CAJ | 학술논문

目的：探讨脑分水岭梗死进展性神经功能恶化( PND)对早期预后的影响。方法回顾性连续纳入2009年3月-2014年3月于南京军区南京总医院神经内科住院,且经影像学检查证实为脑分水岭梗死患者。确定并分析内分水岭梗死、外分水岭梗死及混合分水岭梗死的临床特点、实验室指标及影像学特征。采用美国国立卫生研究院卒中量表( NIHSS)对神经功能缺损进行评分,采用改良Rankin量表( mRS)对患者预后进行评分。应用单因素分析比较组间差异,同时进行多因素Logistic回归分析PND与脑分水岭梗死90 d预后不良的相关性。结果共纳入89例脑分水岭梗死患者,其中外分水岭梗死患者43例,内分水岭梗死36例,混合分水岭梗死10例。单因素分析显示,内分水岭梗死及混合分水岭梗死PND发生率明显高于外分水岭梗死[分别为36.1%(13例)、50.0%(5例)、16.3%(7例)],组间差异有统计学意义(P=0.018)。28例(31.5%)患者90 d预后不良,90 d mRS 为(3.4±1.0)分。预后不良患者梗死类型与预后良好患者间差异有统计学意义(P<0.05),预后不良患者中,以内分水岭梗死患者较多,占50.0%(14例),而预后良好患者中,以外分水岭患者较多,占57.4%(35/61)。预后不良患者PND发生率明显高于预后良好患者[57.1%(16/28)比14.8%(9/61)],组间差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,经过校正混杂因素后,PND与脑分水岭梗死90 d预后不良独立相关( OR=6.969,95%CI：2.451~19.869；P<0.01)。结论相比于脑外分水岭梗死,梗死部位累及内分水岭的患者较易发生PND,且PND与90 d 预后不良独立相关。
목적：탐토뇌분수령경사진전성신경공능악화( PND)대조기예후적영향。방법회고성련속납입2009년3월-2014년3월우남경군구남경총의원신경내과주원,차경영상학검사증실위뇌분수령경사환자。학정병분석내분수령경사、외분수령경사급혼합분수령경사적림상특점、실험실지표급영상학특정。채용미국국립위생연구원졸중량표( NIHSS)대신경공능결손진행평분,채용개량Rankin량표( mRS)대환자예후진행평분。응용단인소분석비교조간차이,동시진행다인소Logistic회귀분석PND여뇌분수령경사90 d예후불량적상관성。결과공납입89례뇌분수령경사환자,기중외분수령경사환자43례,내분수령경사36례,혼합분수령경사10례。단인소분석현시,내분수령경사급혼합분수령경사PND발생솔명현고우외분수령경사[분별위36.1%(13례)、50.0%(5례)、16.3%(7례)],조간차이유통계학의의(P=0.018)。28례(31.5%)환자90 d예후불량,90 d mRS 위(3.4±1.0)분。예후불량환자경사류형여예후량호환자간차이유통계학의의(P<0.05),예후불량환자중,이내분수령경사환자교다,점50.0%(14례),이예후량호환자중,이외분수령환자교다,점57.4%(35/61)。예후불량환자PND발생솔명현고우예후량호환자[57.1%(16/28)비14.8%(9/61)],조간차이유통계학의의(P<0.05)。다인소Logistic회귀분석결과현시,경과교정혼잡인소후,PND여뇌분수령경사90 d예후불량독립상관( OR=6.969,95%CI：2.451~19.869；P<0.01)。결론상비우뇌외분수령경사,경사부위루급내분수령적환자교역발생PND,차PND여90 d 예후불량독립상관。
Objective To investigate the effect of progressive neurological deterioration ( PND) of cerebral watershed infarction on early prognosis. Methods The consecutive patients with cerebral watershed infarction admitted in the Department of Neurology,Jinling Hospital,Nanjing University School of Medicine and their cerebral watershed infarctions confirmed by the imaging examination from March 2009 to March 2014 were enrolled. The clinical features, laboratory indicators and imaging features of internal watershed infarction,cortical-type watershed infarction,and mixed watershed infarction were identified and analyzed. The National Institutes of Health Stroke Scale was used to score neurological deficit. The modified Rankin scale ( mRS) was used to score the prognosis of patients. Single factor analysis was used to compare the differences between the groups. At the same time,the correlation between PND and poor prognosis of cerebral watershed infarction at day 90 was analyzed by multivariable Logistic regression analysis. Results A total of 89 patients with cerebral watershed infarction were enrolled,including 43 cortical-type watershed infarctions,36 internal watershed infarctions, and 10 mixed watershed infarctions. Single factor analysis indicated that the incidences of PND of internal watershed infarction and mixed watershed infarction were significantly higher than the cortical-type watershed infarction (36. 1% [n=13],50. 0% [n=5], and 16. 3% [n=7],respectively;P=0. 018). At day 90,28 patients had poor prognosis,and mRS was (3.4±1. 0) scores at day 90. There was significant difference in the types of infarction between the patients with poor prognosis and patients with good prognosis (P<0. 05). In patients with poor prognosis, most of them were internal watershed infarctions,accounting for 50. 0% (14/28),while in patients with good prognosis,most of them were cortical-type watershed infarctions(57. 4% [35/61]). The incidence of PND in patients with poor prognosis was significantly higher than that in patients with good prognosis (57.1% [16/28] vs. 14. 8% [9/61];P<0. 05). The result of multivariate Logistic regression analysis showed that after adjustment for confounding factor, PND was independently associated with the poor prognosis of cerebral watershed infarction at day 90 (OR 6. 969,95%CI 2. 451-19. 869;P<0. 01). Conclusion Compared with the cortical-type watershed infarction, the patients with internal watershed infarction is more prone to have PND, and PND is independently correlate with the poor prognosis at day 90.