中等直径基底节区单灶脑梗死早期运动障碍加重的危险因素及与大脑中动脉病变关系分析

The correlative factors of early progressive motor deficits in cerebral infarction of moderate size in basal ganglia and its relationship with the stem lesion of middle cerebral artery

目的探讨中等直径基底节区急性单灶脑梗死患者早期运动障碍加重的危险因素及与大脑中动脉主干病变的关系。方法选择发病24h内的局限于基底节区的急性单灶脑梗死患者150例，根据弥散加权成像（DWI）上梗死灶最大直径分为中等大小梗死组（梗死灶直径1．5～3．0cm）和腔隙梗死组（梗死灶直径〈1．5cm），每组75例。通过发病7d内动态的美国国立卫生研究院卒中量表评分、多元Logistic回归分析，研究早期运动障碍加重的危险因素。结果中等大小梗死组早期运动障碍加重的发生率为32．0％（24／75），高于腔隙梗死组的8．0％（6／75），差异有统计学意义（P〈0．05）；多元Logistic回归分析显示人院时升高的收缩压是早期运动障碍加重发生的独立危险因素（P=0．016）。中等大小梗死组中同侧大脑中动脉主干病变的发生率为41.3％（31／75），高于腔隙梗死组的9.3％（7，75），差异有统计学意义（P〈0．01）。结论直径1．5～3．0cm的基底节区急性单灶脑梗死患者较直径〈1．5cm相同部位腔隙性脑梗死患者更易发生早期运动障碍加重，且可能与入院时升高的收缩压有关。这种中等直径的梗死灶可能与同侧大脑中动脉主干病变有关。

Objective To explore the correlative factors of early progressive motor deficits in cerebral infarction of moderately size in basal ganglia and the relationship between motor deficit progression and the stem lesion of middle cerebral artery. Methods One hundred and fifty patients with single acute infarction located in white matter of basal ganglia region were recruited in this study retrospectively. All patients were performed brain and neck MRI and magnetic resonance angiography （MRA） within 72 h after onset. They were divided into two groups based on the maximal diameter of infarction on diffuse weighing imaging （ DWI ） ： moderate size infarction group （ 75 patients, maximal diameter of infarction from 1.5 cm to 3.0 cm） and lacunar infarction group（75 patients, maximal diameter of infarction lower than 1.5 cm）. The scores of dynamic National Institutes of Health Stroke Scale（NIHSS） in 7 d after the admission and multiple Logistic regression analysis were used and the risk factors of the early progressive motor deficits were analyzed. Results The rate of early progressive motor deficits in moderate size infarction group was significant higher than that in lacunar infarction group [ 32.0 % （24/75） vs. 8.0 % （6/75） ] （P 〈 0.05 ）. The multiple Logisticregression analysis showed that elevated systolic blood pressure on admission was the independent risk factor for early progressive motor deficits （P = 0.016 ）. The rate of stern lesion of middle cerebral artery in moderate size infarction group was significantly higher than that in lacunar infarction group [41.3% （31/75） vs. 9.3% （7/75） ] （P 〈 0.01 ）. Conclusions Patients with acute single infarction located in white matter of basal ganglia and with the diameter of 1.5 - 3.0 cm are more prone to early progressive motor deficits and elevated systolic blood pressure on admission is the most significantly independent factor. The pathogenic mechanism may be associated with the stem lesion of middle cerebral artery.