CAJ | 학술논문

目的：探讨孤立性脑桥梗死后进展性运动功能缺损(progressive motor deficits, PMD)的预测因素。方法连续纳入发病48 h内入院的孤立性脑桥梗死患者,根据临床病程及美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)运动项目评分变化分为 PMD 组(7 d内增加≥1分)与非 PMD 组；根据弥散加权成像(diffusion-weighted imaging, DWI)将脑桥梗死模式分为基底表面梗死与深部梗死,侧别分为左侧与右侧,梗死灶层面分为上部、中部和下部。比较两组患者人口统计学、基线临床资料和影像学特征,采用多变量 logistic 回归模型分析孤立性脑桥梗死后 PMD 的预测因素。结果共纳入发病48 h内入院的孤立性脑桥梗死患者101例,其中 PMD 组16例,非 PMD 组85例。 PMD 组患者梗死灶累及脑桥基底表面(87．5%对47．1%；χ2=8．851,P =0．003)、梗死灶层面位于中部(56．2%对24．7%；χ2=4．851, P =0．028)和基底动脉狭窄或闭塞(62．5%对27．1%；χ2=7．689,P =0．006)的构成比显著高于非 PMD 组,而梗死灶侧别位于左侧(18．8%对56．5%；χ2=7．664,P =0．006)和梗死灶层面位于上部(37．5%对72．9%；χ2=7．689,P =0．006)的构成比显著低于非 PMD 组。多变量 logistic 回归分析显示,累及脑桥基底表面梗死(优势比5．650,95%可信区间1．011~31．580；P =0．049)和基底动脉狭窄或闭塞(优势比4．075,95%可信区间1．127~14．741；P =0．032)是孤立性脑桥梗死后 PMD 的独立危险因素。结论累及基底表面的梗死和基底动脉狭窄或闭塞可能是孤立性脑桥梗死后 PMD 的预测因素。
목적：탐토고립성뇌교경사후진전성운동공능결손(progressive motor deficits, PMD)적예측인소。방법련속납입발병48 h내입원적고립성뇌교경사환자,근거림상병정급미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale, NIHSS)운동항목평분변화분위 PMD 조(7 d내증가≥1분)여비 PMD 조；근거미산가권성상(diffusion-weighted imaging, DWI)장뇌교경사모식분위기저표면경사여심부경사,측별분위좌측여우측,경사조층면분위상부、중부화하부。비교량조환자인구통계학、기선림상자료화영상학특정,채용다변량 logistic 회귀모형분석고립성뇌교경사후 PMD 적예측인소。결과공납입발병48 h내입원적고립성뇌교경사환자101례,기중 PMD 조16례,비 PMD 조85례。 PMD 조환자경사조루급뇌교기저표면(87．5%대47．1%；χ2=8．851,P =0．003)、경사조층면위우중부(56．2%대24．7%；χ2=4．851, P =0．028)화기저동맥협착혹폐새(62．5%대27．1%；χ2=7．689,P =0．006)적구성비현저고우비 PMD 조,이경사조측별위우좌측(18．8%대56．5%；χ2=7．664,P =0．006)화경사조층면위우상부(37．5%대72．9%；χ2=7．689,P =0．006)적구성비현저저우비 PMD 조。다변량 logistic 회귀분석현시,루급뇌교기저표면경사(우세비5．650,95%가신구간1．011~31．580；P =0．049)화기저동맥협착혹폐새(우세비4．075,95%가신구간1．127~14．741；P =0．032)시고립성뇌교경사후 PMD 적독립위험인소。결론루급기저표면적경사화기저동맥협착혹폐새가능시고립성뇌교경사후 PMD 적예측인소。
Objective To investigate the predictive factors of progressive motor deficits (PMD) after isolated pontine infarction. Methods Consecutive patients with isolated pontine infarction admitted to hospital within 48 hours after onset were enroled. They were divided into either a PMD group (increase ≥1 within 7 days) or a non-PMD group according to the clinical course and the changes of motor scores of the National Institutes of Health Stroke Scale (NIHSS). The pontine infarction patterns were classified as basal surface infarction and deep infarction, the sides were divided into left and right, the infarct levels were divided into upper, middle, and lower according to diffusion-weighted imaging. The demographics, baseline clinical data, and imaging features were compared between the two groups. Multivariable logistic regression models were used to analyze the predictive factors of PMD after isolated pontine infarction. Results A total of 101 patients with isolated pontine infarction admitted to hospital within 48 h of onset were enroled, including 16 in the PMD group and 85 in the non-PMD group. The proportions of pontine infarction involving the basal surface (87. 5% vs. 47. 1% , χ2 = 8. 851, P = 0. 003), the infarcts on the middle levels (56. 2% vs. 24. 7% , χ2 = 4. 851, P = 0. 028), and basilar artery stenosis or occlusion (62. 5% vs. 27. 1% ,χ2 = 7. 689, P = 0. 006) of the PMD group were significantly higher than those of the non-PMD group, while the proportions of the infarcts on the left sides (18. 8% vs. 56. 5% , χ2 = 7. 664, P = 0. 006) and the infarcts on the upper levels (37. 5% vs. 72. 9% , χ2 = 7. 689, P = 0. 006) of the PMD group was significantly lower than those of the non-PMD group. Multivariate logistic regression analysis identified that pontine infarction involving the basal surface (odds ratio 5. 650, 95% confidence interval 1. 011 - 31. 580, P = 0. 049) and basilar artery stenosis or occlusion (odds ratio 4. 075, 95% confidence interval 1. 127 - 14. 741, P = 0. 032) were the independent risk factors for PMD after isolated pontine infarction. Conclusions Infarction involving the basal surface and basilar artery stenosis or occlusion may be the predictors for PMD after isolated pontine infarction.