大动脉狭窄与大脑中动脉供血区梗死早期神经功能恶化有关

Large arterial stenosis is associated with early neurological deterioration of middle cerebral artery infarction

目的探讨大动脉狭窄与大脑中动脉供血区梗死患者早期神经功能恶化（early neurological deterioration，END）的相关性。方法回顾性收集大脑中动脉供血区脑梗死患者，END定义为人院72h内美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分较基线值增加〉12分。利用颅脑血管成像对大脑中动脉和颈内动脉进行评价，狭窄程度分为无或轻度（〈50％）、中度（50％～70％）、重度（71％～99％）和闭塞（100％）。比较END组与非END组的临床危险因素、神经功能缺损程度、病灶大小以及主干动脉病变情况。结果共纳入256例大脑中动脉供血区梗死患者，其中70例（27．34％）患者发生END。END阳性组年龄（P=0．045）、梗死体积（P=0．045）、基线NIHSS评分（P=0．007）以及主干动脉狭窄程度（P=0．038）均显著高于或大于END阴性组。多变量logistic回归分析显示，基线NIHSS评分较高[优势比（odds ratio，OR）1．071，95％可信区间（confidence interval，CI）1．004～1．142；P=0．037]、梗死灶直径〉20mm（OR2．077，95％CI1．077～3．736；P=0．028）以及主干动脉重度狭窄（OR2．521，95％CI1．079～5．886；P=0．033）或闭塞（OR3．074，95％CI1．262～7．489；P=0．013）是END的独立预测因素。结论主干动脉重度狭窄或闭塞病变可能是急性大脑中动脉供血区梗死患者发生END的独立预测因素。

Objective To investigate the correlation of large artery stenosis and early neurological deterioration （END） of middle cerebral artery infarction. Methods The patients with middle cerebral artery infarction were enrolled retrospectively. END was defined as that the National Institutes of Health Stroke Scale （NIHSS） scores increased ≥2 within 72 hours of admission compared with the baseline value. Middle cerebral artery and internal carotid artery were evaluated by using cerebral angiography. The degree of stenosis was divided into 4 grades： non- or mild （〈 50%）, moderate （50- 70%）, severe （71 - 99%） stenosis, and occlusion （100%）. The clinical risk factors, degree of neurological deficits, size of lesion, and major arterial lesions were compared between the END group and the non-END group. Results A total of 256 patients with middle cerebral artery infarction were enrolled, and END occurred in 70 of them （27. 34% ）. The age （P =0. 045）, infarct volume （P =0. 045）, baseline NIHSS score （P =0. 007）, and major arterial stenosis （P =0. 038） of the END positive group were significantly higher or lager than those of the END negative group. Multivariate logistic regression analysis showed that the higher baseline NIHSS score （odds ratio [OR] 1. 071, 95% confidence interval [CI] 1. 004 - 1. 142; P=0. 037）, infarction diameter 〉 20 mm （OR 2. 077, 95% CI 1. 077 -3. 736; P =0. 028）, and severe stenosis of the major artery （OR 2. 521, 95% CI 1. 079 -5.886; P=0. 033） or occlusion （OR 3. 074, 95% CI1. 262 -7. 489; P =0. 013） were the independent predictor of END. Conclusions Severe stenosis or occlusion of the major artery may be an independent predictor of END in patients with middle cerebral artery infarction.