大脑微梗死与颈动脉狭窄的相关性及对预后的影响  

Correlation Analysis of Cerebral Micro-Infarction with Carotid Artery Stenosis and Its Impact on Prognosis in Patients with Acute Mild Ischemic

作　　者：周肖东 王志飞 史耕郡[1] 宫肇玉 周舰[4] 高婧 姜娟[6] 李顺兰[2] 邓玮 高强 ZHOU Xiaodong;WANG Zhifei;SHI Gengjun;GONG Zhaoyu;ZHOU Jian;GAO Jing;JIANG Juan;LI Shunlan;DENG Wei;GAO Qiang(Department of Neurosurgery,Jilin People's Hospital;Department of Neurology,Jilin People's Hospital;Department of Hematology,Jilin Peoples Hospital;Department of Functional Medicine,Jilin People's Hospital;Medical Imaging Center,Jilin People's Hospital;Emergency Department,Jilin People's Hospital)

机构地区：[1]吉林市人民医院神经外科,吉林132000 [2]吉林市人民医院神经内科 [3]吉林市人民医院血液科 [4]吉林市人民医院功能科 [5]吉林市人民医院影像中心 [6]吉林市人民医院急诊科

出　　处：《中国医学计算机成像杂志》2024年第4期410-415,共6页Chinese Computed Medical Imaging

基　　金：吉林省卫生科技能力提升项目(2022LC144);吉林市科技创新发展计划项目(20230406157)。

摘　　要：目的:探讨急性轻型前循环缺血性脑卒中患者颈动脉狭窄(CS)与3.0 T磁共振成像显示的大脑微梗死(CMI)相关性。方法:连续纳入发病7 d内美国国立卫生研究院卒中量表评分≤3分的急性轻型前循环缺血性脑卒中住院患者,以有无CMI病变分为无CMI组和CMI组,比较2组间基线资料、影像特点、神经功能及预后。结果:无CMI组与CMI组在糖尿病、心房颤动发生率方面有显著性差异(均P<0.05)。2组在CS程度上有差异(χ^(2)=13.744,P=0.003);Spearman相关分析显示CMI组CMI数量与CS程度呈正相关(r=0.520,P<0.001)。多因素logistic回归结果显示糖尿病、心房颤动、卒中病史、腔隙存在、颈动脉重度狭窄或闭塞均与CMI病变独立相关(均P<0.05)。CMI病变组90 d不良预后比例显著高于无CMI病变组(13.64%比28.30%,χ^(2)=11.844,P=0.019)。结论:糖尿病、心房颤动、卒中病史、腔隙存在以及颈动脉重度狭窄或闭塞是CMI病变的独立危险因素,CMI病变与90 d不良预后有关。Purpose:To explore the correlation between carotid artery stenosis(CS)and cerebral micro-infarction(CMI)on 3.0 T magnetic resonance imaging in patients with acute mild ischemic stroke of the anterior circulation.Methods:The subjects of the study were inpatients with acute mild ischemic stroke of the anterior circulation with a stroke score of<3 points on the National Institutes of Health Stroke Scale within 7 consecutive days of onset.The enrolled patients were divided into the non-CMI group and CMI group based on the presence of CMI or not.Further comparative analysis was made on baseline data,imaging characteristics,neurological function,and prognosis between the two groups.Results:There were significant differences in incidences of diabetes and atrial fibrillation between the non-CMI group and the CMI group(all P<0.05).A difference in the degree of CS was found between the two groups(χ^(2)=13.744,P=0.003).Spearman's correlation analysis showed a positive correlation between the number of CMI and the degree of CS in the CMI group(r=0.520,P<0.001).According to the results of multivariate logistic regression analysis,diabetes,atrial fibrillation,stroke history,the presence of lacunae,and severe CS or occlusion were all independently associated with CMI(all P<0.05).In addition,the proportion of poor 90-day prognosis in the CMI group was significantly higher than that in the non-CMI group(13.64%vs 28.30%,χ^(2)=11.844,P=0.019).Conclusion:This study suggests that diabetes,atrial fibrillation,stroke history,the presence of lacunae,and severe CS or occlusion are independent risk factors for CMI,and CMI is associated with a poor 90-day prognosis.

关 键 词：颈动脉狭窄 大脑微梗死 急性缺血性卒中 脑小血管病 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742[医药卫生—诊断学]