不同临床分型脉络膜前动脉梗死患者影像学特征及其神经功能障碍严重程度影响因素分析  

Imaging Features and Influencing Factors of the Severity of Neurological Dysfunction in Patients with Different Clinical Types of Anterior Choroid Artery Infarction

作　　者：王光胜 胡婷 杨金建 田媛媛 黄利 王元伟 顾汉沛 王英 刘国红 汤德 WANG Guangsheng;HU Ting;YANG Jinjian;TIAN Yuanyuan;HUANG Li;WANG Yuanwei;GU Hanpei;WANG Ying;LIU Guohong;TANG De(Department of Neurology,Affiliated Shuyang Hospital of Xuzhou Medical University,Shuyang 223600,China;Department of Radiology,Affiliated Shuyang Hospital of Xuzhou Medical University,Shuyang 223600,China)

机构地区：[1]徐州医科大学附属沭阳医院神经内科,江苏省沭阳市223600 [2]徐州医科大学附属沭阳医院影像中心,江苏省沭阳市223600

出　　处：《实用心脑肺血管病杂志》2020年第10期113-117,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景脉络膜前动脉(AChA)梗死占缺血性脑卒中的3%~11%,易被临床忽视或与大脑中动脉供血区小分支动脉所致的腔隙性梗死相混淆,目前对其流行病学、病因症状学、影像学特征及预后等研究相对较少。探讨AChA梗死的临床特点、分型及影像学特征有重要临床意义。目的分析不同临床分型AChA梗死患者的影像学特征及其神经功能障碍严重程度的影响因素。方法回顾性选取2016年4月—2018年4月于徐州医科大学附属沭阳医院神经内科住院的AChA梗死患者100例为研究对象。收集患者一般资料,包括性别、年龄、高血压发生情况、糖尿病发生情况、心脏病史、脑卒中史、神经功能障碍(包括肢体无力、言语障碍、感觉障碍、意识障碍)发生情况。应用美国国立卫生研究院卒中量表(NIHSS)对患者神经功能障碍严重程度进行评估,根据入院时NIHSS评分把患者分为轻型组(≤5分,78例)、中型组(6~10分,16例)、重型组(>10分,6例)。收集患者影像学特征指标,包括梗死灶侧别、累及部位、梗死灶直径、梗死灶形态及大动脉病变发生情况。AChA梗死患者入院NIHSS评分影响因素分析采用多元线回归分析。结果中型组言语障碍、感觉障碍发生率高于轻型组(P<0.05);重型组感觉障碍、意识障碍发生率和累及豆状核内后区、膝状体率高于轻型组,梗死灶直径大于轻型组,累及豆状核内后区率高于中型组,梗死灶直径大于中型组(P<0.05)。多元线性回归分析结果显示,心脏病病史〔B=-4.013,95%CI(-7.915,-0.111)〕、梗死灶直径〔B=0.208,95%CI(0.059,0.357)〕、累及豆状核内后区〔B=4.703,95%CI(1.916,7.491)〕是AChA梗死患者入院NIHSS评分的影响因素(P<0.05)。结论AChA梗死多表现为深部梗死,属于轻型脑卒中类型;梗死灶直径和累及豆状核内后区是AChA梗死患者神经功能障碍严重程度的影响因素。Background Anterior choroidal artery(AChA)infarction accounts for 3%to 11%of ischemic stroke,which is easily overlooked clinically or confused with lacunar infarction caused by small branch artery in the blood supply area of the middle cerebral artery.At present,there are relatively few studies on its epidemiology,etiology,symptomatology,imaging features and prognosis.It is of great clinical significance to discuss the clinical characteristics,classification and imaging features of AChA infarction.Objective To analyze the imaging features and influencing factors of the severity of neurological dysfunction in patients with different clinical types of AChA.Methods We retrospectively recruited 100 patients with AChA infarction who were hospitalized in the Department of Neurology,Affiliated Shuyang Hospital of Xuzhou Medical University from April 2016 to April 2018.General data of the patients were collected,including gender,age,hypertention,diabetes,heart diseases history,stroke history,neurological dysfunction(including limb weakness,speech disorder,sensory disturbance,consciousness disturbance).NIHSS was used to evaluate the severity of neurological dysfunction.According to the NIHSS score at admission,the patients were divided into mild group(<5 points,78 cases),moderate group(6-10 points,16 cases)and severe group(>10 points,6 cases).The imaging features of the patients were collected,including the location of the infarction,the involved site,the diameter of the infarction,the shape of the infarction and the occurrence of the large artery lesions.Multiple linear regression analysis was used to analyze the influencing factors of NIHSS score in patients with AChA infarction.Results Moderate group had higher incidence of speech disorder and sensory disturbance than mild group(P<0.05);compared with mild group,severe group had higher incidence of sensory disturbance and consciousness disturbance,preferred to involve the posterior part of lenticular nucleus and geniculate body,and had bigger diameter of the infarction(

关 键 词：大脑梗死 脉络膜前动脉梗塞 NIHSS评分 影响学特征 神经功能障碍 影响因素分析 

分 类 号：R743.33[医药卫生—神经病学与精神病学]