国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2013年
6期
435-439
,共5页
段作伟%孙文%黄志新%蔡乾坤%肖露露%陈响亮%曹立平%熊云云%徐格林
段作偉%孫文%黃誌新%蔡乾坤%肖露露%陳響亮%曹立平%熊雲雲%徐格林
단작위%손문%황지신%채건곤%초로로%진향량%조립평%웅운운%서격림
脑梗死%梗死,大脑中动脉%脑动脉疾病%动脉粥样硬化%脑白质疏松%磁共振成像%脑血管造影术%危险因素
腦梗死%梗死,大腦中動脈%腦動脈疾病%動脈粥樣硬化%腦白質疏鬆%磁共振成像%腦血管造影術%危險因素
뇌경사%경사,대뇌중동맥%뇌동맥질병%동맥죽양경화%뇌백질소송%자공진성상%뇌혈관조영술%위험인소
Cerebral Infarction%Infarction,Middle Cerebral Artery%Cerebral Arterial Diseases%Atherosclerosis%Leukoaraiosis%Magnetic Resonance Imaging%Cerebral Angiography%Risk Factors
目的 探讨大脑中动脉(middle cerebral artery,MCA)穿支供血区域内单发性皮质下小梗死(single small subcortical infarction,SSSI)的临床特征和可能机制.方法 连续前瞻性纳入急性SSSI患者,根据病灶部位与MCA的关系将SSSI的分布模式分为近端SSSI(proximal SSSI,pSSSI)和远端SSSI(distal SSSI,dSSSI).比较2组患者的人口统计学、症状、影像学检查结果和相关危险因素的差异.结果 共纳入209例SSSI患者,其中pSSSI组86例,dSSSI组123例.单因素分析显示,pSSSI组病灶直径显著性大于dSSSI组[(14.97±3.14)mm对(11.46± 3.42)mm; t=7.551,P=0.000],糖尿病(25.6％对13.8％；x2=4.612,P=0.032)、高脂血症(32.6％对20.3％；x2=4.001,P=0.045)、同侧MCA狭窄(46.5％对17.1％；x2=21.222,P=0.000)、其他颅内动脉狭窄(45.3％对20.3％；x2=14.918,P=0.000)以及颅外动脉狭窄(26.7％对11.4％;x2 =8.198,P=0.004)患者的构成比显著性高于dSSSI组,但高血压(69.8％对82.1％;x2=4.361,P=0.037)和白质疏松(24.4％对48.8％;x2=12.655,P=0.000)患者的构成比显著性低于dSSSI组.多变量logistic回归分析显示,病灶同侧MCA狭窄[优势比(odds ratio,0R)2.796,95％可信区间(confidence interval,CI)1.258 ～6.214;P=0.012]、其他颅内动脉狭窄(OR2.690,95％ CI 1.251 ～5.783;P =0.011)、白质疏松(OR0.442,95％ CI 0.212～0.922;P =0.030)以及病灶直径(OR 1.285,95％ CI1.155 ～ 1.429；P=0.000)与pSSSI独立相关.结论 依据病灶部位与MCA的关系进行分类的SSSI的临床特征不同,提示SSSI的分布模式可能反映其潜在的发病机制:穿支动脉供血近端区域的SSSI可能是大动脉病变所致,而远端区域的SSSI则更多是小动脉病变所致.
目的 探討大腦中動脈(middle cerebral artery,MCA)穿支供血區域內單髮性皮質下小梗死(single small subcortical infarction,SSSI)的臨床特徵和可能機製.方法 連續前瞻性納入急性SSSI患者,根據病竈部位與MCA的關繫將SSSI的分佈模式分為近耑SSSI(proximal SSSI,pSSSI)和遠耑SSSI(distal SSSI,dSSSI).比較2組患者的人口統計學、癥狀、影像學檢查結果和相關危險因素的差異.結果 共納入209例SSSI患者,其中pSSSI組86例,dSSSI組123例.單因素分析顯示,pSSSI組病竈直徑顯著性大于dSSSI組[(14.97±3.14)mm對(11.46± 3.42)mm; t=7.551,P=0.000],糖尿病(25.6％對13.8％；x2=4.612,P=0.032)、高脂血癥(32.6％對20.3％；x2=4.001,P=0.045)、同側MCA狹窄(46.5％對17.1％；x2=21.222,P=0.000)、其他顱內動脈狹窄(45.3％對20.3％；x2=14.918,P=0.000)以及顱外動脈狹窄(26.7％對11.4％;x2 =8.198,P=0.004)患者的構成比顯著性高于dSSSI組,但高血壓(69.8％對82.1％;x2=4.361,P=0.037)和白質疏鬆(24.4％對48.8％;x2=12.655,P=0.000)患者的構成比顯著性低于dSSSI組.多變量logistic迴歸分析顯示,病竈同側MCA狹窄[優勢比(odds ratio,0R)2.796,95％可信區間(confidence interval,CI)1.258 ～6.214;P=0.012]、其他顱內動脈狹窄(OR2.690,95％ CI 1.251 ～5.783;P =0.011)、白質疏鬆(OR0.442,95％ CI 0.212～0.922;P =0.030)以及病竈直徑(OR 1.285,95％ CI1.155 ～ 1.429；P=0.000)與pSSSI獨立相關.結論 依據病竈部位與MCA的關繫進行分類的SSSI的臨床特徵不同,提示SSSI的分佈模式可能反映其潛在的髮病機製:穿支動脈供血近耑區域的SSSI可能是大動脈病變所緻,而遠耑區域的SSSI則更多是小動脈病變所緻.
목적 탐토대뇌중동맥(middle cerebral artery,MCA)천지공혈구역내단발성피질하소경사(single small subcortical infarction,SSSI)적림상특정화가능궤제.방법 련속전첨성납입급성SSSI환자,근거병조부위여MCA적관계장SSSI적분포모식분위근단SSSI(proximal SSSI,pSSSI)화원단SSSI(distal SSSI,dSSSI).비교2조환자적인구통계학、증상、영상학검사결과화상관위험인소적차이.결과 공납입209례SSSI환자,기중pSSSI조86례,dSSSI조123례.단인소분석현시,pSSSI조병조직경현저성대우dSSSI조[(14.97±3.14)mm대(11.46± 3.42)mm; t=7.551,P=0.000],당뇨병(25.6％대13.8％；x2=4.612,P=0.032)、고지혈증(32.6％대20.3％；x2=4.001,P=0.045)、동측MCA협착(46.5％대17.1％；x2=21.222,P=0.000)、기타로내동맥협착(45.3％대20.3％；x2=14.918,P=0.000)이급로외동맥협착(26.7％대11.4％;x2 =8.198,P=0.004)환자적구성비현저성고우dSSSI조,단고혈압(69.8％대82.1％;x2=4.361,P=0.037)화백질소송(24.4％대48.8％;x2=12.655,P=0.000)환자적구성비현저성저우dSSSI조.다변량logistic회귀분석현시,병조동측MCA협착[우세비(odds ratio,0R)2.796,95％가신구간(confidence interval,CI)1.258 ～6.214;P=0.012]、기타로내동맥협착(OR2.690,95％ CI 1.251 ～5.783;P =0.011)、백질소송(OR0.442,95％ CI 0.212～0.922;P =0.030)이급병조직경(OR 1.285,95％ CI1.155 ～ 1.429；P=0.000)여pSSSI독립상관.결론 의거병조부위여MCA적관계진행분류적SSSI적림상특정불동,제시SSSI적분포모식가능반영기잠재적발병궤제:천지동맥공혈근단구역적SSSI가능시대동맥병변소치,이원단구역적SSSI칙경다시소동맥병변소치.
Objective To investigate the clinical characteristics and possible mechanisms of the single small subcortical infarction (SSSI) of middle cerebral artery (MCA) within the perforating area.Methods The patients with acute SSSI were enrolled consecutively and retrospectively.The distribution patterns of SSSI were divided into proximal SSSI (pSSSI) and distal SSSI (dSSSI) according to the relationship between the lesion sites and MCA.The differences of demographics,symptoms,imaging findings and related risk factor were compared in patients of both groups.Results A total of 209 patients with SSSI were enrolled.There were 86 patients in the pSSSI group and 123 in the dSSSI group.Univariate analysis showed that the lesion diameter in the pSSSI group was significantly greater than that in the dSSSI group (14.97±3.14 mmvs.11.46±3.42 mm; t=7.551,P=0.000),and the composition ratios in patients in diabetes mellitus (25.6％ vs.13.8％;x2 =4.612,P =0.032),hyperlipidemia (32.6％ vs.20.3％ ; x2 =4.001,P =0.045),ipsilateral MCA stenosis (46.5％ vs.17.l％,x2 =21.222,P＜0.001),other intracranial arterial stenosis (45.3％ vs.20.3％;x2=14.918,P＜0.001),and extracranial artery stenosis (26.7％ vs.11.4％;x2 =8.198,P=0.004) were significantly higher than those in the dSSSI group.However,the composition ratios in patients with hypertension (69.8％ vs.82.1％ ;x2 =4.361,P =0.037) and leukoaraiosis (24.4％ vs.48.8％ ;x2 =12.655,P ＜0.001)were significantly lower than those in the dSSSI group.Multivariate logistic regression analysis showed that ipsilateral MCA stenosis of the lesion (odds ratio [OR] 2.796,95％ confidence interval [CI] 1.258-6.214;P =0.012),other intracranial arterial stenosis (OR 2.690,95％ CI 1.251-5.783; P=0.011),leukoaraiosis (OR 0.442,95％ CI 0.212-0.922; P =0.030) and lesion diameter (OR 1.285,95％ CI 1.155-1.429; P ＜0.001) were independently associated with pSSSI.Conelusions The clinical characteristics of SSSI are different in classification based on the relationship between the lesion sites and MCA,SSSI of proximal perforating artery may be caused by the large artery disease,and SSSI of the remote areas are mostly caused by small artery disease.
