复发性脑卒中临床及影像学研究

Clinic and imaging analysis of recurrent stroke

目的探讨复发性脑卒中的临床特点(再发年龄、性别差异、再发间隔时间、再发部位)、危险因素及影像学,指导临床治疗与预防。方法从发生脑梗死的349例病例中筛选出2次及2次以上出现符合脑梗死临床表现的病例147例并进行回顾性分析。结果 (1)缺血性脑卒中后再次脑梗死的发病率42.12%,其中颅脑MR检查DWI序列有异常高信号者35.53%,无异常高信号者6.59%,两者之比5.39∶1。(2)再发脑梗死为男∶女≈1.82∶1,再发高峰年龄55～65岁。其中有再发脑梗死临床表现并颅脑MR检查DWI序列有无新发病灶二者中,年龄和性别比较差异无统计学意义。(3)再发时间间隔平均4a,女性再发时间间隔早于男性。初发脑梗死后再发率第1年内最高且以第1次再发多见。(4)首、再发部位为同一区域者53例(42.74%)。(5)再发脑梗死中83.87%合并高血压和(或)糖尿病,88.75%男性患者有吸烟和(或)饮酒史。结论首次脑梗死后再发脑梗死者部分出现颅脑MR检查DWI序列无异常高信号,男性再发率高于女性,女性再发间隔短于男性。再发经常在同一部位。再发者多数合并危险因素,以高血压和吸烟为著。

Objective To verify the characteristics of recurrent stroke and guide the clinical treatment and prevention. Methods We studied 147 patients who were diagnosed 2 times and more ischemic stroke from 349 patients with ischemic stroke. Results The rate of recurrent cerebral infarction after ischemic stroke was 42.12%, the patients who had abnormal high signal on DWI were 35.53%, no abnormal high signal on DWI were 6.59%. The ratio was 5.39 ： 1. The ratio of number of male/female with recurrent cerebral infarction was about 1.82 ： 1, the peak age of recurrent cerebral infarction was 55-65 year old. We didn＇t find the relationship between abnormal high signal and normal signal on DWI in age and gender. The inter- val of recurrent cerebral infarction was 4 years. The female recurrence interval was earlier than male. Most of recurrent cere- bral infarction happened in first years and was the first after primary cerebral infarction. Totally 53 cases were the same area, accounting for 42.74%. The patients with recurrent cerebral infarction were 83.87% with hypertension and （or） diabetes mel- litus. The male were 88.75% with smoking and （or） drinking. Conclusion Part of recurrent cerebral infarction without abnor- mal high signal on DWI. The male recurrent cerebral infarction is higher than female. Female recurrent interval is shorter than the male, and recurrent is usually in the same position. Most of them are associated with risk factors such as hypertension and smoking.