国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2013年
8期
606-611
,共6页
脑梗死%脑桥%动脉粥样硬化%基底动脉%磁共振成像%危险因素%预后
腦梗死%腦橋%動脈粥樣硬化%基底動脈%磁共振成像%危險因素%預後
뇌경사%뇌교%동맥죽양경화%기저동맥%자공진성상%위험인소%예후
Brain Infarctions%Pons%Atherosclerosis%Basilar Artery%Magnetic Resonance Imaging%Risk Factors%Prognosis
目的 探讨孤立性脑桥梗死的临床和影像学特征以及早期运动障碍进展(progessive motor deficits,PMD)和短期预后的影响因素.方法 对初次发病24 h内入院的86例孤立性脑桥梗死患者进行回顾性分析,根据梗死灶最大直径和部位分为脑桥旁正中梗死(paramedian pontine infarction,PPI)和脑桥腔隙性梗死(lacunar pontine infarction,LPI),根据早期PMD情况分为PMD组和无PMD组,根据出院时改良Rankin量表(modified Rankin Scale,mRS)评分分为转归不良组(mRS评分＞2分)和转归良好组(mRS评分≤2分),对不同病例组的临床和影像学特征进行比较.结果 PPI组(n=35)高脂血症(57.14％对33.33％;x2=4.80,P=0.028)、偏瘫(97.14％对72.55％;x2=8.718,P=0.003)、基底动脉狭窄(45.71％对17.65％;x2=7.930,P=0.005)和出院时转归不良(54.29％对31.37％;x2=4.515,P=0.034)患者构成比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[(6.00 ±2.39)分对(4.61 ±3.41)分；t=2.087,P=0.040]均显著性高于LPI组(n＝ 51).PMD组(n=22)基线舒张压水平[(97.82±15.61)mm Hg对(89.55±12.23)mm Hg,1 mm Hg=0.133 kPa;t =2.258,P=0.031]以及PPI(63.64％对32.81％;x2=6.445,P＝0.011)和基底动脉狭窄(59.10％对18.75％;x2=12.922,P=0.000)的构成比均显著性高于无PMD组(n＝64).转归不良组(n＝ 35)基线NIHSS评分[(6.80±2.63)分对(3.73 ±2.55)分；t＝5.426,P＝0.000]和空腹血糖水平[(9.40±5.15) mmol/L对(6.56 ±2.69) mmol/L;t =2.985,P=0.004]以及PPI患者构成比(54.29％对31.37％;x2 =4.515,P＝0.034)均显著性高于转归良好组(n=51).多变量logistic回归分析显示,基底动脉狭窄是PPI发病[优势比(odds ratio,OR)3.801,95％可信区间(confidence interval,CI)1.357～10.646;P=0.011]和孤立性脑桥梗死早期PMD(OR 4.571,95％ CI1.214～17.214;P=0.025)的独立危险因素,基线NIHSS评分≥5分是其短期转归不良的独立预测因素(OR4.277,95％ CI 1.505 ～ 12.151；P=0.006).结论 PPI主要与基底动脉分支病变有关,基线NIHSS评分≥5分可能是孤立性脑桥梗死短期转归不良的独立预测因素,其早期PMD和短期转归不良均可能与基底动脉病变有关.
目的 探討孤立性腦橋梗死的臨床和影像學特徵以及早期運動障礙進展(progessive motor deficits,PMD)和短期預後的影響因素.方法 對初次髮病24 h內入院的86例孤立性腦橋梗死患者進行迴顧性分析,根據梗死竈最大直徑和部位分為腦橋徬正中梗死(paramedian pontine infarction,PPI)和腦橋腔隙性梗死(lacunar pontine infarction,LPI),根據早期PMD情況分為PMD組和無PMD組,根據齣院時改良Rankin量錶(modified Rankin Scale,mRS)評分分為轉歸不良組(mRS評分＞2分)和轉歸良好組(mRS評分≤2分),對不同病例組的臨床和影像學特徵進行比較.結果 PPI組(n=35)高脂血癥(57.14％對33.33％;x2=4.80,P=0.028)、偏癱(97.14％對72.55％;x2=8.718,P=0.003)、基底動脈狹窄(45.71％對17.65％;x2=7.930,P=0.005)和齣院時轉歸不良(54.29％對31.37％;x2=4.515,P=0.034)患者構成比以及基線美國國立衛生研究院卒中量錶(National Institutes of Health Stroke Scale,NIHSS)評分[(6.00 ±2.39)分對(4.61 ±3.41)分；t=2.087,P=0.040]均顯著性高于LPI組(n＝ 51).PMD組(n=22)基線舒張壓水平[(97.82±15.61)mm Hg對(89.55±12.23)mm Hg,1 mm Hg=0.133 kPa;t =2.258,P=0.031]以及PPI(63.64％對32.81％;x2=6.445,P＝0.011)和基底動脈狹窄(59.10％對18.75％;x2=12.922,P=0.000)的構成比均顯著性高于無PMD組(n＝64).轉歸不良組(n＝ 35)基線NIHSS評分[(6.80±2.63)分對(3.73 ±2.55)分；t＝5.426,P＝0.000]和空腹血糖水平[(9.40±5.15) mmol/L對(6.56 ±2.69) mmol/L;t =2.985,P=0.004]以及PPI患者構成比(54.29％對31.37％;x2 =4.515,P＝0.034)均顯著性高于轉歸良好組(n=51).多變量logistic迴歸分析顯示,基底動脈狹窄是PPI髮病[優勢比(odds ratio,OR)3.801,95％可信區間(confidence interval,CI)1.357～10.646;P=0.011]和孤立性腦橋梗死早期PMD(OR 4.571,95％ CI1.214～17.214;P=0.025)的獨立危險因素,基線NIHSS評分≥5分是其短期轉歸不良的獨立預測因素(OR4.277,95％ CI 1.505 ～ 12.151；P=0.006).結論 PPI主要與基底動脈分支病變有關,基線NIHSS評分≥5分可能是孤立性腦橋梗死短期轉歸不良的獨立預測因素,其早期PMD和短期轉歸不良均可能與基底動脈病變有關.
목적 탐토고립성뇌교경사적림상화영상학특정이급조기운동장애진전(progessive motor deficits,PMD)화단기예후적영향인소.방법 대초차발병24 h내입원적86례고립성뇌교경사환자진행회고성분석,근거경사조최대직경화부위분위뇌교방정중경사(paramedian pontine infarction,PPI)화뇌교강극성경사(lacunar pontine infarction,LPI),근거조기PMD정황분위PMD조화무PMD조,근거출원시개량Rankin량표(modified Rankin Scale,mRS)평분분위전귀불량조(mRS평분＞2분)화전귀량호조(mRS평분≤2분),대불동병례조적림상화영상학특정진행비교.결과 PPI조(n=35)고지혈증(57.14％대33.33％;x2=4.80,P=0.028)、편탄(97.14％대72.55％;x2=8.718,P=0.003)、기저동맥협착(45.71％대17.65％;x2=7.930,P=0.005)화출원시전귀불량(54.29％대31.37％;x2=4.515,P=0.034)환자구성비이급기선미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale,NIHSS)평분[(6.00 ±2.39)분대(4.61 ±3.41)분；t=2.087,P=0.040]균현저성고우LPI조(n＝ 51).PMD조(n=22)기선서장압수평[(97.82±15.61)mm Hg대(89.55±12.23)mm Hg,1 mm Hg=0.133 kPa;t =2.258,P=0.031]이급PPI(63.64％대32.81％;x2=6.445,P＝0.011)화기저동맥협착(59.10％대18.75％;x2=12.922,P=0.000)적구성비균현저성고우무PMD조(n＝64).전귀불량조(n＝ 35)기선NIHSS평분[(6.80±2.63)분대(3.73 ±2.55)분；t＝5.426,P＝0.000]화공복혈당수평[(9.40±5.15) mmol/L대(6.56 ±2.69) mmol/L;t =2.985,P=0.004]이급PPI환자구성비(54.29％대31.37％;x2 =4.515,P＝0.034)균현저성고우전귀량호조(n=51).다변량logistic회귀분석현시,기저동맥협착시PPI발병[우세비(odds ratio,OR)3.801,95％가신구간(confidence interval,CI)1.357～10.646;P=0.011]화고립성뇌교경사조기PMD(OR 4.571,95％ CI1.214～17.214;P=0.025)적독립위험인소,기선NIHSS평분≥5분시기단기전귀불량적독립예측인소(OR4.277,95％ CI 1.505 ～ 12.151；P=0.006).결론 PPI주요여기저동맥분지병변유관,기선NIHSS평분≥5분가능시고립성뇌교경사단기전귀불량적독립예측인소,기조기PMD화단기전귀불량균가능여기저동맥병변유관.
Objective To investigate the clinical and imaging characteristics of isolated pontine infarction as well as the influencing factors for early progressive motor deficits (PMD) and short-term prognosis.Methods A total of 86 patients with isolated pontine infarction who admitted in hospital within 24 hours of symptom onset were analyzed retrospectively.The patients were divided into paramedian pontine infarction (PPI) and lacunar pontine infarction (LPI) according to the maximal diameter of the lesions and the locations of infarction.They were divided into either a PMD group or a non-PMD group according to the early status of PMD.They were also divided into a poor outcome group (mRS score ＞ 2) and a good outcome group (mRS score ≤ 2) according to the modified Rankin Scale (mRS) scores at discharge.The clinical and imaging features of the different patient groups were compared.Results The patients' constituent ratios of hyperlipidemia (57.14％ vs.33.33％;x2 =4.80,P=0.028),hemiplegia (97.14％ vs.72.55％;x2 =8.718,P=0.003),basilar artery stenosis (45.71％ vs.17.65％;x2=7.930,P=0.005) and poor outcome at discharge (54.29％ vs.31.37％ ; x2 =4.515,P =0.034),and the baseline National Institutes of Health Stroke Scale (NIHSS) scores (6.00 ± 2.39 vs.4.61 ± 3.41; t =2.087,P =0.040) in the PPI group (n =35) were significantly higher than those in the LPI group (n =51).The constituent ratios of the baseline diastolic blood pressure levels (97.82 ± 15.61 mm Hg vs.89.55 ± 12.23 mm Hg,1 mm Hg=0.133 kPa; t =2.258,P =0.031),PPI (63.64％ vs.32.81％ ;x2 =6.445,P =0.011) and basilar artery stenosis (59.10％ vs.18.75％ ;x2 =12.922,P =0.000) in the PMD group (n =22) were significantly higher than those in the non-PMD group (n =64).The baseline NIHSS scores (6.80 ± 2.63 vs.3.73 ± 2.55; t =5.426,P =0.000),fasting blood glucose levels (9.40 ±5.15 mmol/L vs.6.56 ±2.69 mmol/L; t =2.985,P=0.004) and the constituent ratios of PPI patients (54.29％ vs.31.37％ ;x2 =4.515,P =0.034) in the poor outcome group (n =35) were significantly higher than those in the good outcome group (n =51).Multivariate logistic regression analysis showed that basilar artery stenosis was an independent risk factor for the onset of PPI (odds ratio [OR] 3.801,95％ confidence interval [CI] 1.357-10.646; P =0.011) and the early PMD of isolated pontine infarction (OR 4.571,95％ CI 1.214-17.214; P=0.025).The baseline NIHSS score ≥ 5 was its independent predictor for poor outcome (OR 4.277,95％ OR 1.505-12.151; P =0.006).Conelusions PPI is mainly associated with the lesions in the branches of basilar artery.The baseline NIHSS score ≥ 5 may be an independent predictor for short-term poor outcome of isolated pontine infarction.Its early PMD and short-term poor outcome may be associated with the basilar artery lesions.
