大脑中动脉中度与重度狭窄所致脑梗死病灶的分布特征分析

Characteristic analysis of distributive pattern of cerebral infarction caused by moderate and severe stenosis of middle cerebral artery

目的探讨大脑中动脉(MCA)中度和重度狭窄所致脑梗死的病灶分布特征。方法回顾性分析51例MCA主干动脉粥样硬化性狭窄(狭窄率>50%)所致急性脑梗死患者的影像学资料,根据MCA主干的狭窄程度,分为中度狭窄组(狭窄率51%～69%,19例)和重度狭窄组(狭窄率70%～99%,32例),比较两组患者脑梗死病灶的分布情况。结果①MCA中度狭窄组和重度狭窄组发生单发性梗死分别为17例(89.5%)和10例(31.3%),多发性梗死分别为2例(10.5%)和22例(68.8%),P<0.001。②MCA中、重度狭窄组的单发性梗死中,小的穿支动脉梗死(SPAI)分别为10例(10/17)和1例(1/10),P=0.018;皮质梗死(CI)分别为1例(1/17)和4例(4/10),P=0.047;分水岭梗死(BZI)分别为0例和3例(3/10),P=0.041。③重度狭窄组多发性梗死中以穿支动脉梗死(PAI)+CI、CI+BZI和PAI+BZI多见,分别为9例、7例和5例。④中、重度狭窄组脑梗死累及穿支动脉供血区分别为18例(18/19)和18例(18/32),P=0.041;其中表现为SPAI的分别为为11/18和4/18,P=0.041。⑤MCA中、重度狭窄组脑梗死累及皮质供血区分别有3例(3/19)和21例(21/32),P=0.001;梗死累及分水岭区分别为0例和16例(16/32),P<0.001。结论 MCA主干中度狭窄和重度狭窄所致脑梗死的梗死病灶分布特征有所不同,前者主要为穿支动脉供血区单发性梗死,后者以多发性梗死为主,提示两者致脑梗死机制存在差异。

Objective To investigate the distributive characteristics of cerebral infarction caused by moderate and severe atherosclerotic stenosis of the main stem of middle cerebral artery （MCA）. Methods The imaging data of 51 patients with acute cerebral infarction caused by atherosclerotic stenosis （stenosis rate 〉 50% ） of the main stem of MCA were analyzed retrospectively. The patients were divided into moderate stenosis group （stenosis rate 51% -69%, n = 19） and severe stenosis group （stenosis rate 70% - 99% , n = 32） according to the severity of MCA main stein stenosis. The distribution of cerebral infarction in both groups was compared. Results （1）The single infarction was 17 （89.5%） and 10 （31.3%） patients respectively, and the multiple infarction was 2 （10. 5% ） and 22 （68.8%） patients respectively in lhe moderate and severe MCA stenosis groups （ P 〈 0. 001 ）. （2）Among the single infarctions in the moderate and severe MCA stenosis groups, the small perforating artery infarct （SPAI） was 10 （10/ 17） and 1 （1/10） patients respectively （ P = 0. 018） ; the cortical infarction （CI） was 1 （ 1/17 ） and 4 （4/10） patients respectively （P =0. 047） ; and the border-zone infarction （BZI） was 0 （0） and 3 （3/ 10） patients respectively （P =0. 041 ）. （3）Among the oatients with multiole infarctions in the severe sienasis group, perforating artery infarct （PAI） ＋ CI, CI ＋ BZI, and PAI＋ BZI were common, they were 9, 7, and 5 patients, respectively. （4）In the nmderate and severe stenosis groups, cerebral infarction involving the perforating artery was 18 （18/19） and 18 （18/32） patients respectively （P = 0. 041 ）. Of those with SPAI were 11/18 and 4/18 respectively （P = 0.041 ）. （5）The patients with cerebral infarction involving cortical territory in the moderate and severe MCA stenosis groups were 3 （3/19） and 21 （21/32） patients respectively （ P = 0. 001 ） ; those with cerebral infarction involving border-zone were 0 （0） and 16 （16/32） patients respectively （P 〈 0.001 ）. Conclusions The distribution characteristics of cerebral infarction caused by the moderate and severe stenosis of MCA main stem was different. The former was mainly single cerebral infarction in the perforating artery territory, and the latter was mainly the multiple cerebral infarctions, and this indicating that the mechanisms of cerebral infarction caused by the above two are different.