脑小血管病缺血事件爆发:一类特征鲜明的急性多发穿支动脉受累的脑梗死  

Outbreak of cerebral microvascular ischemic events:a well-characterized class of cerebral infarction with acute multiple branch artery involvement

作　　者：杨龙 王大同 沈达勇 辛宁 尚振英 耿德勤 程言博 Yang Long;Wang Datong;Shen Dayong(Department of Neurology,Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221002)

机构地区：[1]江苏省徐州医科大学附属医院神经内科,221002

出　　处：《卒中与神经疾病》2024年第4期365-369,共5页Stroke and Nervous Diseases

基　　金：国家卫健委脑防委“中国脑卒中高危人群干预适宜技术研究及推广项目”(GN20180009)。

摘　　要：目的探讨脑小血管病缺血事件爆发(Ischemic events eruption,IEE)现象,分析一组急性多发穿支动脉受累的脑梗死患者的临床、影像学及病因学特点。方法回顾性分析2019年9月1日-2021年8月31日徐州医科大学附属医院收治的缺血性脑血管病患者的临床资料,根据临床及影像学表现筛选符合穿支动脉型脑梗死患者,根据磁共振弥散加权成像显示的病灶数量和部位分为急性多发穿支动脉型和急性单发穿支动脉型,分析2组患者临床特征包括脑血管病的危险因素、血液流变学特征、入院时美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)、改良Rankin量表(Modified Rankin scale,mRS)评分以及发病90 d后脑卒中复发率,NIHSS、mRS评分和影像学特征包括脑白质病变严重程度、微出血灶载量之间的差异,比较2组患者病因和发病机理的差异。结果在174例急性穿支动脉型脑梗死患者中急性多发穿支动脉型脑梗死有39例(22.4%),急性单发穿支动脉型脑梗死有135例(77.6%);2组患者性别、吸烟史、超敏C反应蛋白和载脂蛋白A水平比较均有明显差异(P<0.05),2组其余脑血管病的危险因素和血液指标水平比较均无明显差异(P>0.05)。2组动脉粥样硬化斑块脱落致动脉-动脉栓塞和心源性栓塞都很罕见(P>0.05);急性多发穿支动脉型脑梗死患者较急性单发穿支动脉型脑梗死患者脑白质病变更严重、脑微出血灶数目更多,脑卒中复发率更高(P<0.05)。结论急性多发穿支动脉型脑梗死的发病机制本质上是小血管急性闭塞而非栓塞;相比急性单发穿支动脉型脑梗死患者,急性多发穿支动脉型脑梗死患者的病情更重,预后更差,复发率更高。Objective To investigate the outbreak of cerebral microvascular ischemic events and analyze the clinical,imaging,and etiological characteristics of a group of patients with acute multiple branch artery involvement in cerebral infarction.Methods Retrospectively analyze the clinical data of patients with ischemic cerebrovascular disease,who were admitted to the affiliated hospital of Xuzhou Medical University from September 1,2019 to August 31,2021.Patients with branch artery infarction were screened based on clinical manifestations and imaging results.According to the number and location of lesions shown by diffusion-weighted imaging,patients were divided into acute multiple branch artery infarction and acute single branch artery infarction.Clinical characteristics of the two groups,including cerebrovascular risk factors,hemorheology characteristics,National Institute of Health Stroke Scale and modified Rankin Scale scores at admission,and stroke recurrence rate after 90 days were analyzed to compare the differences in etiology and pathogenesis between the two groups.NIHSS,mRS scores,and imaging characteristics included severity of white matter lesions,the difference in the burden of microbleeds between the two groups.Results Among the 174 patients with ischemic cerebrovascular disease,39 cases(22.4%)had acute multiple branch artery infarction,and 135 cases(77.6%)had acute single branch artery infarction.There were no statistical differences in vascular risk factors and hemorheological characteristics between the two groups of patients,except for gender,smoking history,high-sensitivity C-reactive protein,and apolipoprotein A.Arterial arterial embolism and cardiogenic embolism caused by atherosclerotic plaque shedding were rare in both groups(P>0.05);Compared with acute single branch artery cerebral infarction,patients with acute multiple branch artery cerebral infarction had more severe white matter lesions,more microbleeds,and a higher recurrence rate of stroke(P<0.05).Conclusion Compared to acute single branch a

关 键 词：脑梗死 穿支动脉 缺血事件爆发 炎症反应 

分 类 号：R743.3[医药卫生—神经病学与精神病学]