穿支动脉疾病型脑梗死进展性运动障碍的相关因素分析及预后研究

Analysis on Factors of Progressive Motor Dysfunction and Prognosis in Patients with Cerebral Infarction due to Penetrating Artery Disease

目的分析穿支动脉疾病(penetratingarterydisease,PAD)型脑梗死出现进展性运动障碍(progressive motor deficits,PMD)的相关危险因素及患者预后。方法连续入组经头颅MRI确诊的PAD型脑梗死病例,按是否出现PMD分为PMD组与非PMD组例,比较两组的人口学资料、血管危险因素、病灶特点、实验室指标、3个月和6个月预后良好(mRS评分0~2分)率及脑梗死复发情况。进一步对PMD的可能影响因素进行多因素分析,判断其独立危险因素。结果研究共入组287例PAD型脑梗死患者,其中PMD组95例,非PMD组192例。与非PMD组相比,PMD组男性患者(P=0.03)、吸烟(P=0.04)、糖化血红蛋白(P<0.001)、Hcy(P=0.02)和D-二聚体(P=0.01)水平较高,脑梗死灶直径较大(P<0.001)。两组患者入院时NIHSS评分差异无统计学意义,但出院时PMD组NIHSS评分高于非PMD组(7.69±1.87分vs 2.13±0.49分,P<0.001);3个月随访PMD组预后良好率较低(55.7%vs 70.8%,P=0.01),6个月随访两组预后无显著差异;两组3个月及6个月脑梗死复发率差异无统计学意义。多因素分析显示高糖化血红蛋白水平(OR 1.083,95%CI 1.062~1.105,P=0.03)和较大的脑梗死灶直径(OR 1.051,95%CI 1.030~1.073,P=0.01)是PMD的独立危险因素。结论 PAD型脑梗死患者中,出现PMD者早期神经功能缺损较重,3个月预后较差。糖化血红蛋白水平及脑梗死灶直径可作为PAD型脑梗死患者PMD的预测指标。

Objective To analyze the risk factors of progressive motor dysfunction(PMD) in patients with cerebral infarction due to perforating artery disease(PAD). Methods Patients with PAD cerebral infarction diagnosed by MRI were divided into PMD group and non-PMD Group. The demographic data, vascular risk factors, lesions characteristics, laboratory test result, prognosis and stroke recurrence at 3 and 6 months were compared between the two groups. Multivariate analysis was used to determine the independent risk factors for PMD.Results A total of 287 patients with PAD were enrolled in this study, including 95 patients with PMD and 192 patients with non-PMD. The males(P=0.03), smoking(P=0.04), the glycated hemoglobin(P<0.001), homocysteine(P=0.02), D-dimer(P=0.01) and infarct diameter(P<0.001) were all significantly higher in PMD group than that in non-PMD Group. There was no significant difference in the NIHSS scores at admission between the two groups, but the NIHSS scores at discharge in PMD group was higher than that in non-PMD group(7.69±1.87 vs 2.13±0.49, P<0.001). The rate of good prognosis at 3 months in PMD group was lower than that in non-PMD Group(55.7% vs 70.8%, P=0.01), while the two groups had no statistical difference at 6 months. There were no significant difference in recurrent cerebral infarction at 3 and 6 months between the two groups. Multivariate analysis showed that high glycated hemoglobin level(OR 1.083, 95%CI 1.062-1.105, P=0.03) and large infarct diameter(OR 1.051, 95%CI 1.030-1.073, P=0.01) were independent risk factors for PMD.Conclusions Of patients with cerebral infarction due to PAD, the patients occurring PMD had more severe neurological function deficit and worse prognosis at 3 months. Glycated hemoglobin and infarct diameter can be used as predictors for PMD.