幕上皮质下梗死后进展性运动功能缺损的预测因素

Predictors of progressive motor deficits after supratentorial subcortical infarcts

目的探讨幕上皮质下梗死后进展性运动功能缺损(PMD)的相关预测因素。方法前瞻性纳入142例幕上皮质下梗死患者,根据病情特点及美国国立卫生研究院卒中量表(NIHSS)中运动项目评分,将患者分为PMD组(39例)与稳定组(103例)。比较两组一般临床资料、实验室指标、神经功能评分及影像学特点,采用多因素Logistic回归分析,分析幕上皮质下梗死后PMD的独立危险因素。结果①PMD组患者进展时间平均为(31±11)h,33例(84.6%)病情进展出现在夜间。②单因素分析显示,PMD组中女性(P=0.045)、基线收缩压≥180mm Hg(P=0.000)、放射冠部位梗死(P=0.000)、梗死灶直径15～30 mm(P=0.003)、不稳定性斑块(P=0.001)及大脑中动脉狭窄或闭塞(P=0.015)患者所占的比例明显高于稳定组。而稳定组基底核部位梗死(P=0.000)、梗死直径<15 mm(P=0.000)比例显著高于PMD组。③多因素Logistic回归分析显示,女性(OR=2.837,95%CI:1.076～7.485;P=0.035)、基线收缩压≥180 mm Hg(OR=3.509,95%CI:1.349-9.124;P=0.010)、放射冠部位梗死(OR=6.807,95%CI:2.446～18.944;P=0.000)、不稳定性斑块(OR=3.137,95%CI:1.019～9.657;P=0.046)、大脑中动脉病变(OR=4.027,95%CI:1.160～13.976;P=0.028)是发生PMD的独立危险因素。结论幕上皮质下梗死后PMD的发病率较高,女性、基线收缩压≥180mmHg以及放射冠部位梗死、不稳定性斑块和大脑中动脉病变均为PMD重要的预测因素。

Objective To investigate the related predictors of progressive motor deficits（PMD） after supratentorial subcortical infarcts.Methods A total of 142 patients with supratentorial subcortical infarction were enrolled prospectively.They were divided into either a PMD group or a stable group according to the disease characteristics and the motor scores of the National Institutes of Health Stroke Scale（NIHSS）.The general clinical data,laboratory parameters,neurological score,and imaging characteristics were compared between the two groups.The logistic regression analysis was used to analyze the independent risk factor for supratentorial subcortical infarcts with PMD.Results ①Of the 142 patients with supratentorial subcortical infarcts,39（27.5%） were in the PMD group.The mean time of progression was 30±11 hours,and the progression in 33 patients（84.6%） was during the night.②Univariate analysis revealed that the proportions of female（P=0.045）,baseline systolic blood pressure（SBP） ≥180 mm Hg（P=0.000）,corona radiata infarction（P=0.000）,diameter of infarction 15-30 mm（P=0.003）,unstable plaque（P=0.001）,and patients with middle cerebral artery stenosis or occlusion（P=0.015） in the PMD group were significantly higher than those in the stable group;while the proportions of the basal ganglia infarction（P=0.000） and infarct diameter 15 mm（P=0.000） in the stable group were significantly higher than those in the PMD group.③Multivariate Logistic regression analysis showed that female（OR,2.837,95%CI 1.076-7.485;P=0.035）,baseline SBP ≥180 mm Hg（OR,3.509,95%CI 1.349-9.124;P=0.010）,corona radiata infarction（OR,6.807,95%CI 2.446-18.944;P=0.000）,unstable plaque（OR,3.137,95%CI 1.019-9.657;P=0.046）,and middle cerebral artery lesions（OR 4.027,95%CI 1.160-13.976;P=0.028） were the independent risk factors for PMD.Conclusion The incidence of PMD in patients with supratentorial subcortical infarcts is higher.Female sex,baseline SBP ≥180 mm Hg,corona radiata infarction,unstable plaque,and middle cerebral artery lesions are the important predictors of PMD.