摘要
目的探讨高分辨率磁共振指导下的孤立皮质下梗死(Single subcortical infarction,SSI)患者的CISS分型、相关危险因素及临床预后。方法连续入组符合孤立皮质下梗死的患者,收集患者临床基线资料行高分辨磁共振检查,结合CISS分型标准进行分型,对不同分型的患者进行相关危险因素分析。评估患者入院时及发病72 h的NIHSS评分,3 m后对患者行改良Rankin评分(mRS),评估不同分型患者的预后。结果结合高分辨率磁共振,根据CISS(Chinese ischemic stroke subclassification)分型标准进行分型,其中大动脉粥样硬化型46例,穿支动脉型30例,心源性栓塞型1例,其他原因型1例。单因素分析结果示,大动脉粥样硬化型孤立皮质下梗死高龄(P=0. 002)、高血压(P=0. 019)患者的比例以及脂蛋白a(P=0. 033)、糖化血红蛋白(P=0. 049)水平,显著高于穿支动脉型孤立皮质下梗死患者。多因素回归分析显示,年龄与大动脉粥样硬化型孤立性皮质下梗死的发生独立相关(P=0. 021)。与穿支动脉型患者相比,大动脉粥样硬化型孤立皮质下梗死患者更有可能出现早期临床症状的加重(P=0. 003);而两者的远期3 m临床预后(mRS评分)无明显统计学意义。结论孤立皮质下梗死的CISS分型主要为穿支动脉病变型及大动脉粥样硬化型。年龄是发生大动脉粥样硬化型孤立皮质下梗死的独立危险因素。与穿支动脉型孤立皮质下梗死相比,大动脉粥样硬化型梗死患者早期更容易出现神经功能缺损的进展。
Objective To investigate the Chinese ischemic stroke subclassification( CISS),risk factors and clinical prognosis of patients with single subcortical infarction( SSI) based on high resolution magnetic resonance imaging( HRMRI). Methods Patients with SSI were enrolled in the study. The clinical baseline data of these patients were collected and HRMRI was performed. The risk factors of different groups classified with CISS were analyzed. NIHSS scores were assessed at admission and 72 hours after onset. Modified Rankin Scale( mRS) score was calculated at 3 months after onset to evaluate the prognosis of patients in different groups. Results According to the criteria of CISS,46 SSI were caused by large artery atherosclerosis( LAA),30 were caused by penetrating artery disease( PAD),1 was caused by cardiogenic disease and 1 was caused by other determined disease. Compared with the data of SSI caused by PAD,elder age( P =0. 002),more hypertension( P = 0. 019),higher lipoprotein a( P = 0. 033) and higher Hb A1 c levels( P = 0. 049) were detected in SSI caused by LAA in univariate analysis. Multivariate analysis showed that age was independently associated with SSI caused by LAA( P = 0. 021). Compared with those who caused by PAD,patients with LAA were more likely to get early neurological deterioration( P = 0. 003),but there was no significant difference in clinical prognosis( mRS score) at 3 months. Conclusions Mainly,SSI were caused by PAD and LAA in CISS. Age is an independent risk factor for SSI caused by LAA. Compared with SSI caused by PAD,SSI caused by LAA are more likely to have early neurological deterioration.
作者
陈蓓蕾
李威
杨柳
于海龙
叶靖
王钰
CHEN Beilei;LI Wei;YANG Liu(Department of Neurology,Northern Jiangsu People’s Hospital,Yangzhou 225009,China)
出处
《中风与神经疾病杂志》
CAS
2019年第3期242-247,共6页
Journal of Apoplexy and Nervous Diseases
基金
江苏省青年人才项目(QNRC2016327
QNRC2016328)
关键词
孤立皮质下梗死
高分辨率磁共振
CISS分型
大动脉粥样硬化
穿支动脉病变
Single subcortical infarction
High resolution magnetic resonance imaging
Chinese ischemic stroke subclassification
Large artery atherosclerosis
Penetrating artery disease
