大脑后动脉供血区脑梗死147例的病因和梗死模式

Etiologies and patterns of posterior cerebral artery territory infarcts among 147 patients

目的分析大脑后动脉(PCA)梗死的病因和梗死模式构成。方法回顾性分析147例PCA供血区梗死患者,将其分入单纯PCA梗死组(105例)和多发梗死组(42例),比较两组间脑血管病危险因素、病因、梗死模式的差异。结果多发梗死组中既往有脑梗死(31.0%)和心脏病史的患者比例(42.9%)均显著高于单纯PCA梗死组(分别为11.4%和21.0%,P值均<0.01)。147例患者中,最常见的致病原因为大动脉粥样硬化(LAA,占44.2%);多发梗死组中心源性栓塞(CE)的患者比例(28.6%)显著高于单纯PCA梗死组(13.3%,P<0.01),而小动脉闭塞(SVO)的患者比例(0)显著低于单纯PCA梗死组(35.2%,P<0.01)。147例患者中,梗死模式以丘脑梗死最多见(占63.9%),其次为枕叶(32.7%);多发梗死组中深穿支梗死的患者比例(21.4%)显著低于单纯PCA梗死组(56.2%,P<0.01),而皮层梗死的患者比例(50.0%)显著高于单纯PCA梗死组(18.1%,P<0.01)。结论中国人PCA供血区梗死最常见的病因可能是LAA,最常见的梗死部位是丘脑,后循环供血区单纯PCA梗死与多发梗死患者间病因和梗死模式的构成不同。

Objective To investigate etiologies and patterns of posterior cerebral artery （PCA） territory infarction. Methods A retrospective study was carried out among 147 patients with PCA territory infarction, and they were divided into pure PCA infarction （PPI） group and multiple infarction （MI） group. The risk factors of cerebrovascular diseases, etiologies and infarct patterns were compared between two groups. Results There were a higher proportion of previous stroke history and heart disease in MI group than PPI group （31.0% vs. 11.4%, 42.9% vs. 21.0%, both P〈0.01）. The most frequent etiology was large artery atherosclerosis （LAA, 42.2%）. There was a higher incidence of cardiogenic embolism （CE） in MI group than PPI group （28.6% vs. 13.3 %, P〈0.01）, while a lower incidence of small vessel occlusion （SVO, 0 vs. 35.2 %, P〈0.01 ）. The most common location of cerebral infarction was thalamus （63.9%）, followed by occipital lobe （32.7%）. There was a higher prevalence of superficial infarct in MI group than PPI group （50.0% vs. 18.1%, P〈0.01）, while a lower incidence of deep infarction （21.4% vs. 56.2%, P〈0.01）. Conclusion LAA is the most common etiology of PCA territory infarction in Chinese population, and the thalamus is the most common infarction area. There are various constituent ratios of etiology and infarct pattern between pure PCA territory infarction and multiple infarction in posterior cerebral circulation. （Shanghai Med J, 2016, 39： 425-429）