CAJ | 학술논문

目的：探讨和归纳大动脉粥样硬化性(large artery atherosclerosis,LAA)和心源性(cardioembo-lism,CE)前循环脑梗死的临床特征及梗死灶分布特点。方法对发病1周内磁共振弥散加权成像(DWI)证实为急性前循环脑梗死,且 TOAST 分型为大动脉粥样硬化型(LAA 组)和心源性脑梗死(CE 组)的患者进行回顾性研究。对2组患者的人口学特征、危险因素及入院时的 NIHSS 评分进行对比,同时对2组患者的梗死灶在 DWI 上的分布特征进行总结和归纳。结果LAA 组患者的平均年龄较 CE 组小(P =0.001),且以男性居多(P =0.000)。LAA 组患者中伴有高血压病、糖尿病、高低密度脂蛋白血症等脑卒中危险因素者较 CE 组多(P 值均为0.000)。吸烟史2组间无明显的差异(P =0.275)。CE 组既往有脑卒中史的患者更多(P =0.016)。CE 组患者入院时 NIHSS 评分明显高于 LAA 组(P =0.000)。LAA 组单发病灶病例数明显多于 CE组(P =0.025),但 LAA 组和 CE 组组内均以多发性病灶更为常见(分别占各组总病例数的76.1%和88.9%)。CE 组多发病灶主要为穿支动脉梗死加皮层梗死(PAI+PI)和皮层梗死加皮层梗死(PI+PI)两种表现形式,其中 PAI+PI 要明显多于 LAA 组(P =0.000),CE 组无患者出现分水岭区(BZ)梗死,而 LAA 组多发病灶表现为多种不同的分布形式的组合。结论LAA 与 CE 所致的前循环脑梗死不论在临床特征及梗死灶的分布特点上均有明显的差别,这些差异有助于在急性脑梗死早期对两者进行初步鉴别,以指导临床决策。
목적：탐토화귀납대동맥죽양경화성(large artery atherosclerosis,LAA)화심원성(cardioembo-lism,CE)전순배뇌경사적림상특정급경사조분포특점。방법대발병1주내자공진미산가권성상(DWI)증실위급성전순배뇌경사,차 TOAST 분형위대동맥죽양경화형(LAA 조)화심원성뇌경사(CE 조)적환자진행회고성연구。대2조환자적인구학특정、위험인소급입원시적 NIHSS 평분진행대비,동시대2조환자적경사조재 DWI 상적분포특정진행총결화귀납。결과LAA 조환자적평균년령교 CE 조소(P =0.001),차이남성거다(P =0.000)。LAA 조환자중반유고혈압병、당뇨병、고저밀도지단백혈증등뇌졸중위험인소자교 CE 조다(P 치균위0.000)。흡연사2조간무명현적차이(P =0.275)。CE 조기왕유뇌졸중사적환자경다(P =0.016)。CE 조환자입원시 NIHSS 평분명현고우 LAA 조(P =0.000)。LAA 조단발병조병례수명현다우 CE조(P =0.025),단 LAA 조화 CE 조조내균이다발성병조경위상견(분별점각조총병례수적76.1%화88.9%)。CE 조다발병조주요위천지동맥경사가피층경사(PAI+PI)화피층경사가피층경사(PI+PI)량충표현형식,기중 PAI+PI 요명현다우 LAA 조(P =0.000),CE 조무환자출현분수령구(BZ)경사,이 LAA 조다발병조표현위다충불동적분포형식적조합。결론LAA 여 CE 소치적전순배뇌경사불론재림상특정급경사조적분포특점상균유명현적차별,저사차이유조우재급성뇌경사조기대량자진행초보감별,이지도림상결책。
Objective To analyses the clinical features and lesions patterns of infarctions in anterior cir-culation caused by large artery atherosclerosis(LAA)and cardioembolism (CE).Methods Retrospective study of patients with acute cerebral anterior circulation infarctions within one week.The infarctions were identified through diffusion weighted imaging (DWI).The patients were divided into two groups including LAA group and CE group depending on the etiology based on the TOAST.Then the clinical features including the risk fac-tors and the lesion patterns were compared.Results The patients in LAA group were younger than CE group (P =0.001),and were male dominated (P =0.000).More patients in the LAA group had the history of hy-pertension,diabetes mellitus and high level of low density lipoprotein compared to that in CE group (P =0.000).There was no difference of the history of smoking between the groups (P =0.275),however the pa-tients with the history of stroke in the CE group were more than that in the LAA group (P =0.016).The scores of NIHSS in CE group were higher than that in the LAA group (P =0.000).The multiple infarctions were more common in both LAA and CE groups (76.1 % and 88.9% respectively),and the single infarctions were more common in LAA group than that in the CE group (P =0.025).The two manifestations in the CE group were perforating artery infarct plus pial infarction (PAI+PI)and pial infarction plus pial infarction (PI+PI),while the lesion patterns in LAA group were various,and the PAI+PI in the CE group was more com-mon than that in the LAA group (P =0.000).Meanwhile,there was no border zone (BZ)infarction in CE group.Conclusions There were significant differences of the clinical features and the lesion patterns between the cerebral ischemia caused by LAA and CE.These differences may help us to differentiate the etiology be-tween LAA and CE,and guide our clinical strategy.