大脑后动脉偏侧优势对同侧大脑中动脉病变卒中严重程度及预后的影响

Influence of Posterior Cerebral Artery Laterality on the Prognosis and Severity of Stroke in Patients with Middle Cerebral Artery Stroke

目的探讨同侧大脑后动脉偏侧优势(posterior cerebral artery laterality,PCAL)对同侧大脑中动脉(middle cerebral artery,MCA)M1段严重狭窄或闭塞后急性卒中患者梗死范围、卒中严重程度和短期预后的影响。方法于2010年1月-2015年11月,前瞻性连续性纳入郑州大学第一附属医院MCA M1段严重狭窄(狭窄率70%~90%)或闭塞的161例急性缺血性卒中患者,根据患者有无PCAL分组,比较两组临床基线资料及3个月随访改良Rankin量表(modified Rankin scale,mRS)评分的差异。结果 161例患者中共76例PCAL阳性,85例PCAL阴性。PCAL阳性组既往卒中者少(P=0.021),基于弥散加权成像的Alberta卒中项目早期CT评分(diffusion weighted imaging-Alberta Stroke Programme Early CT Score,DWI-ASPECTS)更高(P=0.045),出院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分更低(P=0.009),3个月mRS评分更低(P=0.002),临床短期预后更好,差异有显著性。多因素Logistic回归分析可见,入院NIHSS评分[OR(odds ratio)1.266,95%CI(confidence interval)1.139~1.407,P<0.01]是预后不良的预测因子,PCAL阳性(OR 0.355,95%CI 0.146~0.864,P=0.022)是预后良好的预测因子。结论 MCA M1段严重狭窄或闭塞的急性缺血性卒中患者,PCAL阳性者梗死范围更小,短期临床预后更好。

Objective To explore the influence of the posterior cerebral artery laterality （PCAL） on the middle cerebral artery （MCA） M1 section severe stenosis or infarct size after occlusion, stroke severity and short-term prognosis. Methods A total of 161 patients with acute ischemic stroke with MCA M1 section severe stenosis （rate of stenosis 70%-90%） or occlusion were included and divided into PCA laterality positive and negative group from Jan 2010 to Nov 2015. The baseline clinical data and modified Rankin Scale （mRS） at 3 months follow-up were compared between the two groups. Results Among the 161 patients, 76 patients presenting PCAL positive and 85 patients presenting negative. In the PCAL positive group, the stroke history was less （P=0.021）; diffusion weighted imaging-Alberta Stroke Programme Early CT Score （DWI-ASPECTS） was higher （P=0.045）; National Institutes of Health Stroke Scale （NIHSS） score at discharge （P=0.009） and mRS score at 3 months were lower （P=0.002）; the short-term prognosis was better, which had significant difference. In the Logistic regression analysis, the NIHSS score at admission [OR （odds ratio） 1.266, 95%CI（confidence interval） 1.139-1.407, P〈0.0 1 ] was the independent predictive factor of poor prognosis, and the PCAL positive （OR 0.355, 95%CI 0.146-0.864, P=0.022） was the predictive factor of good prognosis. Conclusion The smaller infarct size may suggest better short-term prognosis of patients with acute ischemic stroke caused by MCA severe stenosis or occlusion.