孤立性皮质下小梗死的形态学特征与早期神经功能恶化的联系

Relationship between lesion patterns of isolated small subcortical infarction and early neurological deterioration

目的探讨孤立性皮质下小梗死（ISSI）的形态学特征与早期神经功能恶化（END）的关系。方法连续收集2010年1月至2012年12月于南京军区南京总医院神经内科住院的大脑中动脉（MCA）穿支供血区ISSI患者209例。依据病灶形态分为线形ISSI组和圆（或椭圆）形ISSI组。END定义为3d内复评美国国立卫生研究院卒中量表（NIHSS）最高分较人院时增加2分或2分以上。比较组间基线资料和END的发生率，同时筛选早期预测END的独立危险因素。结果71例线形ISSI患者中，28例（39．44％）发生了END，138例圆或（椭圆）形ISSI患者中，25例（18．12％）发生了END。和非END患者相比，病灶形态、性别、人院NIHSS评分[（3．89±1．65）分与（3．22±1．60）分，t=2．588，P=0．010]、冠状动脉粥样硬化性心脏病、病灶侧MCA狭窄及颅内狭窄的差异均具有统计学意义。Logistic回归分析显示，线形病灶（OR=2．525，95％CI 1．164～5．479，P=0．019）是END的独立危险因素。结论线形病灶患者临床病程不稳定，有助于筛选ISSI患者中易于发生END的高危患者。

Objective To explore the relationship between lesion patterns of isolated small subeortieal infarction （ISSI） and early neurological deterioration （END）. Methods Two hundred and nine consecutive patients with ISSI in the perforator territory of middle cerebral artery （MCA） were prospectively recruited between January 2010 and December 2012 and divided into linear ISSI and round or oval ISSI according to lesion morphology. END was defined as any increase in National Institutes of Health Stroke Scale （NIHSS） score t〉 2 in the first 72 h after stroke onset. Risk factors associated with END were analyzed. Results END was found in 28（39.44% ） patients with linear ISSI and 25（ 18.12% ） patients with round or oval ISSI. Univariate analysis indicated that lesion pattern, sex, initial NIHSS score （3.89 ± 1.65 vs 3.22 ± 1.60,t =2. 588, P =0. 010）, coronary heart disease, ipsilateral MCA stenosis and intracranial atherosclerotic stenosis were significantly associated with END. Logistic regression analysis suggested that linear lesion （ OR = 2. 525, 95% CI 1. 164-5.479, P = 0. 019 ） was an independent predictor of END. Conclusion Patients with linear ISSI were more prone to present fluctuated clinical course, which may be helpful in predicting patients with END.