大脑中动脉供血区单发性皮质下小梗死与动脉主干病变的相关性：前瞻性病例系列研究

Correlation between single small subcortical infraction and artery stem lesions in ndddle cerebral artery territory： a prospective case series study

目的探讨大脑中动脉（middlecerebralartery，MCA）穿支供血区域内单发性皮质下小梗死（siIlgtesmallsubcorticalinfarction，SSSI）的临床特征和可能机制。方法连续前瞻性纳入急性SSSI患者，根据病灶部位与MCA的关系将SSSI的分布模式分为近端SSSI（proximalSSSI，pSSSI）和远端SSSI（distalSSSI，dSSSI）。比较2组患者的人口统计学、症状、影像学检查结果和相关危险因素的差异。结果共纳入209例SSSI患者，其中pSSSI组86例，dSSSI组123例。单因素分析显示，pSSSI组病灶直径显著性大于dSSSI组[（14．97±3．14）1111l]对（11．46±3．42）mrrl；t=7．551，P=0，000]，糖尿病（25．6％对13．8％；矿=4．612，P=0．032）、高脂血症（32．6％对20．3％；矿=4．001，P=0．045）、同侧MCA狭窄（46．5％对17．1％；X2=21．222，P=0．000）、其他颅内动脉狭窄（45．3％对20．3％；z。=14．918，P=0．000）以及颅外动脉狭窄（26．7％对11．4％掰。=8．198，P=0．004）患者的构成比显著性高于dSSSI组，但高血压（69．8％对82．1％；矿=4．361，P=0．037）和白质疏松（24．4％对48．8％；，=12．655，P=0．000）患者的构成比显著性低于dSSSI组。多变量logistic回归分析显示，病灶同侧MCA狭窄[优势比（oddsratio，OR）2．796，95％可信区间（confidenceinterval，CI）1．258—6．214；P=0．012]、其他颅内动脉狭窄（OR2．690，95％CI1．251～5．783；P=0．011）、白质疏松（OR0．442，95％C10．212～0．922；P=0．030）以及病灶直径（OR1．285，95％CI1．155—1．429；P=0．000）与pSSSI独立相关。结论依据病灶部位与MCA的关系进行分类的SSSI的临床特征不同，提示SSSI的分布模式可能反映其潜在的发病机制：穿支动脉供血近端区域的SSSI可能是大动脉病变所致，而远端区域的SSSI则更多是小动脉病变所致。

Objective To investigate the clinical characteristics and possible mechanisms of the singlesmall subcortical infarction （SSSI） of middle cerebral artery （MCA） within the perforating area. Methods The patients with acute SSSI were enrolled consecutively and retrospectively. The distribution patterns of SSSI were divided into proximal SSSI （pSSSI） and distal SSSI （dSSSI） according to the relationship between the lesion sites and MCA. The differences of demographics, symptoms, imaging findings and related risk factor were compared in patients of both groups. Results A total of 209 patients with SSSI were enrolled. There were 86 patients in the pSSSI group and 123 in the dSSSI lgoup. Univariate analysis showed that the lesion diameter in the pSSSI group was significantly greater than that in the dSSSI group （14. 97 ± 3. 14 mm vs. 11.46 ± 3.42 mm; t = 7. 551, P =0. 000）, and the composition ratios in patients in diabetes meUitus （25.6% vs. 13.8% ;X2 =4. 612, P= 0.032）, hyperlipidemia （32.6% vs. 20.3%; X2= 4.001, P= 0.045）, ipsilateral MCA stenosis （46. 5% vs. 17. 1%, X2 = 21. 222, P 〈 0. 001）, other intracranial arterial stenosis （45.3% vs. 20. 3% ; X2 = 14. 918, P 〈0. 001）, and extracranial artery stenosis （26. 7% vs. 11.4% ;X2 =8. 198, P =0. 004） were signifi- eantly higher than those in the dSSSI group. However, the composRion ratios in patients with hypertension （69. 8% vs. 82. 1% ;X2 =4. 361, P = 0. 037） and leukoaralosis （24. 4% vs. 48.8% ;X2 = 12. 655, P 〈 0. 001） were significantly lower than those in the dSSSI group. Multivariate logistic regression analysis showed that ip- silateral MCA stenosis of the lesion （odds ratio [ OR] 2. 796, 95% confidence interval [ CI] 1. 258 - 6. 214; P =0. 012）, other intracranial arterial stenosis （OR 2. 690, 95% CI 1. 251 - 5. 783; P = 0. 011）, leukoaraiosis （OR O. 442, 95% C10. 212 -0. 922; P =0. 030） and lesion diameter （OR 1. 285, 95% CI 1. 155 - 1. 429; P 〈 0. 001） were independently associated with pSSSI. Conclusions The clinical characteristics of SSSI are different in classification based on the relationship between the lesion sites and MCA, SSSI of proximal perforating artery may be caused by the large artery disease, and SSSI of the remote areas are mostly caused by small artery disease.