【摘要】 目的探讨大脑中动脉狭窄(Middle Cerebral Artery Stenosis,MCAS)程度与脑梗死模式及卒中严重程度的相关性。方法收集了2014年4月—2016年5月间78例大脑中动脉(Middle Cerebral Artery,MCA)病变所致急性脑梗死(Acute Cerebral Infarction,ACI)患者的影像学资料及一般临床资料,所有患者均行一般血液检查、头颅磁共振检查(Magnetic Resonance Imaging,MRI)及全脑血管造影术(Digital subtraction angiography,DSA),根据MCA狭窄的程度分为中度狭窄组(狭窄率50%～69%,24例)和重度狭窄(狭窄率70%～99%,54例),比较两组患者的病灶分布模式与一般临床资料、入院时及2周后美国国立卫生研究院卒中量表(National Institutes of HealthStroke Scale,NIHSS)评分情况,两周后改良Rankin评分(Modified Rankin score,mRS)之间的关系。结果中度狭窄组和重度狭窄在年龄[(63.75±9.80)岁vs (62.64±11.49)岁,t=0.336]、高血压病史(19例vs 46例,χ~2=0.201)、糖尿病病史(9例vs 12例,χ~2=1.036)、血脂[(2.65±0.74)mmol/L vs (2.51±0.59)mmol/L,t=0.76]、发病时NIHSS评分(2.5 points vs 2 points,t=-0.150)等一般临床特征方面比较差异无统计学意义(P>0.05);中度狭窄组与重度狭窄组相比,以男性居多(93.8%vs 66.7%),两组之间差异有统计学意义(P<0.05);两组之间的梗死病灶分布模式不同,中度狭窄组以皮质下单发小梗死为主(37.5%vs 11.1%,P<0.05);重度狭窄组以穿支+皮质+分水岭的多发性梗死为主(4.2%vs 33.3%,P<0.05);进一步随访发现,两组患者的短期预后与其大脑中动脉狭窄程度无关(P>0.05)。结论大脑中动脉系统梗死患者中,症状严重程度及预后与动脉狭窄程度无关;大脑中动脉狭窄程度不同,梗死病灶分布模式不同,与不同的发病机制有关。更多还原

【Abstract】 Objective To investigate the relationship between the degree of Middle Cerebral Artery Stenosis(MCAS and the severity of cerebral infarction and stroke. Methods The imaging data and general clinical data of 78 patients with acute Cerebral Infarction(ACI) caused by Middle Cerebral Artery(MCA) lesions from April 2014 to May 2016 were collected. All patients were included. All patients underwent general blood test, Magnetic Resonance Imaging(MRI) and Digital subtraction angiography(DSA). According to the degree of stenosis of MCA, they were divided into moderate stenosis group(stenosis rate 50%-69%, 24 cases) and severe stenosis(stenosis rate 70% to 99%, 54 cases),compared with the two groups of patients with lesion distribution patterns and general clinical data, admission and 2 weeks after the National Institutes of Health Stroke Scale(National Institutes The Health Stroke Scale(NIHSS) score,the relationship between modified Rankin scores(mRS) after two weeks. Results The moderate stenosis group and severe stenosis were age [(63.75±9.80)years old vs(62.64±11.49)years old, t=0.336], hypertension history(19 cases vs 46 cases, χ~2=0.201), diabetes history(9 cases vs 12 cases,χ~2=1.036), blood lipids[(2.65±0.74)mmol/L vs(2.51±0.59)mmol/L,t=0.76], and NIHSS scores(2.5 points vs 2 points, t=-0.150) were not different in general clinical features(P>0.05);compared with the severe stenosis group, the moderate stenosis group was mostly male(93.8% vs 66.7%), there was significant difference between the two groups(P<0.05); the distribution pattern of infarct lesions was different between the two groups. In the stenosis group, the small infarct was mainly in the subcortical single infarction(37.5% vs 11.1%,P<0.05). In the severe stenosis group, the multiple infarction with perforating + cortex + watershed was the main(4.2%vs 33.3%, P<0.05). Further follow-up showed that the short-term prognosis of the two groups was not related to the degree of cerebral artery stenosis(P>0.05). Conclusion In patients with middle cerebral artery infarction, the severity of symptoms and prognosis are not related to the degree of arterial stenosis; the degree of middle cerebral artery stenosis is different, and the distribution pattern of infarct lesions is different, which is related to different pathogenesis.更多还原