国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2011年
11期
806-810
,共5页
王栋%张新江%王苇%符长标
王棟%張新江%王葦%符長標
왕동%장신강%왕위%부장표
脑梗死%颅内栓塞和血栓形成%弥散磁共振成像
腦梗死%顱內栓塞和血栓形成%瀰散磁共振成像
뇌경사%로내전새화혈전형성%미산자공진성상
Brain infarction%Intracranial embolism and thrombosis%Diffusion magnetic resonance imaging
目的 探讨急性血栓形成性和栓塞性大脑中动脉闭塞的临床和影像学差异.方法 发病24 h内经弥散加权成像(diffusion-weighted imaging DWI)和磁共振血管造影(magnetic resonance angiography,MRA)证实为急性大脑中动脉主干闭塞的脑梗死患者,根据TOAST分型标准分为大动脉粥硬化血栓形成组(large artery atherosclerosis,LAA)和心源性栓塞组(cardioembolism,CE),在均未接受溶栓治疗的情况下,比较DWI所示病灶体积、形态特征以及人院时和14 d时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分的变化.结果 共纳入急性大脑中动脉主干闭塞的脑梗死患者102例,CE组年龄显著大于LAA组[(67.60±9.62)岁对(62.57±10.18)岁,P=0.017],而且有更多患者存在冠心病(27.27％对2.90％,P=0.001).LAA组病灶体积[ (31.96±39.20)ml对(65.66±84.74) ml,P=0.005]、人院时NIHSS评分[(6.42±3.38)分对(11.67±8.50)分,P=0.007)和病情改善程度(即入院时与14 d时NIHSS评分差值)[(1.55±6.43)分对(5.75±9.28)分,P=0.027)均显著小于CE组,但14 d时NIHSS评分两组无显著差异[(4.87±6.61)分对(5.97±3.60)分,P=0.324).梗死体积与14 d时NIHSS评分显著相关(CE组:r =0.625,P=0.001;LAA组:r=0.295,P=0.014).LAA组以多发性梗死为主(71.01％),而CE组以单发性梗死为主(54.55％) (P=0.016).结论 LAA组和CE组梗死病灶形态存在差异.CE导致的大脑中动脉主干闭塞在发病初期病情更重,梗死体积更大,但部分患者在发病后短时间内可自然显著改善.
目的 探討急性血栓形成性和栓塞性大腦中動脈閉塞的臨床和影像學差異.方法 髮病24 h內經瀰散加權成像(diffusion-weighted imaging DWI)和磁共振血管造影(magnetic resonance angiography,MRA)證實為急性大腦中動脈主榦閉塞的腦梗死患者,根據TOAST分型標準分為大動脈粥硬化血栓形成組(large artery atherosclerosis,LAA)和心源性栓塞組(cardioembolism,CE),在均未接受溶栓治療的情況下,比較DWI所示病竈體積、形態特徵以及人院時和14 d時美國國立衛生研究院卒中量錶(National Institutes of Health Stroke Scale,NIHSS)評分的變化.結果 共納入急性大腦中動脈主榦閉塞的腦梗死患者102例,CE組年齡顯著大于LAA組[(67.60±9.62)歲對(62.57±10.18)歲,P=0.017],而且有更多患者存在冠心病(27.27％對2.90％,P=0.001).LAA組病竈體積[ (31.96±39.20)ml對(65.66±84.74) ml,P=0.005]、人院時NIHSS評分[(6.42±3.38)分對(11.67±8.50)分,P=0.007)和病情改善程度(即入院時與14 d時NIHSS評分差值)[(1.55±6.43)分對(5.75±9.28)分,P=0.027)均顯著小于CE組,但14 d時NIHSS評分兩組無顯著差異[(4.87±6.61)分對(5.97±3.60)分,P=0.324).梗死體積與14 d時NIHSS評分顯著相關(CE組:r =0.625,P=0.001;LAA組:r=0.295,P=0.014).LAA組以多髮性梗死為主(71.01％),而CE組以單髮性梗死為主(54.55％) (P=0.016).結論 LAA組和CE組梗死病竈形態存在差異.CE導緻的大腦中動脈主榦閉塞在髮病初期病情更重,梗死體積更大,但部分患者在髮病後短時間內可自然顯著改善.
목적 탐토급성혈전형성성화전새성대뇌중동맥폐새적림상화영상학차이.방법 발병24 h내경미산가권성상(diffusion-weighted imaging DWI)화자공진혈관조영(magnetic resonance angiography,MRA)증실위급성대뇌중동맥주간폐새적뇌경사환자,근거TOAST분형표준분위대동맥죽경화혈전형성조(large artery atherosclerosis,LAA)화심원성전새조(cardioembolism,CE),재균미접수용전치료적정황하,비교DWI소시병조체적、형태특정이급인원시화14 d시미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale,NIHSS)평분적변화.결과 공납입급성대뇌중동맥주간폐새적뇌경사환자102례,CE조년령현저대우LAA조[(67.60±9.62)세대(62.57±10.18)세,P=0.017],이차유경다환자존재관심병(27.27％대2.90％,P=0.001).LAA조병조체적[ (31.96±39.20)ml대(65.66±84.74) ml,P=0.005]、인원시NIHSS평분[(6.42±3.38)분대(11.67±8.50)분,P=0.007)화병정개선정도(즉입원시여14 d시NIHSS평분차치)[(1.55±6.43)분대(5.75±9.28)분,P=0.027)균현저소우CE조,단14 d시NIHSS평분량조무현저차이[(4.87±6.61)분대(5.97±3.60)분,P=0.324).경사체적여14 d시NIHSS평분현저상관(CE조:r =0.625,P=0.001;LAA조:r=0.295,P=0.014).LAA조이다발성경사위주(71.01％),이CE조이단발성경사위주(54.55％) (P=0.016).결론 LAA조화CE조경사병조형태존재차이.CE도치적대뇌중동맥주간폐새재발병초기병정경중,경사체적경대,단부분환자재발병후단시간내가자연현저개선.
Objective To investigate the clinical and imaging differences in acute thrombotic and embolic middle cerebral artery occlusion.Methods The cerebral infarction patients with acute middle cerebral artery trtmk occlusion confirmed by diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) within 24 hours of onset were divided into large artery atherosclerosis (LAA) group and the cardioembolism (CE) group according to the TOAST classification criteria.Under the circumstances of not receiving thrombolytic therapy,the infarct volume on DWI,morphological characteristics and the changes of the National Institutes of Health Stroke Scale (NIHSS) scores both at admission and day 14 were compared.Results A total of 102 cerebral infarction patients with acute middle cerebral artery trunk occlusion were included.The age of the CE group was significantly older than that of the LAA group (67.60 ± 9.62 years vs.62.57 ± 10.18 years,P =0.017),and more patients with coronary heart disease (27.27％ vs.2.90％,P=0.001 ).The infarct volume (31.96 ±39.20 ml vs.65.66 ±84.74 ml,P =0.005),the NIHSS score at admission (6.42 ± 3.38 vs.11.67 ±8.50,P=0.007),and the improvement of the disease (i.e.the difference of NIHSS scores between admission and day 14) (1.55 ± 6.43 vs.5.75 ± 9.28,P =0.027) in LAA group were significantly lower than those in the CE group.However,there was no significant difference in the NIHSS score between the 2 groups at day 14 (4.87 ± 6.61 vs.5.97 ± 3.60,P =0.324).The infarct volume was significantly correlated with the NIHSS scores at day 14 (CE group:r=0.625,P=0.001; LAA group:r=0.295,P=0.014).The LAA group was mostly the multiple lesions (71.01％),and the CE group was mostly the single lesions (54.55％) (P =0.016).Conclusion There were differences in morphology of cerebral lesion between the LAA and CE groups.In the early stage after onset,CE caused middle cerebral artery trunk occlusion was more serious and had larger infarct volume,but some patients could naturally significantly improve within a short time after onset.
