CAJ | 학술논문

目的探讨内分水岭梗死(internal border-zone infarction,IBZI)病损模式与动脉粥样硬化和转归的相关性.方法根据磁共振弥散加权成像(diffusion-weighted imaging,DWI)回顾性地将81例IBZI患者分为单纯性IBZI组以及合并其他模式梗死的混合性IBZI组,比较两组的临床特点.然后,进一步将混合性IBZI组分为IBZI+皮质梗死(pial infarct,PI)、IBZI+穿支动脉供血区梗死(perforating artery infarct,PAI)以及IBZI+ PI+ PAI等3个亚组,分别与单纯性IBZI组进行比较.结果单纯性IBZI组年龄、高血压等其他临床特征以及支架置入患者例数与混合性IBZI组无显著差异.混合性IBZI组颈内动脉(internal carotid artery,ICA)和(或)大脑中动脉(middle cerebral artery,MCA)严重狭窄-闭塞病变(P=0.009)以及MCA病变(P=0.032)比例显著较高.在MCA病变患者中,单纯性IBZI组重度狭窄显著多于混合性IBZI组(P=0.042),而混合性IBZI组闭塞病变显著多于单纯性IBZI组(P=0.022).混合性IBZI组短期(7d内)病情恶化(P=0.039)和90d时转归不良(改良Rankin 量表评分＞3分)(P=0.030)的比例均显著高于单纯性IBZI组.亚组分析表明,IBZI+ PI+ PAI组短期病情恶化(P=0.001)和90d时转归不良(P=0.010)的患者比例均显著高于单纯性IBZI组.结论 IBZI合并其他梗死模式的患者往往存在严重的脑血管狭窄-闭塞病变,且临床转归较差.对于存在MCA病变者,混合性IBZI更多发生MCA闭塞,而单纯性IBZI更多发生MCA重度狭窄.
목적 탐토내분수령경사(internal border-zone infarction,IBZI)병손모식여동맥죽양경화화전귀적상관성.방법 근거자공진미산가권성상(diffusion-weighted imaging,DWI)회고성지장81례IBZI환자분위단순성IBZI조이급합병기타모식경사적혼합성IBZI조,비교량조적림상특점.연후,진일보장혼합성IBZI조분위IBZI+피질경사(pial infarct,PI)、IBZI+천지동맥공혈구경사(perforating artery infarct,PAI)이급IBZI+ PI+ PAI등3개아조,분별여단순성IBZI조진행비교.결과 단순성IBZI조년령、고혈압등기타림상특정이급지가치입환자례수여혼합성IBZI조무현저차이.혼합성IBZI조경내동맥(internal carotid artery,ICA)화(혹)대뇌중동맥(middle cerebral artery,MCA)엄중협착-폐새병변(P=0.009)이급MCA병변(P=0.032)비례현저교고.재MCA병변환자중,단순성IBZI조중도협착현저다우혼합성IBZI조(P=0.042),이혼합성IBZI조폐새병변현저다우단순성IBZI조(P=0.022).혼합성IBZI조단기(7d내)병정악화(P=0.039)화90d시전귀불량(개량Rankin 량표평분＞3분)(P=0.030)적비례균현저고우단순성IBZI조.아조분석표명,IBZI+ PI+ PAI조단기병정악화(P=0.001)화90d시전귀불량(P=0.010)적환자비례균현저고우단순성IBZI조.결론 IBZI합병기타경사모식적환자왕왕존재엄중적뇌혈관협착-폐새병변,차림상전귀교차.대우존재MCA병변자,혼합성IBZI경다발생MCA폐새,이단순성IBZI경다발생MCA중도협착.
Objective To investigate the correlation of the lesion pattern of internal border zone infarction (IBZI) with atherosclerosis and outcome.Methods Eighty-one patients with IBZI were retrospectively divided into a simple IBZI group and a mixed IBZI group (combined with other infarct patterns) according to diffusion-weighted imaging (DWI).The clinical characteristics were compared between the 2 groups.And then,the mixed IBZI group was further divided into 3 subgroups:IBZI + pial infarct (PI),IBZI + perforating artery infarct (PAI),and IBZI + PI + PAI.They were compared with the simple IBZI group respectively.Results There were no significant differences in the dinical characteristics,such as age,hypertension,and the numbers of patients with stent implantation between the simple IBZI group and the mixed IBZI group.The proportions of severe stenosis and occlusion of internal carotid artery (ICA) and/or middle cerebral artery (MCA) (P =0.009) and MCA lesions (P =0.032) in the mixed IBZI group were significantly higher.Among the patients with MCA lesions,the severe stenosis in the simple IBZI group was significantly more than that in the mixed IBZI group (P =0.042),while the occlusive lesions in the mixed IBZI group were significantly more than those in the simple IBZI group (P =0.022).The short-term (within 7 days) exacerbation (P =0.039) and poor outcome at 90 days (modified Rankin Scale＞ 3) in the mixed IBZI group (P=0.030) were significantly higher than those in the simple IBZI group.The subgroup analysis showed that the proportions of the short-term exacerbation (P =0.001 ) and poor outcome in patients at 90 days (P =0.010) in the IBZI + PI +PAI subgroup were significantly higher than those in the simple IBZI group.Conclusions The IBZI patients combined with other infarct patterns often exist severe cerebrovascular stenosis and occlusion,and their clinical outcome was poorer.For patients with MCA lesions,the mixed IBZI occurred more in patients with MCA occlusion,and the simple IBZI occurred more in patients with severe MCA stenosis.