脉络膜前动脉供血区梗死临床进展及预后的影响因素

Influencing factor of clinical progress and prognosis of anterior choroidal artery blood supply area infarction

目的探讨进展性脉络膜前动脉供血区新发脑梗死的可能机制及临床预后。方法回顾性分析2014年6月~2016年2月经北京潞河医院神经内科诊治的113例经CT或MRI证实的脉络膜前动脉供血区梗死患者,根据入院后的病情变化,将所有患者分成两组:进展性脑卒中组(49例)和非进展性脑卒中组(64例)。所有患者均进行危险因素的采集,完善血管评估,对两组患者的危险因素及血管情况进行比较,探索脑卒中进展的可能原因及机制,并随访6个月,比较两组预后。结果进展性脑卒中组患有高血压、糖尿病、高脂血症(即"三高")的患者明显多于非进展性脑卒中组(P=0.039)。进展性脑卒中组患有冠心病或房颤等心脏疾病的比例明显高于非进展性脑卒中组(P=0.027)。进展性脑卒中组患者颈动脉狭窄及斑块发生率明显高于非进展性脑卒中组(P<0.05)。进展性脑卒中组患者出院时NIHSS评分明显高于非进展性脑卒中组,且6个月后预后差于非进展性脑卒中组(P<0.05)。结论脉络膜前动脉供血区脑梗死易出现临床进展,其临床进展与"三高"、心脏疾病、颈动脉斑块及狭窄有关。进展性脑卒中组患者预后较非进展性脑卒中组差。

Objective To explore the possible mechanism and the prognosis of progressive infarction in the anterior choroidal artery（ACh A） territory. Methods 113 patients with infarction in the ACh A territory, admitted to Beijing Luhe Hospital from June 2014 to February 2016, confirmed by brain computed tomography（CT） or magnetic resonance imaging（MRI） were retrospectively analyzed. All the patients enrolled were divided into two groups： progressive infarction group（49 cases） and no progressive infarction group（64 cases）. Cerebral infarction related risk factors were collected and cerebral vascular evaluations were done in all the patients. Then cerebral infarction related risk factors and cerebral vascular conditions were compared between two groups in order to explore the causes and mechanisms of the progressive infarction. All the patients were followed up for 6 months and the prognosis were compared between two groups.Results Patients with hypertension, diabetes and hyperlipidemia（known as ＂three high disease＂） were obviously more in the progressive infarction group than in the no progressive infarction group（P = 0.039）. Patients with heart disease were also significantly more in the progressive infarction group（P = 0.027）. The national institute of health stroke scale（NIHSS） score of patients in the progressive infarction group were higher at discharge, and patients in the progressive infarction group had worse prognosis than those in no progressive infarction group. Conclusion Neurological deteriora tion is frequent in the ACh A infarction. ＂Three high disease＂, heart disease and carotid atherosclerotic plaque and（or）stenosis are associated with the progress of ACh A infarcts. Patients with progressive ACh A infarction has worse prognosis than those with no progressive ACh A infarction.