大脑中动脉狭窄对心房纤颤患者急性缺血性脑卒中的影响

Effect of middle cerebral artery stenosis on acute ischemic stroke in patients with atrial fibrillation

目的心源性栓塞是心房纤颤（AF）患者发生急性缺血性脑卒中（AIS）最主要病因。大脑中动脉（MCA）支配区AIS是最常见的。研究MCA狭窄（MCAS）与AF患者发生的MCA支配区AIS发病机制的关系。方法选择AIS同时伴有AF的患者232例,其中男性140例,女性92例;年龄57~85岁,平均年龄74.2岁。根据MCA狭窄程度,将AIS患者分为MCAS组（MCA狭窄率≥70%）与大脑中动脉非狭窄（MCANS）组,分别比较两组患者的基本信息、危险因素、临床特点和影像学特点。结果 MCAS患者27例,MCANS患者205例。与MCANS患者相比,MCAS患者高血压发病率较高（P〈0.01）,而心脏病发病率偏低（P〈0.05）。MCANS组入院时美国国立卫生院卒中量表（NIHSS）评分（P=0.01）、出院时改良Rankin量表（m RS）评分（P〈0.01）及左心房前后径（LAD;P=0.03）皆高于MCAS组。腔隙性AIS在MCAS组中更多见（P=0.04）,而多发性AIS在MCANS组中更普遍（P〈0.01）。结论 AF患者发生MCA支配区AIS时,MCA动脉硬化病变可能与AIS不同分型存在相关性。MCA轻中度狭窄时发生心源性AIS中的概率更高。MCA严重狭窄时动脉粥样硬化性AIS的发生率更高。

Objective To investigate the relationship between middle cerebral artery stenosis （MCAS） and acute ischemic stroke （AIS） mechanisms of middle cerebral artery（MCA） infarction in atrial fibrillation（AF） patients, because cardiogenic embolism was the main cause of AIS in AF patients, and AIS in MCA region was the most common. Methods A total of 232 AIS combined with AF were enrolled, which included 140 males and 92 females, aged 57 - 85 years old with mean age of 74.2 years old. All patients were divided into MCAS group（~〉 70 % stenosis） and MCA non-stenosis（MCANS） group（0 % - 69 % stenosis）. The basic characteristics, risk factors, clinical features and image data between 2 groups were compared. Results MCAS were 27 cases and 205 of MCANS, MCAS patients combined with hypertension were higher than that of MCANS（P〈 0.01）, but cardiac disease was lower than that of MCANS（P 〈 0.05）. The score of National Institute of Health Stroke Seale（NIHSS）（P = 0.01） on admission and modified Rankin Scale（mRS） （P〈 0.01） at discharge, and left atrium diameter（LAD）（P = 0.03） in MCANS group were higher than those in MCAS group. The lacunar AIS in MCAS group（P = 0.04） and multiple AIS in MCANS gronp（P 〈 0.01） were common. Conclusion It is demonstrated that MCA atherosclerotie disease may be correlated with AIS different phenotype in AF patient, the probability is increased in cardiac AIS of mild-to-moderate stenosis MCA and atheroselerosis AIS of severe stenosis MCA.