孤立性大脑前动脉供血区梗死:病因学、临床特征和转归  

Isolated anterior cerebral artery territory infarction:etiology,clinical features,and outcome

作　　者：王光胜 鲍俊杰 胡婷 田媛媛 黄利 Wang Guangsheng;Bao Junjie;Hu Ting;Tian Yuanyuan;Huang Li(Department of Neurology,the Affiliated Shuyang Hospital of Xuzhou Medical University,Shuyang 223600,China)

机构地区：[1]徐州医科大学附属沭阳医院神经内科,宿迁223600

出　　处：《国际脑血管病杂志》2024年第6期414-420,共7页International Journal of Cerebrovascular Diseases

基　　金：江苏省卫生健康委科研基金项目(Z2019032)。

摘　　要：目的探讨孤立性大脑前动脉(anterior cerebral artery,ACA)供血区梗死的病因、临床特征和转归。方法回顾性纳入2019年4月至2023年12月期间徐州医科大学附属沭阳医院收治的孤立性ACA供血区梗死患者。收集人口统计学和临床资料。卒中病因学亚型分为大动脉粥样硬化(large artery atherosclerosis,LAA)、心源性栓塞(cardioembolism,CE)、小血管闭塞(small vessel occlusion,SVO)、其他明确病因(stroke of other determined etiology,SOE)和病因未明确(stroke of undetermined etiology,SUE)。在发病后90 d时应用改良Rankin量表进行转归评价,0~2分定义为转归良好,>2分定义为转归不良。应用多变量logistic回归分析确定转归不良的独立危险因素。结果共纳入67例孤立性ACA供血区梗死患者,男性31例(46.27%),年龄(67.20±12.59)岁。LAA型26例(38.81%),CE型10例(14.93%),SVO型7例(10.45%),SOE型12例(17.91%),SUE型12例(17.91%)。52例(77.61%)转归良好,15例(22.39%)转归不良。不同病因学亚型在性别、糖尿病、心房颤动、抗凝血酶-Ⅲ活性、尿失禁、认知损害以及基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分方面差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,既往卒中史(优势比17.995,95%置信区间1.276~253.852;P=0.032)和高基线NIHSS评分(优势比2.094,95%置信区间1.333~3.292;P=0.001)是转归不良的独立危险因素。结论孤立性ACA供血区梗死最常见的病因为LAA,大多数患者转归良好,既往卒中史和高基线NIHSS评分是转归不良的独立危险因素。Objective To investigate the etiology,clinical features and outcome of isolated anterior cerebral artery(ACA)territory infarction.Methods Patients with isolated ACA territory infarction admitted to the Affiliated Shuyang Hospital of Xuzhou Medical University from April 2019 to December 2023 were retrospectively included.The demographic and clinical data were collected.The etiology subtypes of stroke were divided into large artery atherosclerosis(LAA),cardioembolism(CE),small vessel occlusion(SVO),stroke of other determined etiology(SOE),and stroke of undetermined etiology(SUE).At 90 days after onset,the modified Rankin Scale was used to evaluate the outcome.0~2 points were defined as good outcome,and>2 points were defined as poor outcome.Multivariate logistic regression analysis was used to identify independent risk factors for poor outcomes.Results A total of 67 patients with isolated ACA territory infarction were enrolled,including 31 males(46.27%),aged 67.20±12.59 years.There were 26 patients(38.81%)of LAA type,10(14.93%)of CE type,7(10.45%)of SVO type,12(17.91%)of SOE type,and 12(17.91%)of SUE type.Fifty-two patients(77.61%)had good outcome,while 15(22.39%)had poor outcome.There were significant differences in gender,diabetes,atrial fibrillation,antithrombin-Ⅲactivity,urinary incontinence,cognitive impairment,and the baseline National Institutes of Health Stroke Scale(NIHSS)score among different etiological subtypes(all P<0.05).Multivariate logistic regression analysis showed that previous stroke history(odds ratio 17.995,95%confidence interval 1.276-253.852;P=0.032)and high baseline NIHSS score(odds ratio 2.094,95%confidence interval 1.333-3.292;P=0.001)were the independent risk factors for poor outcome.Conclusions The most common etiology of isolated ACA territory infarction is LAA,and most patients have good outcome.Previous stroke history and high baseline NIHSS score are the independent risk factors for poor outcome.

关 键 词：缺血性卒中 大脑前动脉 梗死 大脑前动脉 磁共振成像 治疗结果 

分 类 号：R743.33[医药卫生—神经病学与精神病学]