摘要
目的探讨和归纳大动脉粥样硬化性(large artery atherosclerosis,LAA)和心源性(cardioembolism,CE)前循环脑梗死的临床特征及梗死灶分布特点。方法对发病1周内磁共振弥散加权成像(DWI)证实为急性前循环脑梗死,且TOAST分型为大动脉粥样硬化型(LAA组)和心源性脑梗死(CE组)的患者进行回顾性研究。对2组患者的人口学特征、危险因素及入院时的NIHSS评分进行对比,同时对2组患者的梗死灶在DWI上的分布特征进行总结和归纳。结果 LAA组患者的平均年龄较CE组小(P=0.001),且以男性居多(P=0.000)。LAA组患者中伴有高血压病、糖尿病、高低密度脂蛋白血症等脑卒中危险因素者较CE组多(P值均为0.000)。吸烟史2组间无明显的差异(P=0.275)。CE组既往有脑卒中史的患者更多(P=0.016)。CE组患者入院时NIHSS评分明显高于LAA组(P=0.000)。LAA组单发病灶病例数明显多于CE组(P=0.025),但LAA组和CE组组内均以多发性病灶更为常见(分别占各组总病例数的76.1%和88.9%)。CE组多发病灶主要为穿支动脉梗死加皮层梗死(PAI+PI)和皮层梗死加皮层梗死(PI+PI)两种表现形式,其中PAI+PI要明显多于LAA组(P=0.000),CE组无患者出现分水岭区(BZ)梗死,而LAA组多发病灶表现为多种不同的分布形式的组合。结论 LAA与CE所致的前循环脑梗死不论在临床特征及梗死灶的分布特点上均有明显的差别,这些差异有助于在急性脑梗死早期对两者进行初步鉴别,以指导临床决策。
Objective To analyses the clinical features and lesions patterns of infarctions in anterior cir-culation caused by large artery atherosclerosis（LAA）and cardioembolism （CE）.Methods Retrospective study of patients with acute cerebral anterior circulation infarctions within one week.The infarctions were identified through diffusion weighted imaging （DWI）.The patients were divided into two groups including LAA group and CE group depending on the etiology based on the TOAST.Then the clinical features including the risk fac-tors and the lesion patterns were compared.Results The patients in LAA group were younger than CE group （P =0.001）,and were male dominated （P =0.000）.More patients in the LAA group had the history of hy-pertension,diabetes mellitus and high level of low density lipoprotein compared to that in CE group （P =0.000）.There was no difference of the history of smoking between the groups （P =0.275）,however the pa-tients with the history of stroke in the CE group were more than that in the LAA group （P =0.016）.The scores of NIHSS in CE group were higher than that in the LAA group （P =0.000）.The multiple infarctions were more common in both LAA and CE groups （76.1 % and 88.9% respectively）,and the single infarctions were more common in LAA group than that in the CE group （P =0.025）.The two manifestations in the CE group were perforating artery infarct plus pial infarction （PAI＋PI）and pial infarction plus pial infarction （PI＋PI）,while the lesion patterns in LAA group were various,and the PAI＋PI in the CE group was more com-mon than that in the LAA group （P =0.000）.Meanwhile,there was no border zone （BZ）infarction in CE group.Conclusions There were significant differences of the clinical features and the lesion patterns between the cerebral ischemia caused by LAA and CE.These differences may help us to differentiate the etiology be-tween LAA and CE,and guide our clinical strategy.
出处
《卒中与神经疾病》
2014年第5期273-276,共4页
Stroke and Nervous Diseases
关键词
脑梗死
磁共振弥散加权成像
梗死模式
大动脉粥样硬化
心源性
Cerebral ischemia
Diffusion weighted imaging
Lesion pattern
Large artery atheroscle-rosis
Cardioembolism
