大脑中动脉供血区不同梗死部位对预后的影响

The Influence on the Prognosis by the Different Infarct Locations in the Supply Region of the Middle Cerebral Artery

目的：探讨大脑中动脉供血区不同部位梗死对预后的影响。方法：收集大脑中动脉供血区急性梗死病例,根据梗死部位的不同分为脉络膜前动脉组、分水岭组、中央支组和主干组。梗死后4~16个月电话随访进行改良Rankin量表（MRS）和日常生活能力评分（ADL）,比较各组间MRS和ADL评分及高血压、糖尿病和胆固醇等脑血管疾病危险因素的差异。根据MRS评分,将病例分成预后好组与预后差组,逐步判别分析筛查影响预后的因素。结果：入组88例,其中大脑中动脉中央支组22例,大脑中动脉主干组15例,脉络膜前动脉组40例,分水岭组11例。四组之间的MRS和ADL评分比较,分水岭组ADL评分最高,MRS评分最低,脉络膜前动脉组ADL评分最低,MRS评分最高（P〈0.05）。48例预后好,40例预后差。年龄和梗死部位两项指标进入判别方程。结论：不同梗死部位对大脑中动脉供血区梗死预后有影响,分水岭区梗死预后较好,脉络膜前动脉供血区梗死的预后最差。

Objective ：To investigate the influence of the different infarct locations to the prognosis of the stroke in the supply region of the middle cerebral artery. Methods ： The cases of the acute infarct in the supply region of the middle cerebral artery were employed. All of the cases were divided into four groups ： the anterior choroidal artery, the watershed, the perforating branch, and the trunk group, depending on the different infarct location. The modified rankin scale（MRS） and the ability of daily living（ADL） were interviewed for 4 to 16 months after the strokes. MRS, ADL, and the risk factor were compared among the different groups. All of the cases were also divided into the better and the worse outcome group depending on the outcome of MRS. The factors influencing the prognosis were selected out through the step discriminatory analysis. Results ： 88 cases were employed with 40 cases in the anterior choroidal artery, 11 in the watershed, 22 in the perforating branch and 15 in the trunk group. ADL was the highest in the watershed group, and the lowest in the anterior choroidal artery group. MRS was the lowest in the watershed group, and the highest in the anterior choroidal artery group（P〈0.05）. 48 cases well recovered with 40 cases badly. The age, the infarct location, the degree of the hypertension entered the discrimination equations. Conclusion ： The different infarct location can influence the prognosis of the stroke in the supply region of the middle cerebral artery. The infarcts in the watershed region can best recover while the infarct in the supply region of the anterior choroical artery worst.