不同部位脑梗死华勒变性的特点及对神经功能的影响  

Characteristics of Wallerian degeneration in different parts of cerebral infarction and its effect on nerve function

作　　者：王冬梅[1] 蔡桂淑[1] 刘立生[1] WANG Dong-mei;CAI Gui-shu;LIU Li-sheng(Department of Neurology,Tianjin Beichen Hospital,Tianjin 300400,China)

机构地区：[1]天津市北辰医院神经内科,300400

出　　处：《天津医药》2021年第5期529-533,共5页Tianjin Medical Journal

基　　金：天津市北辰区科技发展计划项目(2017-SHGY-02)。

摘　　要：目的探讨不同部位脑梗死华勒变性的特点及对神经功能的影响。方法对185例急性脑梗死患者依据梗死部位分3组:A组为前循环供血范围内皮层及皮层下梗死(51例),B组为前循环供血范围内半卵圆中心、脑室旁、基底节区梗死(78例),C组为后循环供血范围内胼胝体、丘脑、脑干、小脑梗死(56例)。在患者发病7 d内、3个月、9个月和24个月进行头颅MRI检查,统计不同时间华勒变性发生率。发病14 d内、3个月、9个月和24个月采用Fugl-Meyer运动功能量表(FMA)和日常生活能力量表(ADL)进行神经运动功能、日常生活能力的评估。比较发病时和发病24个月FMA和ADL评分变化,多因素线性回归分析发病24个月患者FMA和ADL评分变化与基线特征的关系。结果脑梗死后3、9、24个月时,与C组比较,A组和B组华勒变性发生率均明显升高(均P<0.01)。多因素线性回归分析结果显示,性别和发生华勒变性的时间是发病24个月患者FMA评分变化的影响因素(均P<0.05),发病24个月男性FMA评分较女性下降2.230分,3个月、9个月、24个月时发生华勒变性的患者FMA下降幅度值分别为15.571、12.970、9.620分。同时,发生华勒变性的时间是发病24个月患者ADL评分变化的影响因素(均P<0.05),于3个月、9个月、24个月时发生华勒变性的患者,其ADL升高幅度值分别为14.323、11.969、8.574分。结论前循环梗死患者更易发华勒变性,且发生时间越早,对患者神经运动功能和日常生活的影响越明显。Objective To investigate the characteristics of Wallerian degeneration in different parts of cerebral infarction and its effect on neurological function.Methods A total of 185 patients with acute cerebral infarction were divided into three groups according to the infarct location:group A(51 cases)with endothelial and subcortical infarcts within the anterior circulation,group B(78 cases)with infarction in the semioval center,paraventricular and basal ganglia within the anterior circulation,and group C(56 cases)with infarction in corpus callosum,thalamus,brainstem and cerebellum within the posterior circulation.MRI was performed within 7 days,3 months,9 months and 24 months after the onset of the disease.The incidence of Wallerian degeneration in different time points was counted.Fugl-Meyer motor function scale(FMA)and activities of daily living scale(ADL)were used to evaluate motor function and activities of daily living within 14 days,3 months,9 months and 24 months after onset.The changes of FMA and ADL scores were compared at onset and 24 months after onset.Multiple linear regression analysis was used to analyze the correlation between the differences of FMA and ADL scores and baseline characteristics.Results At 3,9 and 24 months after cerebral infarction,the incidence of Wallerian degeneration was significantly higher in group A and group B than that in group C(all P<0.01).The results of multivariate linear regression analysis showed that gender and Wallerian degeneration time were the influencing factors of FMA score changes after 24 months(all P<0.05).The FMA score of male patients decreased by 2.230 points more than that of female patients after 24 months,and the decrease range of FMA of patients with Wallerian degeneration at 3 months,9 months and 24 months were 15.571,12.970 and 9.620 points respectively.At the same time,the time of Wallerian degeneration was the influencing factor of ADL score changes in patients after 24 months(all P<0.05).The ADL increased range of patients with Wallerian degeneration

关 键 词：脑梗死 WALLER变性 梗死部位 神经运动功能 日常生活能力 

分 类 号：R743.3[医药卫生—神经病学与精神病学]