急性颈内动脉系统脑梗死患者侧支循环建立情况与预后关系的研究

The relationship between collateral circulation formation and prognosis in patients with acute cere- bral infarction in the territory of internal carotid artery

目的分析不同程度颈动脉狭窄的急性颈内动脉系统脑梗死患者侧支循环代偿情况及其与临床表现、预后的关系。方法选择急性颈内动脉系统脑梗死患者181例，根据北美有症状颈动脉内膜切除试验（North American symptomatic carotid endarterectomy trial，NASCET）标准将颈动脉狭窄程度分为5级，根据区域软脑膜评分（regional lepomeningeal score，rLMC）将侧支循环建立情况分为3组，然后进行颈动脉狭窄程度与侧支循环代偿程度之间，以及侧支循环代偿程度与梗死灶体积、入院时美国国立卫生研究院神经功能缺损评分（national institute of health stroke scale，NIHSS）评分和出院3个月后日常生活能力（activity of daily living，ADL）评分之间的相关性分析。结果颈动脉狭窄程度与侧支循环开放程度呈正相关（r=0．724，P〈0．01）；侧支循环开放程度与脑梗死病灶体积（r=-0．313，P〈O．01）及患者人院时NIHSS评分（r=-0．504，P〈0．01）呈负相关，与出院3个月后ADL评分（r=0．370，P〈0．01）呈正相关。Logistic回归分析表明糖尿病不利于中度侧支循环开放（OR=1．361，95％CI=1．145～1．902，P=0．029），高脂血症不利于中度（OR=1．050，95％CI=1．011—1．219，P〈0．01）和高度（OR=1．048，95％CI=1．010～1．225，P〈0．01）侧支循环开放。结论供血动脉狭窄程度较重者，侧支代偿较好；糖尿病和高脂血症是影响侧支循环建立的危险因素。良好的侧支代偿血流可以减少梗死灶体积并改善预后。

Objective To analyze the relationship between collateral status and clinical manifesta- tions or prognosis in patients with acute cerebral infarction in the territory of internal carotid artery. Methods 181 patients with acute cerebral infarction in internal carotid arterial were selected. According to the North A- merican Symptomatic Carotid Endartereetomy Trial （NASCET） standard, the degree of carotid stenosis was divided into 5 grades.All patients were divided into 3 subgroups according to the status of collateral circula- tion formation evaluated with the Regional Lepomeningeal Score （rLMC）. The correlations were observed be- tween the degree of carotid stenosis and the compensation level of collateral circulation, and the compensation level of collateral circulation and cerebral infarct volume, and the National Institute of Heahh Stroke Scale （NIHSS） on admission and the Activity of Daily Living（ADL） score at 3 months after stroke onset. Results The degree of carotid stenosis positively correlated with the compensation level of collateral circulation （ r= 0.724, P〈0.01 ）. The compensation level of collateral circulation negatively correlated with infarct volume （ r =-0.313 ,P〈0.01 ） and NIHSS score on admission （ r=-0.504,P〈0.01 ）, but positively correlated with ADL score at 3 months after stroke onset （ r= 0.370,P〈0.01 ）. Diabetes was risk factor for the formation of moder- ate （OR= 1.361,95%CI= 1.145-1.902,P= 0.029） collateral circulation,and hyperlipemia was risk factor for the establishment of moderate （ OR= 1.050,95%CI= 1.011-1.219 ,P〈0.01 ） or poor （ OR= 1.048,95%CI= 1.010-1.225 ,P〈0.01 ） collateral circulation. Conclusion The compensation level of collateral circulation posi-tively correlates with the severity of carotid stenosis. Diabetes and Hyperlipemia are risk factors for the formation of collateral circulation. 3he improvement in the status of collateral circulation can significantly reduce infarct volume and improve prognosis in patients with acute cerebral infarction in the territory of internal carotid artery.