椎基底动脉穿支动脉梗死与早期神经功能恶化的关系

Relation between vertebrobasilar artery perforating ischemic stroke and early neurological deterioration

目的 探讨椎基底动脉穿支供血区单发小梗死（SSI）的分布模式与早期神经功能恶化（END）及30 d功能预后的关系.方法 前瞻性纳入椎基底动脉穿支供血区急性SSI患者126例,根据神经功能评分分为END组36例和非END组90例.以30 d后的改良Rankin量表（mRS）评分反映患者短期功能预后,去除5例失访患者,预后良好组102例（mRS 0～2分）,预后不良组19例（mRS≥3分）.结果 与非END组比较,END组糖尿病、基线美国国立卫生研究院卒中量表（NIHSS）评分、病灶直径、动脉主干病变、无症状性脑动脉粥样硬化、近端SSI比例明显增多,差异有统计学意义（P＜0.05,P＜0.01）.logistic回归分析表明,近端SSI与END独立相关（OR=3.222,95％CI：1.170～8.874,P=0.024）.与预后不良组比较,预后良好组基线NIHSS评分[（5.44±2.69）分vs （7.00±1.91）分]、近端SSI（51.0％ vs 78.9％）、END（22.5％ vs 52.6％）比例明显降低（P＜0.05,P＜0.01）.logistic回归分析显示,住院期间是否发生END与30 d的不良功能预后独立相关（OR=4.126,95％CI：1.241～13.713,P=0.021）.结论 椎基底动脉穿支供血近端区域的SSI患者早期容易发生神经功能恶化,并直接影响到患者的短期预后.

Objective To study the relation of vertebrobasilar artery perforating single small infarction （SSI） distribution pattern with early neurological deterioration （END） and SSI prognosis 30 days after its onset.Methods One hundred and twenty-six patients with acute SSI were included in this study.The patients were divided into END group （n=36） and non-END group （n=90） according to their NIHSS score.Except for 5 patients who lost their follow-up,the SSI prognosis was assessed as good in 102 patients （mRS score=0-2） and poor in 19 patients （mRS score ≥3） according to their mRS score.Results The incidence of diabetes mellitus,asymptomatic cerebral atherosclerosis,proximal SSI,parent artery lesion,and the baseline NIHSS score were significantly higher and the diameter of lesions was significantly longer in END group than in non-END group （P＜0.05,P＜0.01）.Logistic regression analysis showed that proximal SSI was independently related with END （OR=3.222,95％CI：1.170-8.874,P=0.024） and the occurrence of END in hospital stay time was independently related with the poor SSI prognosis 30 days after its onset （OR=4.126,95 ％CI：1.241-13.713,P=0.021）.Univariate analysis displayed that proximal SSI,baseline NIHSS score and END were closely related with the poor SSI prognosis 30 days after its onset （P ＜ 0.05,P ＜ 0.01）.Conclusion END usually occurs in patients with vertebrobasilar artery perforating proximal SSI,and directly affects their short-term prognosis.