国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2014年
3期
167-171
,共5页
翟明锋%曹树刚%徐文安%张继%吴倩%贺军%夏明武%赵昊%张文婷
翟明鋒%曹樹剛%徐文安%張繼%吳倩%賀軍%夏明武%趙昊%張文婷
적명봉%조수강%서문안%장계%오천%하군%하명무%조호%장문정
脑梗死%疾病恶化%运动活动%磁共振成像%危险因素
腦梗死%疾病噁化%運動活動%磁共振成像%危險因素
뇌경사%질병악화%운동활동%자공진성상%위험인소
Brain Infarction%Disease Progression%Motor Activity%Magnetic Resonance Imaging%Risk Factors
目的 探讨急性皮质下脑梗死后进展性运动功能缺损(progressive motor deficits,PMD)的预测因素和发生机制.方法 连续纳入发病24 h内的急性皮质下脑梗死患者,根据美国国立卫生研究院卒中量表运动项目评分变化分为PMD组(5d内增加≥2分)和非PMD组,比较两组间人口统计学、影像学资料和相关危险因素的差异,筛选PMD的早期预测因素.对PMD组和部分非PMD组患者进行弥散加权成像复查,从影像学角度分析PMD的发生机制.结果 共纳入117例发病24 h内的急性皮质下脑梗死患者,其中PMD组26例,非PMD组91例.单变量分析显示,PMD组既往卒中或短暂性脑缺血发作史的患者构成比显著性低于非PMD组(11.5％对31.9％;x2=4.206,P=0.040),糖基化血红蛋白(6.7％±2.0％对5.9％±1.7％;t=-2.206,P=0.029)和梗死层面数(3.7±1.4对3.0±1.6;t=-2.147,P=0.034)显著性高于非PMD组,放射冠部位梗死(73.1％对25.3％;x2 =20.081,P＜0.001)以及大脑中动脉(middle cerebral artery,MCA)狭窄或闭塞(76.9％对51.6％;x2 =5.279,P=0.022)的患者构成比显著性高于非PMD组.多变量logistic回归分析显示,放射冠梗死[优势比(odds ratio,OR)10.459,95％可信区间(confidence interval,CI)3.091 ～35.396;P ＜0.001]与MCA狭窄或闭塞(OR 4.036,95％ CI1.057～15.417;P=0.041)是急性皮质下脑梗死后PMD的独立预测因素.PMD组梗死灶扩大(50.0％对6.5％;x2=13.830,P＜0.001)和梗死复发(38.5％对3.2％;x2=11.273,P=0.001)的患者构成比显著性高于非PMD组,无任何改变(23.1％对90.3％;x2 =26.566,P＜0.001)的患者构成比显著性低于非PMD组.结论 放射冠部位梗死以及MCA狭窄或闭塞是急性皮质下脑梗死后PMD的重要独立预测因素,梗死灶扩大和梗死复发可能是PMD的主要发生机制.
目的 探討急性皮質下腦梗死後進展性運動功能缺損(progressive motor deficits,PMD)的預測因素和髮生機製.方法 連續納入髮病24 h內的急性皮質下腦梗死患者,根據美國國立衛生研究院卒中量錶運動項目評分變化分為PMD組(5d內增加≥2分)和非PMD組,比較兩組間人口統計學、影像學資料和相關危險因素的差異,篩選PMD的早期預測因素.對PMD組和部分非PMD組患者進行瀰散加權成像複查,從影像學角度分析PMD的髮生機製.結果 共納入117例髮病24 h內的急性皮質下腦梗死患者,其中PMD組26例,非PMD組91例.單變量分析顯示,PMD組既往卒中或短暫性腦缺血髮作史的患者構成比顯著性低于非PMD組(11.5％對31.9％;x2=4.206,P=0.040),糖基化血紅蛋白(6.7％±2.0％對5.9％±1.7％;t=-2.206,P=0.029)和梗死層麵數(3.7±1.4對3.0±1.6;t=-2.147,P=0.034)顯著性高于非PMD組,放射冠部位梗死(73.1％對25.3％;x2 =20.081,P＜0.001)以及大腦中動脈(middle cerebral artery,MCA)狹窄或閉塞(76.9％對51.6％;x2 =5.279,P=0.022)的患者構成比顯著性高于非PMD組.多變量logistic迴歸分析顯示,放射冠梗死[優勢比(odds ratio,OR)10.459,95％可信區間(confidence interval,CI)3.091 ～35.396;P ＜0.001]與MCA狹窄或閉塞(OR 4.036,95％ CI1.057～15.417;P=0.041)是急性皮質下腦梗死後PMD的獨立預測因素.PMD組梗死竈擴大(50.0％對6.5％;x2=13.830,P＜0.001)和梗死複髮(38.5％對3.2％;x2=11.273,P=0.001)的患者構成比顯著性高于非PMD組,無任何改變(23.1％對90.3％;x2 =26.566,P＜0.001)的患者構成比顯著性低于非PMD組.結論 放射冠部位梗死以及MCA狹窄或閉塞是急性皮質下腦梗死後PMD的重要獨立預測因素,梗死竈擴大和梗死複髮可能是PMD的主要髮生機製.
목적 탐토급성피질하뇌경사후진전성운동공능결손(progressive motor deficits,PMD)적예측인소화발생궤제.방법 련속납입발병24 h내적급성피질하뇌경사환자,근거미국국립위생연구원졸중량표운동항목평분변화분위PMD조(5d내증가≥2분)화비PMD조,비교량조간인구통계학、영상학자료화상관위험인소적차이,사선PMD적조기예측인소.대PMD조화부분비PMD조환자진행미산가권성상복사,종영상학각도분석PMD적발생궤제.결과 공납입117례발병24 h내적급성피질하뇌경사환자,기중PMD조26례,비PMD조91례.단변량분석현시,PMD조기왕졸중혹단잠성뇌결혈발작사적환자구성비현저성저우비PMD조(11.5％대31.9％;x2=4.206,P=0.040),당기화혈홍단백(6.7％±2.0％대5.9％±1.7％;t=-2.206,P=0.029)화경사층면수(3.7±1.4대3.0±1.6;t=-2.147,P=0.034)현저성고우비PMD조,방사관부위경사(73.1％대25.3％;x2 =20.081,P＜0.001)이급대뇌중동맥(middle cerebral artery,MCA)협착혹폐새(76.9％대51.6％;x2 =5.279,P=0.022)적환자구성비현저성고우비PMD조.다변량logistic회귀분석현시,방사관경사[우세비(odds ratio,OR)10.459,95％가신구간(confidence interval,CI)3.091 ～35.396;P ＜0.001]여MCA협착혹폐새(OR 4.036,95％ CI1.057～15.417;P=0.041)시급성피질하뇌경사후PMD적독립예측인소.PMD조경사조확대(50.0％대6.5％;x2=13.830,P＜0.001)화경사복발(38.5％대3.2％;x2=11.273,P=0.001)적환자구성비현저성고우비PMD조,무임하개변(23.1％대90.3％;x2 =26.566,P＜0.001)적환자구성비현저성저우비PMD조.결론 방사관부위경사이급MCA협착혹폐새시급성피질하뇌경사후PMD적중요독립예측인소,경사조확대화경사복발가능시PMD적주요발생궤제.
Objective To investigate the predictors and pathogenesis of progressive motor deficits (PMD) after acute subcortical cerebral infarction.Methods Consecutive patients with acute subcortical cerebral infarction admitted to hospital within 24 hours of after onset were enrolled.They were divided into either a PMD group (increase ≥ 2 points within 5 days) or a non-PMD group according to the changes of motor scores of the National Institutes of Health Stroke Scale.The differences of demographics,imaging data and related risk factors were compared between two groups in order to screen for the early predictors for PMD.The reexamination of diffusion-weighted imaging (DWI) was conducted for all patients in the PMD group and part of patients in the non-PMD group.The pathogenesis of PMD was analyzed from the radiological point of view.Results A total of 117 patients with acute subcortical cerebral infarction within 24 hours of after onset were enrolled,26 of them were in the PMD group,and 91 were in the non-PMD group.Univariate analysis showed that the proportions of the history of previous stroke or transient ischemic attack of the PMD group were significantly lower than those of the non-PMD group (11.5％ vs.31.9％;x2 =4.206,P =0.040); glycated hemoglobin (6.7％ ± 2.0％ vs.5.9％ ± 1.7％; t =-2.206,P =0.029)and infarction levels (3.7± 1.4vs.3.0± 1.6,t=-2.147,P=0.034) of the PMD group were significantly higher than those of the non-PMD group; the proportions of corona radiata infarct (73.1％ vs.25.3％ ; x2 =20.081,P ＜ 0.001) and middle cerebral artery (MCA) stenosis or occlusion (76.9％ vs.51.6％;x2 =5.279,P=0.022) of the PMD group were significantly higher than those of the non-PMD group.Multivariate logistic regression analysis showed that corona radiata infarct (odds ratio [OR] 10.459,95％ confidence interval [CI] 3.091-35.396; P ＜ 0.001) and MCA stenosis or occlusion (OR 4.036,95％ CI 1.057-15.417; P=0.041) were the independent predictors for PMD after acute subcortical cerebral infarction.The proportions of infarct expansion (50.0％ vs.6.5％;x2 =13.830,P ＜ 0.001) and recurrent infarction (38.5％ vs.3.2％ ; x2 =11.273,P =0.001) of the PMD group were significantly higher than those of the non-PMD group.However,the proportion of patients without any change (23.1％ vs.90.3％;x2 =26.566,P ＜ 0.001) was significantly lower than that of the non-PMD group.Conclusions Corona radiata infarct and MCA stenosis or occlusion are the important and independent predictors for PMD after acute subcortical cerebral infarction.Infarct expansion and recurrent infarction may be the main mechanism of PMD.
