国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2011年
8期
574-579
,共6页
张慧%马召玺%温仲民%赵合庆
張慧%馬召璽%溫仲民%趙閤慶
장혜%마소새%온중민%조합경
脑梗死%颈动脉狭窄%大脑中动脉%颅内动脉硬化%弥散磁共振成像%血管造影术,数字减影%磁共振血管造影术%颅内栓塞
腦梗死%頸動脈狹窄%大腦中動脈%顱內動脈硬化%瀰散磁共振成像%血管造影術,數字減影%磁共振血管造影術%顱內栓塞
뇌경사%경동맥협착%대뇌중동맥%로내동맥경화%미산자공진성상%혈관조영술,수자감영%자공진혈관조영술%로내전새
Cerebral infarction%Carotid stenosis%Middle cerebral artery%Intracranial arteriosclerosis%Diffusion magnetic resonance imaging%Angiography,digital subtraction%Magnetic resonance angiography%Intracranial embolism
目的 探讨颈内动脉（internal carotid artery，ICA）和大脑中动脉(middle cerebral artery，MCA)重度狭窄（狭窄程度70％ ～ 99％）或闭塞患者脑梗死模式和机制，为个体化防治提供依据。方法回顾性分析76例急性脑梗死患者的弥散加权成像（diffusion-weighted imaging,DWI）显示的相应MCA供血区责任病灶，根据血管检查将患者分为ICA病变组、MCA病变组以及数字减影血管造影或CT血管造影检查结果阴性组（negative results，NR）。将梗死灶分为单发和多发，前者按部位分为穿支动脉梗死（perforating artery infarct，PAI）、皮质支梗死（pial infarct，PI）和分水岭区梗死（border-zone infarct，BZ）。结果 MCA供血区梗死灶形态分为9种；不同病变导致的梗死灶形态存在差异(x2=34.000，P=0.001)。多发性梗死病灶分布模式占所有患者的73.68％( 56/76)。ICA组PAI+ PI梗死模式显著多于NR组（17/42对1/16,x2 =6.837，P=0.009）。动脉狭窄程度与梗死灶形态亦存在一定的关联，重度ICA病变更多呈现为PAI伴PI（7/17对1／16,x2=5.475，P=0.019），而重度MCA病变则多呈PAI伴BZ(3/8对1/17,x2 =4.046，P=0.040）。结论 ICA或MCA重度狭窄或闭塞的脑梗死患者大多呈现为多发梗死模式，提示卒中发病的不同机制，可能与动脉-动脉栓塞或低灌注有关。
目的 探討頸內動脈（internal carotid artery，ICA）和大腦中動脈(middle cerebral artery，MCA)重度狹窄（狹窄程度70％ ～ 99％）或閉塞患者腦梗死模式和機製，為箇體化防治提供依據。方法迴顧性分析76例急性腦梗死患者的瀰散加權成像（diffusion-weighted imaging,DWI）顯示的相應MCA供血區責任病竈，根據血管檢查將患者分為ICA病變組、MCA病變組以及數字減影血管造影或CT血管造影檢查結果陰性組（negative results，NR）。將梗死竈分為單髮和多髮，前者按部位分為穿支動脈梗死（perforating artery infarct，PAI）、皮質支梗死（pial infarct，PI）和分水嶺區梗死（border-zone infarct，BZ）。結果 MCA供血區梗死竈形態分為9種；不同病變導緻的梗死竈形態存在差異(x2=34.000，P=0.001)。多髮性梗死病竈分佈模式佔所有患者的73.68％( 56/76)。ICA組PAI+ PI梗死模式顯著多于NR組（17/42對1/16,x2 =6.837，P=0.009）。動脈狹窄程度與梗死竈形態亦存在一定的關聯，重度ICA病變更多呈現為PAI伴PI（7/17對1／16,x2=5.475，P=0.019），而重度MCA病變則多呈PAI伴BZ(3/8對1/17,x2 =4.046，P=0.040）。結論 ICA或MCA重度狹窄或閉塞的腦梗死患者大多呈現為多髮梗死模式，提示卒中髮病的不同機製，可能與動脈-動脈栓塞或低灌註有關。
목적 탐토경내동맥（internal carotid artery，ICA）화대뇌중동맥(middle cerebral artery，MCA)중도협착（협착정도70％ ～ 99％）혹폐새환자뇌경사모식화궤제，위개체화방치제공의거。방법회고성분석76례급성뇌경사환자적미산가권성상（diffusion-weighted imaging,DWI）현시적상응MCA공혈구책임병조，근거혈관검사장환자분위ICA병변조、MCA병변조이급수자감영혈관조영혹CT혈관조영검사결과음성조（negative results，NR）。장경사조분위단발화다발，전자안부위분위천지동맥경사（perforating artery infarct，PAI）、피질지경사（pial infarct，PI）화분수령구경사（border-zone infarct，BZ）。결과 MCA공혈구경사조형태분위9충；불동병변도치적경사조형태존재차이(x2=34.000，P=0.001)。다발성경사병조분포모식점소유환자적73.68％( 56/76)。ICA조PAI+ PI경사모식현저다우NR조（17/42대1/16,x2 =6.837，P=0.009）。동맥협착정도여경사조형태역존재일정적관련，중도ICA병변경다정현위PAI반PI（7/17대1／16,x2=5.475，P=0.019），이중도MCA병변칙다정PAI반BZ(3/8대1/17,x2 =4.046，P=0.040）。결론 ICA혹MCA중도협착혹폐새적뇌경사환자대다정현위다발경사모식，제시졸중발병적불동궤제，가능여동맥-동맥전새혹저관주유관。
Objective To investigate the cerebral infarction patterns and pathogenesis in patients with internal carotid artery (ICA) and middle cerebral artery (MCA) severe stenosis (the degree of stenosis 70％- 99％ ) or occlusion in order to provide evidence for the individualized prevention and treatment strategies. Methods Seventy-six patients with acute cerebral infarction who showed the responsible lesions at the corresponding MCA territory on diffusion-weighted imaging (DWI) were analyzed retrospectively. The patients were divided into ICA lesion, MCA lesion and negative result on digital subtraction angiography and CT angiogaphy (NR) groups according to the vascular examinations. Their infarcts were divided into single and multiple infarctions. According to the positions, the former was divided into perforating artery infarct (PAI), pial infarct (PI), and border-zone infarct (BZ). Results The infarct morphologies in the MCA territory were divided into 9 types. The different lesions caused infarct morphologies were different (x2 =34. 000, P =0. 001). The distribution pattern of multiinfarcts accounted for 73.68％ of all patients (56/76). The distribution pattern of PAI + PI in the ICA lesion group was significantly more than that in the NR goup (17/42 vs. 1/16,x2 =6. 837, P =0. 009). There were some correlations between the degree of artery stenosis and the infarct morphology. The severe ICA lesions mostly showed PAI with PI (7/17 vs. 1/16,x2 =5. 475, P =0. 019), and the severe MCA lesions mostly showed PAI with BZ (3/8 vs. 1/17,x2 =4. 046, P =0. 040). Conclusions In patients with cerebral infarction of ICA or MCA severe stenosis or occlusion, most of them showed multiinfarct pattern. This suggested that the different mechanisms of stroke onset might be associated with the arterial-arterial embolization or hypoperfusion.
