摘要
目的通过对大脑中动脉(MCA)主干动脉粥样硬化性狭窄和闭塞所致MCA不同供血区脑梗死的对比研究,为相关治疗策略提供依据。方法回顾性分析61例由MCA动脉粥样硬化性狭窄(狭窄率>50%)和闭塞所致的新发脑梗死患者的临床和影像学资料。将患者分为狭窄组(27例)和闭塞组(34例)。根据发病1周内磁共振弥散加权像(DWI)的结果,确定脑梗死的部位并进行对比。结果狭窄组和闭塞组单发性梗死分别为15例(55.6%)和8例(23.5%),多发性梗死分别为12例(44.4%)和26例(76.5%),P<0.05。狭窄组和闭塞组单发性梗死中,小穿支动脉脑梗死为11例(11/15)和2例(2/8),P=0.039;多发性梗死中,穿支动脉脑梗死(PAI)合并皮质梗死(PI)为7/12和3/26(11.5%),P=0.005;多发性梗死中,PAI+PI+分水岭梗死为1例(1/12)和16例(61.5%),P=0.004;分水岭梗死分别为5例和23例,P<0.001。结论MCA主干动脉粥样硬化性狭窄和闭塞所致的脑梗死部位有显著差异,前者多引起单发性脑梗死,后者多引起多发性脑梗死。提示两者的发病机制存在不同之处。
Objective To investigate the pathogenesis of middle cerebral artery（MCA） stenosis and occlusion caused cerebral infarction by a contrast study on atherosclerotic stenosis and occlusion of the main stem of MCA caused cerebral infarction in different MCA blood supplied areas and to provide evidence for the relative therapeutic strategies. Methods The clinical and imaging data of 61 patients with fresh cerebral infarction caused by atherosclerotic MCA stenosis（ stenosis 〉 50% ） and occlusion were analyzed retrospectively. The patients were divided into stenosis group（ n = 27 ） and occlusion group （n = 34）. The locations of cerebral infarction were determined and compared according to the results of MRI diffusion-weighted imaging（DWI） within one week after onset. Results Single infarction in the stenosis and occlusion groups were 15（55.6% ） and 8（23.5% ） patients, respectively, and the multiple infarctions in the two groups were 12（44. 4% ） and 26 （76. 5% ） patients, respectively（ P 〈 0. 05 ）. Among the patients with single infarctions, the small perforating artery infarct（SPAI） in the stenosis and occlusion groups were 11 （ 11/15 ） and 2 （ 2/8 ） patients（ P = 0. 039 ） ; among the patients with multiple infarctions, the perforating artery infarct（PAI） complicated with cortical infarction（ pial infarct, PI） were 7 （7/12） and 3 （3/26） patients （P = 0. 005 ） ; among the patients with multiple infarctions, PAI complicated with PI and borderzone infarct（BZI） were 1 （1/12） and 16（16/26） patients（P =0. 004） ; there were 5 and 23 patients with BZI（P 〈0. 001 ）. Conclusions The sites of cerebral infarction caused by atherosclerotic stenosis and occlusion of main-stem of MCA has significant difference. It is suggested that there are different pathogenesis between them. Cerebral infarction caused by MCA stenosis may be resulted from the ostial lesion of the perforating artery and embolism. The former caused more single infarctio
出处
《中国脑血管病杂志》
CAS
2008年第6期241-245,共5页
Chinese Journal of Cerebrovascular Diseases
基金
南京市科技计划项目(200702066)
关键词
梗塞
大脑中动脉
动脉粥样硬化
对比研究
Infarction, Middle cerebral artery
Atherosclerosis
Comparative study
