CAJ | 학술논문

目的：急性腔隙性脑梗死患者早期神经功能恶化（ early neurological deterioration ， END）的影响预测指标目前尚不明确。文中拟探讨首发急性腔隙性脑梗死患者脑微出血病灶的位置、数量与END的联系。方法选取2009年3月至2012年5月发病24 h内收治于安徽省立医院神经内科的急性腔隙性脑梗死患者217例。所有患者完成磁共振磁敏感成像检查，探讨微出血病灶的位置、数量与END的联系。结果 END发生率占35．0％。其中检出脑微出血（cerebral microbleeds， CMBs）阳性患者33例，占43．4％。 CMBs阳性组与阴性组之间END发生率差异无统计学意义（P＝0．173）。在病灶数量分级的比较中，＞5个CMBs病灶的患者发生END的可能性显著增加（P＝0．005）。 Logistic回归结果显示，相对于CMBs阴性患者，CMBs病灶数目＞5个与END存在相关性（OR＝3．14，95％CI：1．22～8．13），≤5个CMBs病灶与END不存在统计学关联（OR＝1．12，95％CI：0．53～2．37）。 CMBs病灶位置与END发生无统计学关联（P＞00．5）。结论磁共振SWI成像中的CMBs病灶分布位置与早期神经功能波动无关，但5处以上的CMBs病灶可能是END的独立预测因素。
목적：급성강극성뇌경사환자조기신경공능악화（ early neurological deterioration ， END）적영향예측지표목전상불명학。문중의탐토수발급성강극성뇌경사환자뇌미출혈병조적위치、수량여END적련계。방법선취2009년3월지2012년5월발병24 h내수치우안휘성립의원신경내과적급성강극성뇌경사환자217례。소유환자완성자공진자민감성상검사，탐토미출혈병조적위치、수량여END적련계。결과 END발생솔점35．0％。기중검출뇌미출혈（cerebral microbleeds， CMBs）양성환자33례，점43．4％。 CMBs양성조여음성조지간END발생솔차이무통계학의의（P＝0．173）。재병조수량분급적비교중，＞5개CMBs병조적환자발생END적가능성현저증가（P＝0．005）。 Logistic회귀결과현시，상대우CMBs음성환자，CMBs병조수목＞5개여END존재상관성（OR＝3．14，95％CI：1．22～8．13），≤5개CMBs병조여END불존재통계학관련（OR＝1．12，95％CI：0．53～2．37）。 CMBs병조위치여END발생무통계학관련（P＞00．5）。결론자공진SWI성상중적CMBs병조분포위치여조기신경공능파동무관，단5처이상적CMBs병조가능시END적독립예측인소。
Objective The predictive indexes which affect early neurological deterioration ( END) of patients with acute la-cunar stroke still remain unclear .The purpose of the article was to investigate the correlation between the location and numbers of cere -bral microbleeds (CMBs) and END in patients with first-onset lacunar stroke. Methods 217 patients with acute lacunar stroke hos-pitalized in Anhui Provincial Hospital within 24 hours after occurrence from Mar 2009 to May 2012 were prospectively enrolled .All pa-tients underwent susceptibility-weighted imaging MRI right after admission , followed by the investigation on the relationship of the loca-tion and numbers of CMBs and END . Results END occurred in 76 (35.0%) patients.Among these patients, there were 33 positive cases with CMBs (43.3%).There were no significant difference in END incidence between positive group and negative group (P=0.173).In the comparison of the numbers of CMBs foci , patients with more than 5 foci were more prone to END (P=0.005).Logistic regression analysis showed there was relation between CMBs foci numbers>5 and END (OR=3.14, 95% CI: 1.22 ~8.13), and there was no relation between CMBs foci numbers≤5 and END ( OR=1.12, 95%CI:0.53~2.37)as to CMBs negative patients.No signifi-cant relationship was found in CMBs location and END occurrence ( P>0.05). Conclusion The distribution of CMBs foci has nothing to do with early neurological fluctuation .However , more than 5 CMBs foci might be the independent prediction cause of END .