孤立性脑桥梗死形态学部位与急性期神经功能缺损进展的关系

Relationship between topographic location and neurological deterioration in acute isolatedpontine infarction

目的探讨孤立性脑桥梗死形态学部位与急性期神经功能缺损进展的关系。方法回顾性收集温州医科大学附属第三医院神经内科自2010年1月至2013年8月收治的经MRI证实的259例新发孤立性脑桥梗死患者的临床资料，按其临床是否发生急性期神经功能缺损进展分为进展组与非进展组，依据头颅磁共振弥散加权成像（DWI）检查所示形态学部位不同分为上部、中部及下部梗死，统计学分析进展组与非进展组患者的危险因素、实验室检查、临床表现及形态学部位的差异，以及形态学部位与急性期神经功能缺损进展的相关性。结果259例孤立性脑桥梗死患者中发生急性期神经功能缺损进展71例（27．4％1，未进展者188例（72．6％）。单因素分析显示：进展组与非进展组患者在实验室检查、美国国立卫生研究院卒中量表评分、治疗措施等方面比较差异均无统计学意义（P〉0．05）；在女性比例[41（57．7％）US．82（43．6％）]及吸烟[10（14．2％）vs 49（26．2％）]、住院时间[（22．72±7．01）vs．（19．42±7．76）d]、短期临床预后不良比例[56（78．87％）VS．64（34．04％）]、下部脑桥梗死发生率[31（43．7％）％57（30-3％）]方面比较差异均有统计学意义（P〈0．05）。Logistic回归分析发现．下部梗死是急性期神经功能缺损进展的独立危险因素（OR=I．952，95％CI：1．081-3．524，P=-0．027）。结论下部梗死可作为孤立性脑桥梗死急性期神经功能缺损进展的预测指标。

Objective To discuss the relationship between topographic location and neurological deterioration （ND） in patients with acute isolated pontine infarction. Methods Two hundred and fifty-nine patients with acute isolated pontine infarction, collected in our hospital from January 2010 to August 2013 and identified by diffusion weighted imaging （DWI）, were included for retrospective review. Patients were divided into two groups according to their clinical symptoms： patients with ND and patients without ND. According to neuroimaging of DWI, the topographic location of pontine infarction was divided into three types： the upper, middle and lower ones; and the correlations of ND with risk factors, laboratory examination results, clinical manifestations and different topographic locations were explored by statistical tests. Results Of 259 patients, 27.4% （71） were diagnosed with ND; 72.6% （188） were diagnosed without ND. Univariate analysis showed that there were no differences in laboratory test results, N1HSS scores and medications between the two groups （P〉0.05）; there were differences in female ratio （41 [57.7%] vs. 82143.6%]）, smoking ratio （10114.2%] vs. 49126.2%]）, mean length of hospital stay （[22.72＋7.01] d vs. [19.42±.76] d）, ratio of worse short-term clinical outcomes （56[78.87%] vs. 64[34.04%]） and ratio of lower pontine infarction （31 [43.7%] vs. 57[30.3%]） between the two groups （P〈0.05）. Logistic regression analysis showed that lower pontine infarction was the independent risk factor of ND （odds ratio=l.952, 95% confidence interval=l.081-3.524, P=0.027）. Conclusion Topographic location of lower pons lesions may be reliable predictor of ND in acuteisolated pontine infarction.