脑侧支循环形成对急性脑梗死患者近期神经功能的影响

Effect of cerebral collateral circulation on early neurological function in patients with acute cerebral infarction

目的 探讨侧支循环的形成对急性脑梗死患者近期神经功能的影响。方法 选择2015年1月至2016年6月于华北理工大学附属医院神经内科住院治疗的急性脑梗死患者225例。经头部CT或磁共振成像确诊，将急性脑梗死患者分为前循环病变患者和后循环病变患者；采用头颈部256层螺旋CT血管造影检查对脑侧支循环形成进行评估，根据结果将患者分为有侧支循环形成组和无侧支循环形成组。分别采用美国国立卫生研究院卒中量表（NIHSS）评分标准及日常生活活动能力（ADL）量表评估患者入院时及治疗14 d时神经功能情况。结果 前循环病变患者128例（56.9%），后循环病变患者97例（43.1%）。在前循环病变患者中，侧支循环形成组77例（60.2%），无侧支循环形成组51例（39.8%）；在后循环病变患者中，有侧支循环形成组38例（39.2%），无侧支循环形成组59例（60.8%）。在前循环病变患者中，有侧支循环形成患者比例高于后循环病变患者，差异有统计学意义（P=0.002）。在急性脑梗死患者中，有侧支循环形成组入院时NIHSS评分及ADL缺陷程度与无侧支循环形成组比较，差异无统计学意义（P＜0.05）。在前循环病变患者和后循环病变患者中，有侧支循环形成组治疗14 d时NIHSS评分［（3.6±2.3）分比（5.0±2.6）分、（3.7±2.4）分比（5.0±3.4）分］及ADL缺陷程度均明显低于无侧支循环形成组，差异均有统计学意义（均P＜0.05）。结论 侧支循环形成有利于急性脑梗死患者，特别是前循环急性脑梗死患者近期神经功能恢复。

Objective To investigate the effect of collateral circulation on early neurological function in patients with acute cerebral infarction. Methods Totally 225 patients with acute cerebral infarction in North China University of Science and Technology Affiliated Hospital were enrolled from January 2015 to June 2016. Anterior and posterior circulation lesions were diagnosed by CT or magnetic resonance imaging examination; cerebral collateral circulation was evaluated by 256 slice spiral CT angiography. The degree of neurological deficits was evaluated by the National Institute of Health Stroke Scale（NIHSS） and Activities of Daily Living（ADL） before and 14 d after hospitalization. Results There were 128 cases（56.9%） of anterior circulation lesion（group A） and 97 cases（43.1%） of posterior circulation lesion（group B）. Group A had 77 cases（60.2%） of collateral circulation; group B had 38 cases（39.2%） of collateral circulation; the collateral circulation rate in group A was significantly higher than that in group B（P=0.002）. In 225 cases, NIHSS and ADL scores had no significant differences between patients with and without collateral circulation（P〉0.05）. In group A and group B, the NIHSS score[（3.6±2.3）points vs （5.0±2.6）points, （3.7±2.4）points vs （5.0±3.4）points] and ADL score after 14 d of hospitalization in patients with collateral circulation were significantly lower than those in patients without collateral circulation（P〈0.05）. Conclusion Collateral circulation is beneficial to early recovery of neurological function in patients with acute cerebral infarction, especially in anterior circulation infarction.