急性双侧脑梗死临床特点及病因分型和预后  

Clinical Characteristics,Etiological Classification and Prognosis of Acute Bilateral Cerebral Infarction

作　　者：杨一萍 俞越 马海蓉[1] YANG Yi-ping;YU Yue;MA Hai-rong(Department of Neurology,Kunshan Traditional Chinese Medicine Hospital,Kunshan Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Traditional Chinese Medicine,Kunshan,Jiangsu,215300,China)

机构地区：[1]南京中医药大学附属昆山市中医医院神经内科,江苏昆山215300

出　　处：《中国血液流变学杂志》2021年第1期43-48,56,共7页Chinese Journal of Hemorheology

摘　　要：目的比较急性双侧脑梗死不同于单侧脑梗死的临床特点、病因分型及预后。方法将2年间确诊为急性脑梗死的患者分为单侧脑梗死组与双侧脑梗死组,回顾分析临床资料。结果749例急性脑梗死中双侧组70例(9.3%),单侧组679例(90.7%)。既往卒中史比例(30.0%vs 18.9%)和D-二聚体水平[(1.93±4.87)mg/L vs(0.67±1.70)mg/L]双侧组较单侧组高(P<0.05),性别、年龄、并发出血、高血压、糖尿病、心房颤动史、吸烟史、最严重时NIHSS评分、LDL-C、FBG、PLT、FIB、HCY等组间差异无统计学意义(P>0.05)。双侧组病因分型依次为大动脉粥样硬化型(LAA)29例(41.4%),不明原因型(SUE)22例(31.4%),心源性栓塞型(CE)12例(17.1%),其他原因型(SOE)4例(5.7%),小动脉闭塞型(SAO)3例(4.3%),单侧组病因分型依次为LAA 324例(47.7%),SAO 259例(38.1%),CE 62例(9.1%),SUE 24例(3.5%),SOE 10例(1.5%),双侧组CE、SOE、SUE占比高于单侧组(P<0.05),单侧组SAO占比高于双侧组(P<0.001),LAA占比组间差异无统计学意义(P>0.05)。双侧组按累及病灶分为后循环组23例(32.9%)、前循环组26例(37.1%)、前后循环组21例(30.0%),后循环组LAA型占78.3%,高于前循环组(38.5%)和前后循环组(4.8%)(χ^(2)=7.8、24.2,P<0.01);前后循环组SUE型占比为66.7%,高于后循环组(8.7%)和前循环组(23.1%)(χ^(2)=9.0、15.9,P<0.01)。双侧脑梗死发病机制依次为机制不明(31.4%),动脉-动脉栓塞(30.0%),心源性栓塞(17.1%),血栓形成(12.9%),低灌注/栓子清除障碍(4.3%),其他(4.3%)。双侧组与单侧组最严重时mRS评分0~2分和≥3分的占比差异均无统计学意义(P>0.05),发病3个月mRS评分≥3分双侧组占比高于单侧组(24.3%vs 15.0%,χ^(2)=4.075,P=0.044)。结论急性脑梗死中双侧脑梗死约占9.3%,既往卒中史和D-二聚体水平高易致双侧脑梗死,我国现有诊断条件下LAA、SUE、CE是主要病因,双侧后循环以LAA型多见,前后循环均有病灶的患者病因较难确定,双侧脑梗死预后�Objective To compare the clinical characteristics,etiology classification and prognosis of acute bilateral cerebral infarction different from unilateral cerebral infarction.Methods Patients diagnosed with acute cerebral infarction in the past 2 years were divided into unilateral cerebral infarction group and bilateral cerebral infarction group,and the clinical data were retrospectively analyzed.Results Among the 749 cases of acute cerebral infarction,70 cases(9.3%)were in the bilateral group and 679 cases(90.7%)were in the unilateral group.Proportion of previous stroke history(30.0%vs 18.9%)and D-dimer level[(1.93±4.87)mg/L vs(0.67±1.70)mg/L]in the bilateral group was higher than the unilateral group(P<0.05),gender,age,hypertension,diabetes,fibrillation,smoking history,NIHSS score,LDL-C,FBG,PLT,FIB,HCY,etc.had no statistical significance(P>0.05).The etiology classification of the bilateral group was as follows:LAA 29 cases(41.4%),SUE 22 cases(31.4%),CE 12 cases(17.1%),SOE 4 cases(5.7%),SAO 3 cases(4.3%),the etiology classification of the unilateral group was LAA 324 cases(47.7%),SAO 259 cases(38.1%),CE 62 cases(9.1%),SUE 24 cases(3.5%),SOE 10 cases(1.5%).The proportion of CE,SOE and SUE in the bilateral group was higher than that in the unilateral group(P<0.05),the proportion of SAO in the unilateral group was higher than that in the bilateral group(P<0.001),LAA in groups was not statistically significant(P>0.05).The bilateral cerebral infarction was subdivided into the posterior circulation group with 23 cases(32.9%),the anterior circulation group with 26 cases(37.1%),the anterior and posterior circulation group with 21 cases(30.0%),the accounted for LAA type 78.3%in the posterior circulation group,which was higher than the anterior circulation group(38.5%)and the anterior and posterior circulation group(4.8%)(χ^(2)=7.8,24.2,P<0.01),the anterior and posterior circulation group SUE type 66.7%which was higher than that of the posterior circulation group(8.7%)and the anterior circulation group(23.1%)(χ^(2)=9.0,

关 键 词：急性脑梗死 临床特点 病因分型 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]