脑白质高信号与大脑中动脉供血区单发皮质下小梗死发生早期神经功能恶化的关系  

The Relationship Between High White Matter Signal and Early Neurological Deterioration of Single Subcortical Small Infarction in the Middle Cerebral Artery Blood Supply Area

作　　者：丁意平 黄双娇 李达文[1] 盛世英[1] DING Yi-ping;HUANG Shuang-jiao;LI Da-wen;SHENG Shi-ying(Department of Neurology,Changzhou First People's Hospital,Changzhou 213000,Jiangsu,China)

机构地区：[1]常州市第一人民医院神经内科,江苏常州213000

出　　处：《医学信息》2022年第12期138-142,共5页Journal of Medical Information

基　　金：2021年常州市卫健委科技项目(编号:常卫规财〔2021〕334号)。

摘　　要：目的 探讨脑白质高信号(WMH)与大脑中动脉供血区单发皮质下小梗死(SSSI)早期神经功能恶化的关系。方法 回顾性分析2020年7月-2021年3月于常州市第一人民医院神经内科住院的大脑中动脉SSSI患者213例,根据是否发生早期神经功能恶化(END)分为END组(n=26)和非END组(n=187)。将WMH分为脑室周围WMH和深部脑白质WMH,用Fazekas量表对白质高信号进行分级。比较两组基线资料、临床、影像资料及WMH严重程度,Logistic回归分析WMH严重程度与大脑中动脉单发皮质下小梗死END的关系。结果 213例大脑中动脉SSSI患者大部分梗死灶位于基底节区,其中内囊、放射冠区、丘脑、半卵圆中心、和侧脑室后角分别占56.81%、15.49%、14.55%、10.80%、2.35%;其中26例患者(12.21%)发生END;单因素分析显示,两组年龄、既往脑梗死史、糖尿病史、高脂血症史、冠心病史、吸烟史、饮酒史、抗血小板聚集药物、他汀类药物服用史、入院NIHSS评分、基线舒张压、收缩压、WBC、LDL、TG、TC、UA、PLT、BUN、Scr、CRP、HCY、Hb、入院血糖及糖化血红蛋白比较,差异无统计学意义(P>0.05);而脑卒中后END组高血压病史的比例、WMH严重程度、侧脑室后角梗死比例均高于非END组(P<0.05);Logistic回归分析结果显示,侧脑室后角梗死是END的独立危险因素(OR=14.535,95%CI=2.007~105.271;P=0.008);以轻度WMH为参照,中度WMH(OR=11.228,95%CI=3.341~33.733;P=0.000)与重度WMH(OR=7.030,95%CI=2.244~22.021;P=0.001)均是END的独立危险因素。结论 中重度WMH及侧脑室后角梗死是大脑中动脉SSSI患者的早期神经功能恶化的独立危险因素。Objective To investigate the relationship between high white matter signal(WMH) and early neurological deterioration of single subcortical small infarction(SSSI) in the middle cerebral artery blood supply area.Methods A retrospective analysis of 213 patients with middle cerebral artery SSSI hospitalized in the Department of Neurology,Changzhou First People’s Hospital from July 2020 to March 2021 was performed.According to whether early neurological deterioration(END) occurred,the patients were divided into END group( n=26) and non-END group(n=187).WMH was divided into periventricular WMH and deep white matter WMH,and the white matter high signal was graded with Fazekas scale.The baseline data,clinical data,imaging data and severity of WMH were compared between the two groups.Logistic regression analysis was used to analyze the relationship between the severity of WMH and END in single subcortical small infarction of middle cerebral artery.Results Most of the infarcts were located in the basal ganglia in 213 patients with middle cerebral artery SSSI,and the internal capsule,corona radiata,thalamus,centrum semiovale and posterior horn of lateral ventricle accounted for 56.81%,15.49%,14.55%,10.80% and 2.35%,respectively.END occurred in 26 patients(12.21%);univariate analysis showed that there were no significant differences in age,previous history of cerebral infarction,history of diabetes,history of hyperlipidemia,history of coronary heart disease,history of smoking,history of drinking,history of antiplatelet aggregation drugs,history of statins,admission NIHSS score,baseline diastolic blood pressure,systolic blood pressure,WBC,LDL,TG,TC,UA,PLT,BUN,Scr,CRP,HCY,Hb,admission blood glucose and glycosylated hemoglobin between the two groups(P>0.05);while the proportion of hypertension history,the severity of WMH and the proportion of lateral ventricular posterior horn infarction in END group were higher than those in non-END group( P<0.05).Logistic regression analysis showed that the posterior horn infarction of late

关 键 词：脑白质高信号 单发皮质下小梗死 大脑中动脉 侧脑室后角 神经功能恶化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]