软脑膜侧支循环与大脑中动脉闭塞脑梗死预后的相关性分析

The correlation analysis between leptomeningeal anastomosis and middle cerebral artery occlusion

目的探讨大脑中动脉(middle cerebral artery,MCA)M1段闭塞的脑梗死患者头颈部CT血管成像所见软脑膜动脉吻合(leptomeningeal anastomosis,LMA)程度与Willis环侧支循环情况之间的关系,以及影响软脑膜侧支循环建立和临床预后的因素。方法回顾性收集2010年1月至2014年12月在本院神经内科住院,经头颈部CT血管成像(computed tomography angiography,CTA)确诊的88例单侧大脑中动脉M1段闭塞的前循环梗死患者的临床资料。(1)根据CTA成像对软脑膜侧支循环进行评分,再根据评分结果将患者分为两组,即侧支循环好组(软脑膜侧支评分为2~3分)和侧支循环差组(软脑膜侧支评分为0~1分)。评估所有患者的Willis环状态(无交通支开放计0分,前循环开放者计1分,病灶侧后循环开放者计2分,前后交通均开放者计3分),比较两组患者Willis环状态的差异,分析Willis侧支开放情况与软脑膜评分之间关系。(2)根据出院时m RS评分将88例患者分为两组,即预后良好组(m RS评分0~1分)和预后不良组(m RS评分≥2分)。分析两组患者的临床资料,与软脑膜侧支吻合的关系以及影响患者预后的因素。结果 88例患者年龄范围为39~79岁,平均(67.4±11.0)岁;男72例,平均年龄(67.0±10.9)岁,女16例,平均年龄(68.9±11.5)岁。侧支循环好组共49例,男38例,女11例;侧支循环差组共39例,男34例,女5例。预后良好组共57例,男47例,女10例;预后不良组共31例,男25例,女6例。(1)侧支循环好组的患者中,无交通支开放9例,前交通支开放10例,后交通支开放14例,前后交通支均开放16例;侧支循环差组中,无交通支开放15例,前交通支开放7例,后交通支开放10例,前后交通支均开放7例。卡方检验显示两组Willis环开放情况差异有显著性(P<0.05)。(2)对软脑膜侧支循环差组与侧支循环好组进行单因素分析发现,软脑膜侧支循环差组有卒中家族史的比例以及入院时体温、血糖水平较高(P=0.015、0.025、0.029),而侧支循环好组的患者出院时NIHSS评分及m RS评分相对更低(P=0.042、0.039),差异有显著性。结论单侧大脑中动脉M1段闭塞的急性前循环梗死患者,LMA评分与Willis环开放呈正相关,即Willis环开放越完全,LMA评分越高,侧支循环越好。软脑膜侧支循环建立良好的前循环梗死患者其短期预后较好;影响软脑膜侧支循环建立的因素包括卒中家族史、入院时体温和血糖水平。

Objective To observe clinical prognostic factors and to investigate the relationship between the extent of leptomeningeal anastomosis （LMA） and the collateral establishment of circle of Wills detected by computed tomography angiography （CTA） in patient with Ml-segment middle cerebral artery （MCA） occlusion. Method All patients confirmed the presence of M1-MCA occlusion by the head and neck computed tomography angiography （CTA） were collected retrospectively in Beijing Friendship Hospital from January 2010 to December 2014. （1） According to the result of scoring in CTA performance, a good set of collateral circulation （pia mater score for 2-3 minutes） and a poor collateral circulation （pia mater score of 0-1）. Assess all patients Willis ring state （no communication branches record 0, the anterior communication record 1, the posterior circulation record 2, the anterior and posterior circulation all opening record 3）. Compare the difference of Willis ring between the two groups. （2） Making mRS as the primary outcome of patients. The patients were divided into the good outcome group （mRS〈2） and the bad outcome group （mRS≥2）. Retrospectively collecting the clinical data of two groups analyzed and compared the influence factors and affecting prognosis. Result 88 cases with MCAO were collected, their years were between 39-79 years old. The average age was （67.40± 11.00） years. There were 72 males （81.81%）, the average was 67.04± 10.92 years and 16 females （18.18%）, the average was 68.88± 11.54 years. （1） The good collateral circulation, there were 9 cases with no communication branches, 10 cases with the anterior communication, 14 cases with the posterior circulation, 16 cases with the anterior and posterior circulation all opening; The poor collateral circulation, 15 cases with no communication branches, 7 cases with the anterior communication, 10 cases with the posterior circulation, 7 cases with the anterior and posterior circulation all opening; Chi-square test between two groups, the result was statistically significant difference between the two groups （P〈0.05）. （2） Compared with the good collateral circulation （LMA≥2） and the poor collateral circulation （LMA〈2）. Single factor analysis showed that family history of stroke, high body temperature and blood glucose level have significant difference between the two groups（P score respectively 0.015, 0.025 and 0.029）. In good collateral circulation, hospital discharge NIHSS and the mRS are lowerer than the poor collateral circulation （P score are 0.042 and 0.039）. Conclusion There are positive correlations between the LMA score and Willis ring condition in M1 segment of MCAO patients. The more completer the Willis ring, the higher the LMA score. There is a good short-term prognosis in good collateral circulation group. Factors influencing the pia mater of collateral circulation are family history of stroke, body temperature and blood glucose level.