孤立性脑桥梗死的临床和影像学特征：脑桥旁正中梗死与脑桥腔隙性梗死的比较

Clinical and imaging characteristics of isolated pontine infarction： a comparison between paramedian pontine infarction and lacunar pontine infarction

目的探讨孤立性脑桥梗死的临床和影像学特征以及早期运动障碍进展（progressive motor deficits，PMD）和短期预后的影响因素。方法对初次发病24h内入院的86例孤立性脑桥梗死患者进行回顾性分析，根据梗死灶最大直径和部位分为脑桥旁正中梗死（pararl-ledian pontine infarction，PPI）和脑桥腔隙性梗死（lacunar pontine infarction，LPI），根据早期PMD情况分为PMD组和无PMD组，根据出院时改良Rankin量表（modified Rankin Scale，mRS）评分分为转归不良组（mRS评分〉2分）和转归良好组（mRS评分≤2分），对不同病例组的临床和影像学特征进行比较。结果PPI组（n=35）高脂血症（57．14％对33．33％；X^2=4．80，P=0．028）、偏瘫（97．14％对72．55％；X^2=8．718，P=0．003）、基底动脉狭窄（45．71％对17．65％；X^2=7．930，P=0．005）和出院时转归不良（54．29％对31．37％；X^2=4．515，P=0．034）患者构成比以及基线美国国立卫生研究院卒中量表（National Institutes of Health Strokescale，NIHSS）评分[（6．00±2．39）分对（4．61±3．41）分；t=2．087，P=0．040]均显著性高于LPI组（n=51）。PMD组（n=22）基线舒张压水平[（97．82±15．61）minHg对（89．55±12．23）mmHg，1mmHg=0．133kPa；t=2．258，P=0．031]以及PPI（63．64％对32．81％；X^2=6．445，P=0．011）和基底动脉狭窄（59．10％对18．75％；X^2=12．922，P=0．000）的构成比均显著性高于无PMD组（n=64）。转归不良组（n=35）基线NIHSS评分[（6．80±2．63）分对（3．73±2．55）分；t=5．426，P=0．000]和空腹血糖水平[（9．40±5．15）mmol／L对（6．56±2．69）mmol／L；t=2．985，P=0．004]以及PPI患者构成比（54．29％对31．37％；X2=4．515，P=0．034）均显著性高于转归良好组（n=51）。多变量logistic回归分析显示，基底动脉狭窄是PPI发病[优势比（oddsratio，OR）3．801，95％可信区间（confidence interval，CI）1．357～10．646；P=0．011]和孤立性脑桥梗死早期PMD（OR4．571，95％ CI 1．214～17．214；P=0．025）的独立危险因素，基线NIHSS评分≥5分是其短期转归不良的独立预测因素（OR 4．277，95％ CI 1．505～12．151；P=0．006）。结论PPI主要与基底动脉分支病变有关，基线NIHSS评分≥5分可能是孤立性脑桥梗死短期转归不良的独立预测因素，其早期PMD和短期转归不良均可能与基底动脉病变有关。

Objective To investigate the clinical and imaging characteristics of isolated pontine infarction as well as the influencing factors for early progressive motor deficits （PMD） and short-term prognosis. Methods A total of 86 patients with isolated pontine infarction who admitted in hospital within 24 hours of symptom onset were analyzed retrospectively. The patients were divided into paramedian pontine infarction （PPI） and lacunar pontine infarction （LPI） according to the maximal diameter of the lesions and the locations of infarction. They were divided into either a PMD group or a non-PMD group according to the early status of PMD. They were also divided into a poor outcome group （mRS score 〉2） and a good outcome group （mRS score ≤ 2） according to the modified Rankin Scale （mRS） scores at discharge. The clinical and imaging features of the different patient groups were compared. Results The patients＇ constituent ratios of hyperlipidemia （57. 14% vs. 33.33% ; g2 = 4. 80, P = 0. 028）, hemiplegia （97. 14% vs. 72. 55% ; X2 = 8. 718, P = 0. 003）, basilar artery stenosis （45. 71% vs. 17. 65%; X2= 7. 930, P= 0. 005） and poor outcome at discharge （54. 29% vs. 31.37% ; X2 = 4. 515, P = 0. 034）, and the baseline National Institutes of Health Stroke Scale （NIHSS） scores （6.00±2.39vs. 4. 61±3.41; t=2.087, P=0.040） in the PPI group （n=35） were significantly higher than those in the LPI group （n = 51）. The constituent ratios of the baseline diastolic blood pressure levels （97. 82 ± 15.61 mm Hg vs. 89. 55 ± 12. 23 mm Hg, 1 mm Hg = 0. 133 kPa; t = 2. 258, P = 0. 031）, PPI （63.64% vs. 32. 81% ;X2 =6. 445, P =0. 011） and basilar artery stenosis （59. 10% vs. 18.75% ; X2 = 12. 922, P =0. 000） in the PMD group （n ---22）were sigtificantly higher than those in the non-PMD group （n =64）. The baseline NIHSS scores （6. 80 ＋ 2. 63 vs. 3.73 ± 2. 55; t = 5.426, P = 0. 000）, fasting blood glucose levels （9. 40 ±5. 15 mmol/L vs. 6. 56 ±2. 69 mmol/L; t =2. 985, P=0. 004） and the constituent ratios of PPI patients （54. 29% vs. 31.37% ; X2 = 4. 515, P = 0. 034） in the poor outcome group （n = 35） were significantly higher than those in the good outcome group （n = 51 ）. Multivariate logistic regression analysis showed that basilar artery stenosis was an independent risk factor for the onset of PPI （odds ratio [ OR ] 3. 801, 95% confidence interval [ CI] 1. 357 - 10. 646; P = 0. 011） and the early PMD of isolated pontine infarction（OR 4.571, 95% CI 1.214- 17.214; P= 0.025）. The baseline NIHSS score ≥ 5 was its independent predictor for poor outcome （OR 4. 277, 95% OR 1. 505 - 12. 151; P =0. 006）. Conclusions PPI is mainly associated with the lesions in the branches of basilar artery. The baseline NIHSS score ≥ 5 may be an independent predictor for short-term poor outcome of isolated pontine infarction. Its early PMD and short-term poor outcome may be associated with the basilar artery lesions.