CAJ | 학술논문

目的探索大脑中动脉(MCA)供血区的梗死灶形态与脑卒中可能发病机制之间的关系.方法回顾性分析了148例连续的急性缺血性脑卒中患者,所有患者均为颈内动脉(ICA)系统脑梗死,DWI显示相应MCA供血区责任病灶,根据血管及心脏检查将患者分为ICA病变组、MCA病变组、ICA+MCA病变组、心源性栓塞组(CE组)及检查结果阴性组(NR组).将梗死灶形态分为单发和多发,前者按部位分为:穿动脉梗死灶(PAI)、皮质支梗死灶(PI)、分水岭梗死灶(BZ)、大面积梗死灶.结果 MCA供血区的梗死灶形态可分为12种;不同病变所致脑卒中的梗死灶形态存在差异(χ2=55.88,P=0.004).但在MCA组、ICA组、MCA+ICA组及CE组中,未发现各自特异的梗死灶形态,仅PAI更多见于MCA组;与NR组相比,ICA组患者中更多出现PAI伴PI(7/27,χ2=6.61,P<0.05),而MCA组和CE组均未见特征性的梗死灶形态.动脉狭窄的程度与梗死灶形态亦存在一定关联,重度ICA病变更多地表现为PAl伴PI(5/16,χ2=7.32,P<0.05);而重度MCA病变则好发PAI伴BZ(4/30,χ2=5.59,P<0.05)及PAI伴PI和BZ(6/30,χ2=6.41,P<0.05).结论 MCA供血区内的梗死灶形态与其颅内动脉病变之间存在一定的关系,揭示脑卒中发生的不同机制,可能与动脉-动脉栓塞、灌注不良有关;我们以检查结果阴性患者为对照比较,尚不能完全揭示MCA供血区内的梗死灶形态和与脑卒中的不同机制之间的相关性.
목적 탐색대뇌중동맥(MCA)공혈구적경사조형태여뇌졸중가능발병궤제지간적관계.방법 회고성분석료148례련속적급성결혈성뇌졸중환자,소유환자균위경내동맥(ICA)계통뇌경사,DWI현시상응MCA공혈구책임병조,근거혈관급심장검사장환자분위ICA병변조、MCA병변조、ICA+MCA병변조、심원성전새조(CE조)급검사결과음성조(NR조).장경사조형태분위단발화다발,전자안부위분위:천동맥경사조(PAI)、피질지경사조(PI)、분수령경사조(BZ)、대면적경사조.결과 MCA공혈구적경사조형태가분위12충;불동병변소치뇌졸중적경사조형태존재차이(χ2=55.88,P=0.004).단재MCA조、ICA조、MCA+ICA조급CE조중,미발현각자특이적경사조형태,부PAI경다견우MCA조;여NR조상비,ICA조환자중경다출현PAI반PI(7/27,χ2=6.61,P<0.05),이MCA조화CE조균미견특정성적경사조형태.동맥협착적정도여경사조형태역존재일정관련,중도ICA병변경다지표현위PAl반PI(5/16,χ2=7.32,P<0.05);이중도MCA병변칙호발PAI반BZ(4/30,χ2=5.59,P<0.05)급PAI반PI화BZ(6/30,χ2=6.41,P<0.05).결론 MCA공혈구내적경사조형태여기로내동맥병변지간존재일정적관계,게시뇌졸중발생적불동궤제,가능여동맥-동맥전새、관주불량유관;아문이검사결과음성환자위대조비교,상불능완전게시MCA공혈구내적경사조형태화여뇌졸중적불동궤제지간적상관성.
Objective To identify lesion patterns and stroke mechanisms in middle cerebral artery (MCA) territory using early diffusion-weighted imaging (DWI) combined with CTA as well as EKG and echocardiography.Methods One hundred and forty-eight acute ischemic stroke patients who had (1) symptomatic lesions located in the unilateral MCA territory on DWI performed within 1 week of symptom onset,and (2) either corresponding MCA disease,internal carotid artery (ICA) disease,MCA & ICA disease or cardio embolism (CE),or (3) neither corresponding MCA disease,ICA disease,nor CE which were taken as group of negative results (NR),were reviewed.Acute DWI lesion patterns were classified as (1) single (small perforator < 2 cm;large perforator ≥2 cm;pial;large territorial;border-zone) and (2) multiple according to principle of single-blind.Results There were 12 types of lesions in MCA territory.Distribution of lesion patterns in different stroke subtypes might be different (χ2= 55.88,P = 0.004).No specific pattern could be found in patients with MCA disease,ICA disease,MCA & ICA disease or CE.Big perforator infarcts might be more common in patients with MCA disease than with ICA disease and CE.Compared with negative group,concomitant perforator and pial infarcts were more common in patients with ICA disease (7/27,χ2=6.61,P <0.05),especially with severe stenosis or occlusion (5/16,χ2=7.32,P < 0.05);No specific pattern could be found in patients with MCA disease or CE.Concomitant perforator,pial,with border-zone infarcts (6/30,χ2= 6.41,P <0.05),and concomitant perforator with border-zone infarcts (4/30,χ2= 5.59,P < 0.05) were more often in patients with severe stenosis or occlusion of MCA.Conclusion Different lesion patterns may indicate different mechanisms of stroke such as hypoperfusion and arterial embolism could be coexistent in MCA territory.The relationship has not been identified perfectly.