大脑前动脉区域脑梗死解剖模式、临床表现及预后的研究

Lesion pattern,clinical features and prognosis in patients with anterior cerebral artery territory stroke

目的探讨大脑前动脉（ACA）区域脑梗死患者的临床特点及其预后.方法分析经头颅MRI证实为大脑前动脉区域急性脑梗死的80例患者的危险因素、临床表现、影像学特点、同时随访3个月观察其预后.按照脑卒中患者临床神经功能缺损程度评分（NDS）标准,改善程度分为预后良好组和不良组.结果93.75%患者存在运动症状,其中以下肢瘫为重;影像学发现累及部位以胼胝体为最多（72.5%）;而病因主以大动脉粥样硬化为主（72.5%）,其中ACA本身动脉粥样硬化占84.4%.3个月随访根据预后情况将80例患者分为预后良好组（68例）,预后不良组（12例）,其中出现2例（2.5%）患者死亡;多变量Logistic回归分析发现辅助运动区病变（OR 6.063,1.374~16.415,P=0.014）、基线NDS评分（ OR 4.004,1.018~5.49,P=0.045）是ACA区域脑梗死患者预后不良的独立危险因素.结论 ACA区域脑梗死患者的临床表现主以运动症状为主,以胼胝体为主累及部位;病因上以ACA动脉粥样硬化为主;短期随访发现ACA区域脑梗死临床预后相对较好,一些症状和体征可提示本病的诊断及预后.

Objective To investigate the clinical features, lesion pattern and prognosis of patients with anterior cerebral artery （ACA） territory stroke. Methods Eighty patients with acute ischemic stroke in ACA territory confirmed by MRI were admit-ted from 2009 to 2012, the patients were followed up for 3 months. The demographics, risk factors, clinical features, laboratory and neuroimaging data of patients were analyzed. Results Motor deficit was the most common symptom accounting for 93.75%,especial y in the lower extremity. Corpus cal osum was most frequently involved accounting for 72.5%. The presence of atherosclerosis infarction accounted for 72.5%,among which stenosis of ACA atherosclerosis was 84.4%. The presence of car-dioembolic infarction was only 12.5%. The patients were classified into good prognosis group （68 patients） and poor prognosis group（12 patients） according to the NDS score after 3-months fol ow-up. Two patients died within three months with an in-mor-tality rate of 2.5%. Multivariate logistics regression analysis demonstrated that both the baseline NDS and supplementary motor area（SMA） involved were independent risk factors for poor outcome. Conclusions Patients with infarcts in the ACA territory gen-eral y have a favorable outcome, except having the high baseline NDS score or supplementary motor area involved.