脑梗死大脑中动脉狭窄患者随访观察研究

Follow-up studies on patients with middle cerebral artery stenosis in cerebral infarction

目的 探讨脑梗死大脑中动脉 (MCA)狭窄的转归和预后。方法 采用德国DWL公司生产的经颅多普勒 (TCD)检测仪 ,对经CT或MRI证实的脑梗死患者进行TCD检查 ,依据TCD血管狭窄诊断标准 ,筛选有MCA狭窄的脑梗死患者 60例。间隔 6个月后复查TCD ,记录 6个月内任何脑血管事件的发生 ,根据前后 2次检查狭窄MCA血流速度的变化 ,判断狭窄MCA的转归。结果 首次检查时有 73条MCA狭窄 ;间隔 6个月TCD复查时 ,73条狭窄的MCA有 1 5条 ( 1 5 / 73 ,2 1 %)狭窄好转或恢复正常 ,4 6条 ( 4 6/ 73 ,63 %)狭窄稳定 ,1 2条 ( 1 2 / 73 ,1 6%)狭窄进展或闭塞。 6个月内1 0例患者 ( 1 0 / 60 ,1 7%)有脑血管事件再发 ,在 1 0例再发患者的 1 0条症状性MCA中 ,7条狭窄进展 ,3条狭窄稳定 ,狭窄进展组患者再次发生脑血管事件的几率高于狭窄稳定组 (t =1 7 91 ,P <0 0 1 )。Kendall等级相关分析显示脑血管事件的再发与血管狭窄的严重程度有关 (CI =0 2 96,P <0 0 1 )。 结论 TCD随访检查可用于评价狭窄MCA的转归和预后 ,并可预示脑血管事件的发生 ;脑血管事件的再发与MCA狭窄进展有关 ,狭窄程度越高 ,再发脑血管事件的危险性越大。

Objective The aim of this study was to investigate the outcomes and prognosis of patients with stenosis in middle cerebral arteries (MCAs) in cerebral infarction Methods Patients of acute ischemic stroke with MCA stenosis confirmed by cranial CT scanning or MRI were recruited consecutively Patients were screened for MCA stenosis by a transcranial Doppler (TCD) scanner, made in DWL Company in Germany, in accordance with the diagnostic criterion for MCA stenosis The patients were re-examined with TCD scanning 6 month after the first examination and any cerebral vascular events were recorded during this period Outcomes of the stenotic MCAs were evaluated, based on the change in the speed of blood flow in it between two examinations Results Sixty cases of cerebral infarction with stenosis in 73 MCAs were enrolled into this study Fifteen of the 73 stenotic MCAs during initial examinations became better or restored normal (15/73, 21%), 46(46/73, 63%)MCAs remained stable, and 12(12/73, 16%)stenotic MCAs progressed or occluded in the second examination During the 6 months, cerebral ischemic events were recurred in 10 patients (10/60, 17%) in the areas supplied by the stenosed MCAs, and stenosis in seven of the 10 symptomatic stenotic MCAs progressed or even occluded and 3 remained in stable condition ( t =17 91, P <0 01) Kendall correlation analysis showed that recurrence of ischemic events correlated with the severity of stenosis in MCAs ( CI =0 296, P <0 01) Conclusions Repeated TCD scanning could be used to assess the outcomes and prognose of stenotic MCAs and to predict recurrence of cerebral ischemic events in patients with ischemic strokes Recurrence of cerebral ischemic events correlated to progression of symptomatic stenosis in MCAs detected by TCD The more severe in stenosis, the higher risk for recurrence of cerebral ischemic events