脑血管储备对重度大脑中动脉狭窄所致内分水岭梗死患者发展转归的影响

Effects of cerebrovascular reserve on progress and outcome in patients with internal border zone infarction induced by severe middle cerebral artery stenosis

目的评估重度大脑中动脉狭窄所致内分水岭区梗死(IBZI)的脑血管储备(CVR)功能,并探讨对疾病的进展及临床转归的影响。方法收集我院单纯一侧大脑中动脉重度狭窄的急性IBZI患者84例。通过屏气诱发高碳酸血症,行TCD检测大脑中动脉血流速度变化,评估CVR。根据CVR将患者分为储备下降组(CVR<10%)和储备正常组(CVR≥10%)。入院后14 d内行NIHSS评分评价神经功能缺损情况,出院时对两组患者行mRS评分观察急性期转归。随访6个月,分析两组患者复发、合并症和死亡率情况。人数比例为34.78%、结果储备下降组进展性脑梗死的发生率(67.39%)高于储备正常组(42.11%)(P<0.05)。储备下降组发生转归不良的比率(63.04%)高于储备正常组(36.84%)(P<0.05)。在6个月随访过程中,储备下降组病例复发及发生合并症的人数比率分别为34.78%45.65%,均明显高于储备正常组(15.79%,23.68%)(均P<0.05)。而两组的死亡率差异无统计学意义(P>0.05)。结论对于重度大脑中动脉狭窄所致的IBZI患者,CVR的下降可能预示着其易于进展和临床转归不良。

Objective To assess cerebrovascular reserve （CVR） function in patients with internal border zone infarction （IBZI） induced by severe middle cerebral artery （MCA） stenosis, and investigate the impact on progression and outcome of the disease. Methodd A total of 84 patients with unilateral severe MCA stenosis were selected. Hypercapnia was induced by holding breath. The change of blood flow velocity in MCA was measured by transcranial Doppler （TCD） to calculate CVR. According to CVR, patients were divided into impaired regional CVR group （ CVR 〈 10% ） and normal CVR group （ CVR ≥ 10% ）. The NIHSS was used to evaluate neurological function in both groups within 14 d, and mRS was used to evaluate acute stage outcome of the patients at discharge. All the patients were followed-up for 6 months, the incidences of recurrence, complications and mortality in the two groups were analyzed. Results The incidence of progressive cerebral infarction in the impaired regional CVR group （67.39%） was significantly higher than that in the normal CVR group （42. 11% ） （P 〈 0. 05 ）. The impaired regional CVR group showed higher proportion of patients with poor clinical outcome at discharge （ mRS ≥ 3 ） （ 63.04% ） compared to the normal CVR group （ 36.84% ） （ P 〈 0. 05 ）. In the followed-up 6 months, the incidences of recurrence and complications were 34.78% and 45.65% respectively in the impaired regional CVR group, they were significantly higher than that in normal CVR group（ 15.79% ,23.68% ） （ P 〈 0.05 ）. The overall mortality rates did not differ significantly between the two groups （P 〉 0. 05 ）. Conclusion Impaired regional CVR may be predictive of subsequent progressive cerebral infarction and poor clinical outcomes in patients with IBZI induced by severe MCA stenosis.