穿支动脉型脑梗死的临床特征及预后分析

Chinical Features and Prognosis of Penetrating Artery Type Cerebral Infarction

目的探讨穿支动脉疾病型脑梗死的临床特点、危险因素及预后。方法回顾性分析南方医科大学珠江医院2015年6月—2016年6月神经内科收治的急性脑梗死患者120例,其中穿支动脉疾病(PAD)型脑梗死组60例,大动脉粥样硬化(LAA)型脑梗死组60例,比较PAD组和LAA组患者的危险因素、临床表现、梗死部位分布及预后。结果两组患者性别、年龄的差异无统计学意义(P>0.05);与LAA组相比,PAD组吸烟、饮酒及高脂血症患者明显减少(P<0.05),但糖尿病和高同型半胱氨酸血症患者明显增多(P<0.05);PAD组出现进展性运动功能障碍(PMD)的患者更常见((40.00%vs 20.00%,P<0.05);与LAA组比较,PAD组发病部位多位于侧脑室旁(46.67%vs 23.33%,P<0.05);两组入院及出院NIHSS评分比较差异无统计学意义(P>0.05),随访两组患者发病3个月的改良Rankin量表(mRS)评分无统计学差异(P>0.05)。结论 LAA组患者大多与吸烟率、饮酒率、脂代谢异常等因素有关,而PAD患者多患有糖尿病和高同型半胱氨酸血症,PAD组发病部位多位于侧脑室旁,且早期多出现PMD,但发病3个月预后良好。

Objective To investigate the clinical features, risk factors and outcomes of penetrating artery disease （PAD） cerebral infarction. Methods From June 2015 to June 2016 in the department of neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, a total of 120 patients with cerebral infarction were divided into 60 cases of PAD group and 60 cases of LAA （ large artery atherosclerosis） group. The risk factors, clinical features, distribution characteristics of the infarcts, progressive motor deficits（PMD） and outcome were compared between PAD cerebral infarction and LAA cerebral infarction. Results No statistically significant differences of gender and age was found between the two groups（P 〉0. 05 ） , while smoking rate, drinking rate and hyperlipemia rate of LAA group were statistically significantly higher than those of PAD group （ P 〈 0. 05 ） , No statistically significant differences of incidence of hypertension was found between the two groups （ P 〉 0. 05 ） , incidence of diabetes and hyperhomocysteinemia of PAD group was statistically significantly higher than that of LAA group, respectively. Compared with LAA group, PMD occurred in PAD group more frequently （40. 0 0 % vs 20. 00% , P 〈 0. 05 ） ; lesions were located in the lateral ventricles in most PAD group which was significantly different from LAA group （46. 6 7 % vs 23. 3 3 % , P 〈 0. 05 ） . No statistically significant differences of baseline and discharged from hospital NIHSS score were found between the two groups （ P 〉 0. 05） . Modified Rankin Scale, （ mRS） was not significantly different between two groups （ P 〉0. 05） at 3 months. Conclusion Compared with patients with PAD cerebral infarction, the smoking rate, drinking rate and hyperlipemia were significantly higher in LAA patients （ P 〈 0.05）,while incidence of diabetes and hyperhomocysteinemia of PAD group were statistically significantly higher than that of LAA group （P 〈 0. 05）. The lateral ventricles type infarcts were occurred more frequently in PAD infarction. Patients with PAD cerebral infarction have PMD at early stage but have good prognosis at three months.