中国血液流变学杂志
中國血液流變學雜誌
중국혈액류변학잡지
CHINESE JOURNAL OF HEMORHEOLOGY
2014年
4期
493-498
,共6页
脑分水岭脑梗死%MRI%颈动脉彩超%病因%发病机制
腦分水嶺腦梗死%MRI%頸動脈綵超%病因%髮病機製
뇌분수령뇌경사%MRI%경동맥채초%병인%발병궤제
cerebral watershed infarction%MRI%carotid ultrasonography%etiology%pathogenesis
目的：目前不同类型脑分水岭梗死（CWI）的病因及发病机制仍然存在争论，该研究通过对CWI的病因及可能的发病机制进行探讨，旨在为CWI的病因治疗提供临床依据。方法根据颅脑CT或MRI确诊73例CWI患者并进行分型。对其进行详细的观察与记录，内容包括：病史、体征、既往史、影像学（头CT、MRI）及临床特征、血液检验、颈动脉彩超、脑彩超、头颈部血管CTA或MRA检查，综合分析CWI的病因与发病机制。结果颅内动脉重度狭窄或闭塞的发生率皮质下型CWI组（15/45，33.33%）高于皮质型CWI组（3/28，10.71%），差异有统计学意义。皮质型CWI组（25/28，89.28%）与皮质下型CWI组（32/45，71.11%）的动脉粥样硬化斑块的发生率差异无统计学意义。皮质型CWI组（25/28，89.28%）动脉粥样硬化斑块的发生率高于典型“串珠样”皮质下CWI组（20/32，62.50%），差异有统计学意义。结论不同类型CWI的病因及发病机制仍然存在争论。皮质下型CWI可能和血流动力学异常关系更密切，但其中占据一定比例的皮质下前/后型CWI病例和微栓塞的关系可能更大。因此，对于皮质型CWI及整个皮质下型CWI来说微栓塞的出现并无明显差别，但相对典型“串珠样”皮质下型CWI，微栓塞机制对皮质型CWI的影响可能更大。不同类型CWI的病因是多元化的，是多种因素综合作用、随机组合的结果。
目的：目前不同類型腦分水嶺梗死（CWI）的病因及髮病機製仍然存在爭論，該研究通過對CWI的病因及可能的髮病機製進行探討，旨在為CWI的病因治療提供臨床依據。方法根據顱腦CT或MRI確診73例CWI患者併進行分型。對其進行詳細的觀察與記錄，內容包括：病史、體徵、既往史、影像學（頭CT、MRI）及臨床特徵、血液檢驗、頸動脈綵超、腦綵超、頭頸部血管CTA或MRA檢查，綜閤分析CWI的病因與髮病機製。結果顱內動脈重度狹窄或閉塞的髮生率皮質下型CWI組（15/45，33.33%）高于皮質型CWI組（3/28，10.71%），差異有統計學意義。皮質型CWI組（25/28，89.28%）與皮質下型CWI組（32/45，71.11%）的動脈粥樣硬化斑塊的髮生率差異無統計學意義。皮質型CWI組（25/28，89.28%）動脈粥樣硬化斑塊的髮生率高于典型“串珠樣”皮質下CWI組（20/32，62.50%），差異有統計學意義。結論不同類型CWI的病因及髮病機製仍然存在爭論。皮質下型CWI可能和血流動力學異常關繫更密切，但其中佔據一定比例的皮質下前/後型CWI病例和微栓塞的關繫可能更大。因此，對于皮質型CWI及整箇皮質下型CWI來說微栓塞的齣現併無明顯差彆，但相對典型“串珠樣”皮質下型CWI，微栓塞機製對皮質型CWI的影響可能更大。不同類型CWI的病因是多元化的，是多種因素綜閤作用、隨機組閤的結果。
목적：목전불동류형뇌분수령경사（CWI）적병인급발병궤제잉연존재쟁론，해연구통과대CWI적병인급가능적발병궤제진행탐토，지재위CWI적병인치료제공림상의거。방법근거로뇌CT혹MRI학진73례CWI환자병진행분형。대기진행상세적관찰여기록，내용포괄：병사、체정、기왕사、영상학（두CT、MRI）급림상특정、혈액검험、경동맥채초、뇌채초、두경부혈관CTA혹MRA검사，종합분석CWI적병인여발병궤제。결과로내동맥중도협착혹폐새적발생솔피질하형CWI조（15/45，33.33%）고우피질형CWI조（3/28，10.71%），차이유통계학의의。피질형CWI조（25/28，89.28%）여피질하형CWI조（32/45，71.11%）적동맥죽양경화반괴적발생솔차이무통계학의의。피질형CWI조（25/28，89.28%）동맥죽양경화반괴적발생솔고우전형“천주양”피질하CWI조（20/32，62.50%），차이유통계학의의。결론불동류형CWI적병인급발병궤제잉연존재쟁론。피질하형CWI가능화혈류동역학이상관계경밀절，단기중점거일정비례적피질하전/후형CWI병례화미전새적관계가능경대。인차，대우피질형CWI급정개피질하형CWI래설미전새적출현병무명현차별，단상대전형“천주양”피질하형CWI，미전새궤제대피질형CWI적영향가능경대。불동류형CWI적병인시다원화적，시다충인소종합작용、수궤조합적결과。
Objective At present, the etiology and pathogenesis of different types of cerebral watershed infarction (CWI) are still in dispute. The study is discussing the causes and the possible mechanism of CWI to provide some clinical basis for the etiological treatment of CWI.Methods According to the head CT or MRI, we diagnosed 73 cases of CWI patients, classifi ed the types, observe and record their content, including history, past medical history, signs, imaging (CT, MRI) and the clinical features, blood tests, carotid ultrasonography, TCD, head and neck vascular CTA or MRA examination, which can provide a comprehensive analysis of the etiology and pathogenesis of CWI.Results Severe stenosis or occlusion of intracranial arteries appears more frequently in the internal CWI group (15/45, 33.33%) than cortical CWI group (3/28, 10.71%). The different frequency of atherosclerotic plaques in the cortical CWI group (25/28, 89.29%) and internal CWI group (32/45, 71.11%) was no signifi cant. Atherosclerotic plaque formation appears more frequently in cortical CWI group (25/28, 89.28%) than the typical "beaded" internal CWI group (20/32, 62.50%).Conclusion The etiology and pathogenesis of different types of CWI are still in dispute, the relationship between the internal CWI and the abnormal hemodynamics was more close relatively. But among them some cases belong to the internal before/after CWI may have a closer relationship with the microembolization. Therefore, there is no obvious difference between the cortical CWI and the whole internal CWI in the microembolization. But compared with the typical "beaded" internal CWI, the effect of the microembolization may be closer to the cortical CWI. The causes of different types of CWI is diversifi ed. It results from the comprehensive function and random combinations of various factors.
