CAJ | 학술논문

目的探讨中等直径基底节区急性单灶脑梗死患者早期运动障碍加重的危险因素及与大脑中动脉主干病变的关系.方法选择发病24 h内的局限于基底节区的急性单灶脑梗死患者150例,根据弥散加权成像(DWI)上梗死灶最大直径分为中等大小梗死组(梗死灶直径1.5～3.0 cm)和腔隙梗死组(梗死灶直径＜1.5cm),每组75例.通过发病7d内动态的美国国立卫生研究院卒中量表评分、多元Logistic回归分析,研究早期运动障碍加重的危险因素.结果中等大小梗死组早期运动障碍加重的发生率为32.0％(24/75),高于腔隙梗死组的8.0％ (6/75),差异有统计学意义(P＜0.05)；多元Logistic回归分析显示入院时升高的收缩压是早期运动障碍加重发生的独立危险因素(P=0.016).中等大小梗死组中同侧大脑中动脉主干病变的发生率为41.3％(31/75),高于腔隙梗死组的9.3％(7/75),差异有统计学意义(P＜0.01).结论直径1.5～3.0cm的基底节区急性单灶脑梗死患者较直径＜1.5cm相同部位腔隙性脑梗死患者更易发生早期运动障碍加重,且可能与入院时升高的收缩压有关.这种中等直径的梗死灶可能与同侧大脑中动脉主干病变有关.
목적 탐토중등직경기저절구급성단조뇌경사환자조기운동장애가중적위험인소급여대뇌중동맥주간병변적관계.방법 선택발병24 h내적국한우기저절구적급성단조뇌경사환자150례,근거미산가권성상(DWI)상경사조최대직경분위중등대소경사조(경사조직경1.5～3.0 cm)화강극경사조(경사조직경＜1.5cm),매조75례.통과발병7d내동태적미국국립위생연구원졸중량표평분、다원Logistic회귀분석,연구조기운동장애가중적위험인소.결과 중등대소경사조조기운동장애가중적발생솔위32.0％(24/75),고우강극경사조적8.0％ (6/75),차이유통계학의의(P＜0.05)；다원Logistic회귀분석현시입원시승고적수축압시조기운동장애가중발생적독립위험인소(P=0.016).중등대소경사조중동측대뇌중동맥주간병변적발생솔위41.3％(31/75),고우강극경사조적9.3％(7/75),차이유통계학의의(P＜0.01).결론 직경1.5～3.0cm적기저절구급성단조뇌경사환자교직경＜1.5cm상동부위강극성뇌경사환자경역발생조기운동장애가중,차가능여입원시승고적수축압유관.저충중등직경적경사조가능여동측대뇌중동맥주간병변유관.
Objeetive To explore the correlative factors of early progressive motor deficits in cerebral infarction of moderately size in basal ganglia and the relationship between motor deficit progression and the stem lesion of middle cerebral artery.Methods One hundred and fifty patients with single acute infarction located in white matter of basal ganglia region were recruited in this study retrospectively.All patients were performed brain and neck MRI and magnetic resonance angiography (MRA) within 72 h after onset.They were divided into two groups based on the maximal diameter of infarction on diffuse weighing imaging(DWI):moderate size infarction group(75 patients,maximal diameter of infarction from 1.5 cm to 3.0 cm) and lacunar infarction group(75 patients,maximal diameter of infarction lower than 1.5 cm).The scores of dynamic National Institutes of Health Stroke Scale(NIHSS) in 7 d after the admission and multiple Logistic regression analysis were used and the risk factors of the early progressive motor deficits were analyzed.Results The rate of early progressive motor deficits in moderate size infarction group was significant higher than that in lacunar infarction group [32.0 ％ (24/75) vs.8.0 ％ (6f75)] (P ＜ 0.05).The multiple Logistic regression analysis showed that elevated systolic blood pressure on admission was the independent risk factor for early progressive motor deficits (P =0.016).The rate of stem lesion of middle cerebral artery in moderate size infarction group was significantly higher than that in lacunar infarction group [41.3 ％ (31/75) vs.9.3 ％ (7/75)] (P ＜ 0.01).Conclusions Patients with acute single infarction located in white matter of basal ganglia and with the diameter of 1.5-3.0 cm are more prone to early progressive motor deficits and elevated systolic blood pressure on admission is the most significantly independent factor.The pathogenic mechanism may be associated with the stem lesion of middle cerebral artery.