73例脑分水岭梗死患者病因及发病机制分析

Analysis on Etiology and Pathogenesis of Cerebral Watershed Infarction

目的：目前不同类型脑分水岭梗死（CWI）的病因及发病机制仍然存在争论，该研究通过对CWI的病因及可能的发病机制进行探讨，旨在为CWI的病因治疗提供临床依据。方法根据颅脑CT或MRI确诊73例CWI患者并进行分型。对其进行详细的观察与记录，内容包括：病史、体征、既往史、影像学（头CT、MRI）及临床特征、血液检验、颈动脉彩超、脑彩超、头颈部血管CTA或MRA检查，综合分析CWI的病因与发病机制。结果颅内动脉重度狭窄或闭塞的发生率皮质下型CWI组（15/45，33.33%）高于皮质型CWI组（3/28，10.71%），差异有统计学意义。皮质型CWI组（25/28，89.28%）与皮质下型CWI组（32/45，71.11%）的动脉粥样硬化斑块的发生率差异无统计学意义。皮质型CWI组（25/28，89.28%）动脉粥样硬化斑块的发生率高于典型“串珠样”皮质下CWI组（20/32，62.50%），差异有统计学意义。结论不同类型CWI的病因及发病机制仍然存在争论。皮质下型CWI可能和血流动力学异常关系更密切，但其中占据一定比例的皮质下前/后型CWI病例和微栓塞的关系可能更大。因此，对于皮质型CWI及整个皮质下型CWI来说微栓塞的出现并无明显差别，但相对典型“串珠样”皮质下型CWI，微栓塞机制对皮质型CWI的影响可能更大。不同类型CWI的病因是多元化的，是多种因素综合作用、随机组合的结果。

Objective At present, the etiology and pathogenesis of different types of cerebral watershed infarction （CWI） are still in dispute. The study is discussing the causes and the possible mechanism of CWI to provide some clinical basis for the etiological treatment of CWI.Methods According to the head CT or MRI, we diagnosed 73 cases of CWI patients, classifi ed the types, observe and record their content, including history, past medical history, signs, imaging （CT, MRI） and the clinical features, blood tests, carotid ultrasonography, TCD, head and neck vascular CTA or MRA examination, which can provide a comprehensive analysis of the etiology and pathogenesis of CWI.Results Severe stenosis or occlusion of intracranial arteries appears more frequently in the internal CWI group （15/45, 33.33%） than cortical CWI group （3/28, 10.71%）. The different frequency of atherosclerotic plaques in the cortical CWI group （25/28, 89.29%） and internal CWI group （32/45, 71.11%） was no signifi cant. Atherosclerotic plaque formation appears more frequently in cortical CWI group （25/28, 89.28%） than the typical beaded internal CWI group （20/32, 62.50%）.Conclusion The etiology and pathogenesis of different types of CWI are still in dispute, the relationship between the internal CWI and the abnormal hemodynamics was more close relatively. But among them some cases belong to the internal before/after CWI may have a closer relationship with the microembolization. Therefore, there is no obvious difference between the cortical CWI and the whole internal CWI in the microembolization. But compared with the typical beaded internal CWI, the effect of the microembolization may be closer to the cortical CWI. The causes of different types of CWI is diversifi ed. It results from the comprehensive function and random combinations of various factors.