大脑中动脉闭塞患者侧枝循环开放与脑梗死的关系及其影响因素

Relationship between collateral circulation and cerebral infarction in patients with middle cerebral artery occlusion and its risk factor

目的探讨大脑中动脉闭塞患者侧枝循环开放程度与脑梗死的关系及其影响因素。方法收集65例大脑中动脉闭塞患者的临床资料,按脑血管DSA表现将侧枝循环开放程度进行评估分级,再根据分级结果将患者分为侧枝循环代偿良好组（27例,3~4级）与侧枝循环代偿不良组（38例,0~2级）。比较两组患者头部CT片上脑梗死体积的差异及其影响因素。结果侧枝循环代偿良好组脑梗死体积（4.89±3.41 cm3）明显小于代偿不良组（25.75±11.45 cm3）（P〈0.05）,入院时NIHSS评分、住院时间及住院费用也均低于代偿不良组（均P〈0.05）;低密度脂蛋白（LDL）在两组间差别有统计学意义（P〈0.05）。结论大脑中动脉闭塞患者侧枝循环开放程度与脑梗死的发生密切相关,良好的侧枝代偿可改善临床结局;高LDL可能促进侧枝循环开放。

Objective To explore the relationship between collateral circulation and cerebral infarction in patients with middle cerebral artery occlusion and its risk factors. Methods The clinical data of 65 patients with middle cerebral artery occlusion were collected in the study. The patients were divided into two groups according to their digital subtraction angiography findings about the collateral circulation grade： a better collateral circulation group（ n = 27,3 ~ 4 grade） and a worse collateral circulation group（ n = 38,0 ~ 2 grade）. The differences of the cerebral infarct volume in the CT images and the stroke risk factors between the two groups were compared. Results Compared with the worse collateral circulation group（ 25. 75 ± 11. 45 cm3）,the mean infarct volume of the better group（ 4.89 ±3. 41 cm3） was significantly decreased（ P 0. 05）,and also,the NIHSS scores,the hospitalization time and the total expense of hospitalization were lower than the better group（ all P 0. 05）; there was significant difference of Low Density Lipoprotein（ LDL） between the two groups. Conclusions There is significant relationship between thrombosis and the extent of collateral circulation,a better collateral circulation may lead a better clinical outcome; the higher LDL may play a promotive role for the establishment of the collateral circulation.