急性孤立性桥脑梗死形态学分类及其临床相关性

Morphological classification of acute isolated pontine infarction and it's clinical relevance

目的从一个前瞻性多中心研究中比较基于形态学分类的急性孤立性桥脑梗死(AIPI)临床特征、危险因素和预后差异,探索AIPI基于形态学的分类方法的I临床价值。方法自2008年6月至2010年10月全国47家中心连续入组住院治疗的急性脑梗死患者3821例,包含DWI序列1129例,筛选AIPI并根据病灶形态学及是否合并基底动脉狭窄(>50%)将AIPI按病因分为三类:基底动脉穿支动脉疾病(BABD),小动脉疾病(SAD)及大动脉闭塞性疾病(LAOD)。排除心源性栓塞及前循环梗死。记录人口学特征、临床资料,危险因素及预后等,并进行统计分析。结果175例AIPI最终纳入研究。各分类亚型中,BABD最常见(46.3%),其次为SAD(36.0%),LAOD最少见(17.7%)。危险因素方面,高血压在三组间具有统计学差异(P<0.05)。就诊时神经功能缺损SAD组(平均NIHSS 3.49分),LAOD组(平均NIHSS 5.93分)和BABD组(平均NIHSS 5.97分),三组比较差异有统计学意义(P<0.001)。所有AIPI患者不良预后(mRS>2)占13.7%,三组比较差异无统计学意义。结论根据AIPI的形态学分类,BABD是AIPI的最常见亚型。不同形态学分组间具有特定的临床特征和独立的危险因素,提示AIPI的形态学特征与病因可能存在相关性,研究支持基于形态学的AIPI分类方法,临床应用简便,对病因机制评估及治疗决策具有一定的价值。

Objective To investigate a diffusion weighted imaging (DWI)-based morphological classification for acute isolated pontine infarcts (AIPI)and to assess differences in clinical characteristics, risk factors and functional outcomes among the different morphologies.Methods All participants from SMART cohort with DWI-proven AIPI were included and categorized into 3groups:basilar artery branch disease (BABD)group,small artery disease (SAD)group and large-artery-occlusive disease (LAOD) group,according to lesion extent of the transverse axial plane and basilar artery atherosclerosis severity.The clinical characteristics,vascular risk factors and 6-month's functional outcome was analyzed among 3groups. Results Of the 1129patients enrolled,175had AIPI.BABD was the most frequent subtype of AIPI (46.3%),followed by SAD (36.0%)and LAOD (17.7%).Neurological impairment on admission was more severe in the LAOD and BABD group than SAD group (P <0.001).In terms of risk factors,the percentage of hypertension was significant different among three groups (P<0.05).The average National Institute of Health stroke scale was 3.49for SAD group,5.93for LAOD group,5.97for BABD group,and the differences were significant (P <0.001).The Poor outcome (mRS >2)was found in only 13.7%of patients at 6-month post-stroke and there was no difference among 3groups.Conclusions According to the morphological classification,BABD is the most frequent subtype of AIPI.The differences of the clinical characteristics and risk factors among three groups indicate that differences observed in morphology might have distinct pathophysiologic mechanisms.AIPI can be reliably classified based on morphology using clinical magnetic resonance images.