CAJ | 학술논문

目的探讨单发性腔隙性梗死（singlelacunarinfarct，SLI）和同侧多发性腔隙性梗死（multiple lacunar infarct， MLI）的特征以及二者危险因素和病因学的差异。方法回顾性分析2008年8月1日至2014年12月13日期间所有急性颈内动脉供血区脑梗死患者的临床资料，根据临床表现和影像学结果筛选腔隙性梗死，根据弥散加权成像显示的病灶数量和部位分为S LI组、单侧同一血管供血区M LI组（ M LI 1组）和单侧不同血管供血区M LI组（ M LI 2组）。应用多变量logistic回归分析确定潜在的独立危险因素。结果 MLI 1组同侧颈动脉斑块（73．33％对48．67％；χ2＝5．801，P＝0．016）、同侧不稳定颈动脉斑块（70．0％对42．5％；χ2＝7．192，P＝0．007）及同侧颈动脉狭窄≥50％（16．67％对1．77％；χ2＝8．327，P＝0．004）发生率均显著高于SLI组；MLI 2组心房颤动发生率显著高于SLI组（40．0％对0．88％；χ2＝15．887，P＜0．001）；其余危险因素在各组之间均无显著统计学差异。多变量logistic回归分析显示，心房颤动[优势比（odds ratio， OR）14．452，95％可信区间（confidence interval， CI）1．558~134．011；P＝0．019]和同侧颈动脉狭窄≥50％（ OR 11．483，95％CI 2．202~59．891；P＝0．011）为MLI的独立危险因素。结论 MLI可能具有与SLI不同的危险因素和发病机制。动脉粥样硬化病变和栓塞为M LI的重要发病机制，而S LI则不然。
목적탐토단발성강극성경사（singlelacunarinfarct，SLI）화동측다발성강극성경사（multiple lacunar infarct， MLI）적특정이급이자위험인소화병인학적차이。방법회고성분석2008년8월1일지2014년12월13일기간소유급성경내동맥공혈구뇌경사환자적림상자료，근거림상표현화영상학결과사선강극성경사，근거미산가권성상현시적병조수량화부위분위S LI조、단측동일혈관공혈구M LI조（ M LI 1조）화단측불동혈관공혈구M LI조（ M LI 2조）。응용다변량logistic회귀분석학정잠재적독립위험인소。결과 MLI 1조동측경동맥반괴（73．33％대48．67％；χ2＝5．801，P＝0．016）、동측불은정경동맥반괴（70．0％대42．5％；χ2＝7．192，P＝0．007）급동측경동맥협착≥50％（16．67％대1．77％；χ2＝8．327，P＝0．004）발생솔균현저고우SLI조；MLI 2조심방전동발생솔현저고우SLI조（40．0％대0．88％；χ2＝15．887，P＜0．001）；기여위험인소재각조지간균무현저통계학차이。다변량logistic회귀분석현시，심방전동[우세비（odds ratio， OR）14．452，95％가신구간（confidence interval， CI）1．558~134．011；P＝0．019]화동측경동맥협착≥50％（ OR 11．483，95％CI 2．202~59．891；P＝0．011）위MLI적독립위험인소。결론 MLI가능구유여SLI불동적위험인소화발병궤제。동맥죽양경화병변화전새위M LI적중요발병궤제，이S LI칙불연。
ObjectiveToinvestigatethecharacteristicsofsinglelacunarinfarct(SLI)andipsilateral multiple lacunar infarction (MLI), and the differences of risk factors and and pathologies betw een them. Methods The clinical data of al patients w ith cerebral infarction in acute internal carotid artery territory from August 1, 2008 to December 13, 2014 w ere analyzed retrospectively. Lacunar infarctions w ere screened according to the clinical manifestations and imaging findings. The patients w ere divided into a SLI, a unilateral MLI in the same blood supply area (MLI 1) and a unilateral MLI in the different blood supply area (MLI 2) group according to the number and location of the lesions show ed on diffusion w eighted imaging. Multivariate logistic regression analysis w as used to identify potential independent risk factors. Results The incidences of ipsilateral carotid plaque (73.33%vs.48.67%; χ2 =5.801, P=0.016), ipsilateral unstable carotid plaque ( 70.0%vs.42.5%; χ2 =7.192, P= 0.007 ), and ipsilateral carotid stenosis ≥50%(16.67%vs.1.77%; χ2 =8.327, P=0.004) of the MLI 1 group w ere significantly higher than those of the SLI group; the incidence of atrial fibril ation of the MLI 2 group w as significantly higher than that of the SLI group (40.0%vs.0.88%; χ2=15.887, P<0.001); there w ere no significant differences in the remaining risk factors among each group. Multivariate logistic regression analysis showed that atrial fibrilation (odds ratio [OR] 14.452, 95% confidence interval [CI] 1.558-134.011; P=0.019) and ipsilateral carotid stenosis ≥50% (OR 11.483, 95%CI 2.202-59.891; P=0.011) w ere the independent risk factors for MLI. Conclusions MLI may have different risk factors and pathogeneses w ith SLI. Atherosclerotic lesions and embolism are the important pathogeneses of MLI, w hile SLI is not.