超急性期严重缺血性卒中患者大脑中动脉高密度征研究

Hyperdense middle cerebral artery sign among patients with severe ischemic attack on ultra-early phase

目的:了解超急性期(发病3 h内)大脑中动脉(middle cerebral artery,MCA)区严重缺血性卒中[基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≥10]患者大脑中动脉高密度影(hyperdense middle cerebral artery sign,HMCAS)发生率,比较HMCAS(+)组和HMCAS(-)组患者临床情况和预后的异同。方法:共43名患者纳入研究,进行临床评价、实验室和影像学检查。随访90 d记录改良Rankin评分(modified Rankin scale,mRS)、Bathel指数(Bathel index,BI)和死亡情况。结果:HMCAS(+)发生率为23.3%(10/43)。HMCAS(+)组发病24 h NIHSS评分和大面积脑梗死比例明显高于HMCAS(-)组(20.2±5.4 vs.14.8±7.2,P=0.037;100%vs.39.1%,P=0.001),两组患者年龄、性别、卒中危险因素、就诊间隔、实验室检查和90 d结局比较差异均无统计学意义。结论:超急性期HMCAS(+)的严重缺血性卒中患者,发病24 h病情恶化更为显著,随后发生大面积梗死者比例更高;临床表现为严重缺血性卒中的患者基线非增强CT出现HMCAS需要引起注意。

Objective： To detect the frequency of hyperdense middle cerebral artery sign（HMCAS） among patients with severe ischemic attack（baseline NIHSS score≥10） in the middle cerebral artery（MCA） territory within 3 hours after onset and compare the baseline characteristics and 90-day outcomes between the HMCAS（＋） and HMCAS（-） groups.Methods： A total of 43 patients were evaluated with baseline clinical characteristics,laboratory tests and brain CT/MRI.Follow-up evaluation at the end of 90 days included the modified Rankin Scale（mRS）,the Bathel Index（BI） and death.Results： Ten out of fourty-three（23.3%） patients were HMCAS（＋）.The 24-hour NIHSSS of HMCAS（＋） group was significantly higher than that of HMCAS（-） group（20.2±5.4 vs.14.8±7.2,P= 0.037）.The follow-up scanning confirmed that all HMCAS（＋） patients had larger MCA territory infarction and the ratio of large MCA territory infarction was significantly higher than that of HMCAS（-） group（100% vs.39.1%,P = 0.001）.There were no significant differences in age,gender,risk factors,time intervals,laboratory tests,90-day functional outcomes between the two groups.Conclusion： The HMCAS（＋） patients had notable deterioration 24 hours after onset and had more severe MCA infarction.HMCAS detected by non-enhanced CT at admission should be considered as an alarming sign among patients with severe neurological deficit of MCA territory infarction.