑梗死/TIA病史,发病到入院的时间短,总胆固醇和纤维蛋白原指标高,后部梗死,梗死体积大,存在动脉粥样硬化,伴有重度脑白质病变的脑梗死患者PMD阳性发生率较高(P<0.05)。多元逻辑回归分析提示,后部梗死(OR=5.449,95%CI=1.321~22.474,P=0.019)、梗死体积(OR=1.003,95%CI=1.001~1.005,P=0.006)、发病到入院的时间(OR=0.976,95%CI=0.957~0.995,P=0.015)、动脉粥样硬化(OR=3.904,95%CI=1.504~10.132,P=0.005)、既往TIA/脑梗死病史(OR=3.298,95%CI=1.125~9.667,P=0.030)、椎-基底动脉狭窄(OR=42.384,95%CI=3.852~466.3,P=0.002)与PMD的发生显著相关,是PMD发生的独立预测因素。结论病灶累及后部、病灶体积、既往TIA/脑梗死病史、发病到入院的时间、动脉粥样硬化病史、椎-基底动脉狭窄可能是进展性运动功能缺损的危险因素。Objective To investigate the correlation between the clinical features,biochemical parameters and imaging features of isolated middle cerebral artery deep perforating branch infarction and progressive motor dysfunction(PMD).Methods Patients with isolated infarction of deep perforating branch of middle cerebral artery confirmed by transcranial magnetic resonance within 72 hours of onset were included.Within 5 days after onset,NIHSS score increased by more than 2 points,and the duration was at least 24 hours as the diagnostic criterion of PMD.The patients were divided into PMD group and non-PMD group.The general clinical data,laboratory biochemical indicators and imaging characteristics were compared between the two groups.Multivariate logistic regression model was used to analyze the independent predictors of PMD after isolated middle cerebral artery deep penetrating branch infarction.Results Among 185 patients,53 were in PMD group and 132 were in non-PMD group.Women,past history of cerebral infarction/TIA,short time from onset to admission,high total cholesterol and fibrinogen index,posterior infarction,large infarction volume,presence of atherosclerosis,cerebral infarction patients with vertebral-basilar artery stenosis and severe leukoencephalopathy had a higher incidence of PMD positive(P<0.05).Logistic analysis suggests,posterior infarction(OR=5.449,95%CI=1.321~22.474,P=0.019),infarct volume(OR=1.003,95%CI=1.001~1.005,P=0.006),time from onset to admission(OR=0.976,95%CI=0.957~0.995,P=0.015),atherosclerosis(OR=3.904,95%CI=1.504~10.132,P=0.005),past TIA/cerebral infarction history(OR=3.298,95%CI=1.125~9.667,P=0.030),vertebral-basilar artery stenosis(OR=42.384,95%CI=3.852~466.3,P=0.002)were significantly correlated with PMD,which were independent predictors of PMD.Conclusion The lesion involved the posterior part,the volume of the lesion,the history of TIA/cerebral infarction,the time from onset to admission,atherosclerosis and vertebral-basilar artery stenosis may be the risk factors for progressive motor defic

关 键 词：大脑中动脉深穿支脑梗死 进展性运动功能缺损 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]