软脑膜侧支代偿对伴大脑中动脉粥样硬化性闭塞脑梗死患者缺血性脑卒中复发的影响

Effect of Leptomeningeal Anastomoses Compensation on Ischemic Stroke Recurrence in Cerebral Infarction Patients With Middle Cerebral Artery Occlusion

目的探讨软脑膜侧支(LMA)代偿对伴大脑中动脉(MCA)粥样硬化性闭塞脑梗死患者1年内缺血性脑卒中复发的影响。方法选择2010年1月—2013年1月在武汉市中心医院神经内科住院治疗的符合纳入标准的单侧MCA粥样硬化性闭塞脑梗死患者112例为研究对象,采用磁共振血管造影(MRA)评价MCA闭塞及LMA代偿情况。根据1年随访结果,按照代偿程度分为LMA代偿阳性组和LMA代偿阴性组,按照代偿途径分为双途径代偿组、单途径代偿组、无代偿组。比较各组患者随访期间缺血性脑卒中复发情况。结果 112例MCA粥样硬化性闭塞患者中,LMA代偿阳性组76例,LMA代偿阴性组36例。112例患者随访1年内共有10例病变血管同侧再发缺血性脑卒中事件,1年复发率为8.9%;其中LMA代偿阳性组复发3例(脑梗死),1年复发率为3.9%(3/76);LMA代偿阴性组复发7例〔脑梗死3例、短暂性脑缺血发作(TIA)4例〕,1年复发率为19.4%(7/36),两组缺血性脑卒中1年复发率比较,差异有统计学意义(χ2=7.220,P=0.007)。112例患者中,双途径代偿组患者34例,1年复发率为2.9%(1/34);单途径代偿组患者42例〔大脑前动脉(ACA)代偿14例、大脑后动脉(PCA)代偿28例〕,1年复发率为4.8%(2/42);无代偿组患者36例,1年复发率为19.4%(7/36)。不同LMA代偿途径患者缺血性脑卒中1年复发率比较,差异有统计学意义(χ2=7.29,P=0.026)。复发组与未复发组患者除抗血小板药物停用率间差异有统计学意义(P<0.05)外,其他基线资料比较,差异均无统计学意义(P>0.05)。结论伴MCA粥样硬化性闭塞的脑梗死患者,LMA阳性代偿可以减少缺血性脑卒中1年复发率,且双途径代偿对缺血性脑卒中的保护作用优于单途径代偿及无LMA代偿者。

Objective To investigate the effect of leptomeningeal anastomoses（LMA） compensation on the recurrence of ischemic stroke within one year after onset in cerebral infarction patients with middle cerebral artery（MCA）atherosclerotic occlusion.Methods We enrolled 112 cerebral infarction patients with unilateral MCA atherosclerotic occlusion who accorded with the inclusion standard and were admitted into the Department of Neurology of Central Hospital of Wuhan from January 2010 to January 2013.The MCA occlusion and LMA compensation were evaluated by MRA.According to the results of one-year follow-up and the compensation degree,the subjects were divided into LAM positive group and LMA negative group;according to the number of compensation pathway,the subjects were also divided into double-pathway compensation group,one-pathway compensation group and no-pathway compensation group.The recurrence of ischemic stroke in follow-up period was compared among all the groups.Results Among the 112 subjects,76 subjects were in LMA positive group,36 subjects were in LMA negative group.There were 10 cases of ipsilateral ischemic stroke recurrence within 1-year follow-up,with a recurrence rate of 8.9%.Of the 10 cases of recurrence,3 cases（cerebral infarction） were in the LAM positive group,with a recurrence rate of 3.9%（3/76）,and 7 cases（3 cases of cerebral infarction and 4 cases of TIA） were in the LAM negative group,with a recurrence rate of 19.4%（7/36）.The two groups were significantly different in one-year recurrence rate of ischemic stroke（χ2= 7.220,P = 0.007）.There were 34 subjects in double-pathway compensation group,with a recurrence rate of 2.9%（1/34）; there were 42 subjects in one-pathway compensation group,among which 14 subjects were of ACA compensation and28 were of PCA compensation,with a recurrence rate of 4.8%（2/42）; there were 36 subjects in the no-pathway compensation group,with a recurrence rate of 19.4%（7/36）.The subjects with different number of LMA compensation pathway were significantly different in the one-year recurrence rate（χ2= 7.29,P = 0.026）.The recurrence group and the non-recurrence group were significantly different（P 0.05） in the discontinuation rate of antiplatelet drug,and no significant differences were noted in other baseline data between the two groups.Conclusion Among the cerebral infarction patients with MCA occlusion,LMA positive compensation can effectively reduce the incidence of recurrent ischemic stroke within 1 year after onset,and double-pathway LMA is superior to the single-pathway LMA and no-pathway LMA in the protection from recurrent ischemic stroke.