大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄的关系

Relationship between the patterns of acute middle cerebral artery deep perforator infarctions and arterial stenosis

目的探讨大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄之间的关系。方法回顾性连续分析2007年2月至2009年4月我院住院的152例脑梗死患者的临床资料。依据磁共振弥散加权成像（DWI）分为大脑中动脉深穿支小梗死组（小PAI组，直径≤3．20em）、大脑中动脉深穿支大梗死组（大PAI组，直径〉3．20cm）、大脑中动脉深穿支＋大脑中动脉皮质支梗死组（PAI＋Pl组）、大脑中动脉深穿支＋分水岭梗死组（PAI＋BZ组）、大脑中动脉深穿支＋大脑中动脉皮质支＋分水岭梗死组（PAI＋PI＋Bz组）。比较各组之间动脉狭窄检出率及动脉重度狭窄或闭塞检出率。结果各组动脉狭窄检出率分别为16／87、9／11、17／17、11／12、23／25，小PAI组与其余4组相比差异有统计学意义（0=21．780、48．065、30．567、55．523，P值均为0．000）；各组动脉重度狭窄或闭塞检出率分别为1／87、2／11、12／17、9／12、21／25，小PAI组与PAI＋PI组、PAI＋BZ组及PAI＋PI＋BZ组相比差异有统计学意义（X2=56．505、55．465、79．283，P值均为0．000），大PAI组与PAI＋PI组、PAI＋Bz组及PAI＋PI＋Bz组相比差异有统计学意义（X2=7．337、7．425、11．633，P值分别为0．007、0．006、0．001）；小PAI两亚组（2．00cm〈直径≤3．20cm亚组与直径≤2．00cm亚组）动脉狭窄检出率差异无统计学意义（X2=0．253，P=0．615）。结论小PAI组动脉狭窄检出率及动脉重度狭窄或闭塞检出率均较低；大PAI组、PAI＋PI组、PAI＋BZ组及PAI＋PI＋BZ组动脉狭窄检出率均较高，且PAl＋PT组、PAl＋BZ组、PAl＋PI＋BZ组动脉重度狭窄或闭塞检出率均较高。

Objective To explor the relationship between the different types of perforating artery fresh infarcts of the middle cerebral artery and related arterial stenosis. Methods All 152 acute ischemic stroke patients hospitalized in our hospital from February 2007 to April 2009 were retrospectively reviewed. Lesions of middle cerebral artery were classified on diffusion weighted imaging （DWI） as small perforator infarcts （ small PAI, diameter ≤ 3.20 cm）, large perforator infarcts （ large PAI, diameter 〉 3.20 cm）, concomitant perforator and pial infarcts （PAI ＋ PI）, concomitant perforator and border-zone infarcts （PAI ＋ BZ）, concomitant perforator, pial and border-zone infarcts （ PAI＋ PI ＋ BZ）. The percentages of arterial stenosis and the severity of arterial stenosis or arterial occlusion were analyzed in each group and compared among each group. Results Arterial stenosis was 16/87, 9/11, 17/17, 11/12, 23/25 in the group of small PAI, large PAI, PAI＋ PI, PAI ＋ BZ, PAI＋ PI ＋ BZ, respectively. There was significant difference between small PAI group and other four groups （~2 =21. 780, 48. 065, 30. 567, 55. 523, P=0. 000）; the arterial severe stenosis or arterial occlusion were 1/87, 2/11, 12/17, 9/12, 21/25 in each groups, and there was significant difference between small PAI group and other groups （ ~2 = 56. 505, 55. 465, 79. 283, P = O. 000）, between large PAI group and other groups （X2＇ =7. 337, 7. 425, 11. 633, P =0. 007, O. 006, 0. 001 ）. There was no significant difference between infarcts of bigger than 2. 00 cm but smaller than 3.20 cm and infarcts smaller than 2. 00 cm （ X2 = 0. 253, P = 0. 615 ）. Conclusion The small PAI group had a lower percentage of arterial stenosi, and lower percentage of severe arterial stenosis or arterial occlusion. The large PAI group, PAI＋ PI group,PAI ＋ BZ group and PAI ＋ PI ＋ BZ group had higher percentages of arterial stenosis. The PAI＋ PI group, PAI＋ BI group and PAI＋ PI ＋ BZ group had higher percentages of severe arterial stenosis or arterial occlusion.