脉络膜前动脉供血区脑梗死静脉溶栓效果分析

Clinical Analysis of Intravenous Thrombolysis in Anterior Choroidal Artery Territory Stroke

目的探讨脉络膜前动脉供血区脑梗死临床特点及静脉溶栓效果。方法回顾性分析23例MRI-DWI证实的脉络膜前动脉供血区脑梗死,根据病情是否出现波动,分为进展组及非进展组,分析其临床特点、加重因素、应用阿替普酶(重组组织型纤溶酶原激活剂,rt-PA)的效果及90 d预后。结果 23例病人均于发病4.5 h内给予静脉溶栓治疗,非进展组6例经治疗后症状好转/无进展,进展组17例病人在发病最初3 d内出现症状波动,合并糖尿病的病人更容易出现病情进展。进展组与非进展组入院时及溶栓1 h美国国立卫生研究院卒中量表(NIHSS)评分差异无统计学意义,但出院时NIHSS评分相比有统计学意义(P<0.05),进展组更重。进展组与非进展组90 dmRS评分具有统计学意义,进展组病人预后良好占88.2%,非进展组的病人90 d全部预后良好。结论脉络膜前动脉供血区梗死多以运动受累为主要表现,73.9%的病人在发病最初3 d内有症状波动,但经溶栓治疗,病人90 d预后良好,仍应积极进行溶栓治疗。

Objective To explore the clinical characteristics and the effect of intravenous thrombolysis therapy of the anterior choroidal artery（AChA）territory stroke.Methods Retrospective analysis of 23 cases of AChA territoty stroke confirmed by magnetic resonance imaging（MRI）-diffusion-weighted imaging（DWI）,which was divied into unprogressive group and progressive group,the clinical features,fluctuation factors,effects of actilyse（recombinant human tissue plasminogen activator for injection,rt-PA）,and prognosis for 90 days were analyzed.Results Twenty-three cases were given rt-PA intravenous thrombolytic therapy in 4.5 hours after clinical onset,6 cases symptoms stabilized or improvement after treatment.The symptoms of 17 patients are fluctuate within the first 3 days of the onset of symptoms.Patients with diabetes mellitus were more prone to disease progression.There was statistic difference in National Institutes of Health Stroke Scale（NIHSS）score between unprogressive group and progressive group at discharge（P 〈0.05）.NIHSS score in progressive group was higher than that in unprogressive group.There was statistic difference in modified Rankin scale（mRS）score after 90 days of onset between unprogressive group and progressive group.The rate of good prognosis was 88.2%in progressive group and 100%in the other group.Conclusion Motor function damage is the main clinical manifestations in patients of AChA infarction.73.9% of patients had symptomatic fluctuations or aggravation within the first 3 days of onset.Rt-PA itrravenous thrombolysis should be applicated actively because the good prognosis at 90 days after onset.