摘要
目的探讨急性大脑中动脉闭塞患者MRI液体衰减反转恢复序列（FLAIR）高信号血管征（hyperintense vessel，HV）对于其预后的评估作用。方法从南京卒中注册系统中提取2009年5月至2011年2月间表现为大脑中动脉区首次急性梗死的患者共74例，其中男性48例（64．9％）；平均（60．7±15．3）岁，NIHSS评分12（1～25）分[采用中位数（范围）表示]。所有患者均已行头颅MRI检查（包括DWI、FLAIR），并且经MRA或DSA提示大脑中动脉近端闭塞（M1段或M2段）。根据FLAIR序列HV出现的部位和范围，将患者分为无HV组、近端HV组和远端HV组；比较各组间基线资料及神经功能评分，并以90d改良Rankin评分（mRS）为预后指标，行Logistic回归分析。结果74例中无HV组25例（33．8％），近端HV组7例（9．5％），远端HV组42例（56．8％）。远端HV组患者人院时NIHSS评分[11（1～22）分]、入院10dNIHSS评分[14（4—25）分]、梗死体积[大面积梗死5例（6．8％）]及90dmRS评分[3～6分者12例（16．2％）]明显低于无远端HV组[即近端HV组合并无HV组，分别为15（6—25）分，Z=-3．544；7（0～22）分，Z=-4．461；20例（27．0％），Х^2=20．916；27例（36．5％），Х^2=22．689；均P〈0．01]；从早期神经功能恢复及短期预后改善程度上看，远端HV组均明显优于无远端HV组。Logistic回归分析发现，年龄（OR=1．111，95％CI1．036～1．191，P=0．003）、梗死体积（OR=3．679，95％CI1．350～10．025，P=0．011）、远端HV（OR=0．131，95％CI0．027～0．638，P=0．012）与90dmRS评分显著相关。结论远端HV是急性脑梗死预后的重要预测指标。
Objective To evaluate the prognostic value of hyperintense vessel （HV） in patients with acute middle cerebral artery （MCA） occlusion. Methods Seventy-four consecutive patients with first ever stroke（48 male and 26 female, the mean age was （60. 7 ±15.3） years） in the territory of MCA, retrieved from Nanjing Stroke Registry Program between May 2009 and February 2011, were enrolled as subjects. All subjects completed brain MRI, and MRA or DSA indicated proximal MCA occlusion. According to the location and extent of HV, all subjects were classified into 3 groups ： without HV, proximal HV and distal HV. Clinical data were obtained and compared among patients with different grades of HV. Logistic regression analysis was employed to confirm the relevant factors of prognosis 90 days after index stroke. Results HV was observed in 49 （66.2%） of the 74 enrolled patients. Among patients with HV, 7（9.4% ） were classified as proximal HV and 42 （56. 8% ） as distal HV. Initial NIHSS score （11 （1- 22） ）, 10-day NIHSS score （13.5（4-25））, infarction size （ 〉 2/3：5 cases （6. 8% ） ）, and 90-day mRS score （3-6 scores： 12 cases（ 16. 2% ）） were significantly lower in patients with distal HV than those without （ 15（6-25）, Z = -3. 544;7（0-22）, Z = -4. 461 ;20 cases（27.0% ）, Х^2 = 20. 916;27 cases （36. 5% ） , Х^2 =22. 689;all P 〈0. 01 ）. The NIHSS score decreased from baseline to that on 10 days and the mils score decreased from 10 days to ihat on 90 days in patients with distal HV was more than that in patients without distal HV. Muhiwriate analysis revealed that patients with older age （ OR = 1. 11 1 , 959% Cl 1.036-1. 191,P =0.003）, high infarction size （OR =3.679, 95% CI 1.35-10.025, P = 0. 011 ） worsened outeonle, whereas distal HV （ P = 0. 012, OR = 0. 131 , 95% CI 0. 027-0. 638 ） improved outcome. Conclusion Distal HV on FLAIR may predict a favorable outcome in patients with acute middle cerebral arlery occlusion.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2012年第3期174-178,共5页
Chinese Journal of Neurology
基金
国家自然科学基金面上项目资助项目（30870848）
关键词
梗死
大脑中动脉
脑血管循环
侧支循环
磁共振成像
预后
Infarction, middle cerebral arlerv
Cerebrovascular circulation
Collateral circulation
Magnetic resonance imaging
Prognosis
