大脑中动脉狭窄程度与脑梗塞类型的关系研究

Research on Correlation between the Middle Cerebral Artery Stenosis Degree and Cerebral Infarction Type

目的研究大脑中动脉(middle cerebral artery,MCA)动脉粥样硬化所致狭窄程度与脑梗塞类型的关系。方法对2012年1月—2015年12月该院收治的324例大脑中动脉狭窄的急性脑梗塞患者进行分析,按照动脉分支支配区域的单发性梗死、分水岭梗塞及多发性梗塞,对照研究大脑中动脉主干的狭窄程度,以探讨脑梗塞病变模式与大脑中动脉狭窄程度的关系以及其发病机制。结果分水岭梗塞及多发性梗塞大脑中动脉重度狭窄率(分别为33.3%和42.5%)高于单发性梗塞(11.7%),差异有统计学意义(P=0.004,P=0.001)。分水岭脑梗塞与多发性脑梗塞的大脑中动脉重度狭窄的比率没有明显的差别,差异无统计学意义(P=0.405)。穿支动脉梗死的患者大脑中动脉重度狭窄的比率与其他原因的单发性梗塞(PI+LTI)患者(分别为0.7%,46.5%)、多发性脑梗塞梗死患者(分别为0.7%,42.5%)、内分水岭梗塞患者(分别为0.7%和53.3%),差异有统计学意义(P<0.01)。大脑中动脉重度狭窄的程度在不同脑梗塞模式之间差异有统计学意义(P=0.000)。结论大脑中动脉狭窄致穿支动脉梗塞最常见,但是大脑中动脉的狭窄程度与穿支动脉梗塞的发生率没有正相关性;大脑中动脉重度狭窄易导致分水岭梗死,其中内分水岭梗死最为常见;大脑中动脉重度狭窄是导致大面积梗死重要原因之一。

Objective To study the correlation between the middle cerebral artery stenosis degree and cerebral infarction type. Methods 324 cases of patients with middle cerebral artery stenosis degree and cerebral infarction type admitted and treated in our hospital from January 2012 to December 2015 were selected, and the correlation between the cerebral infarction lesion model and middle cerebral artery stenosis degree and pathogenesis were studied according to the single infarctional dementia, cerebral watershed infarction and multiple infarctional dementia in the artery branch. Results The severe stenosis of middle cerebral artery of cerebral watershed infarc- tion and multiple infarctional dementia were higher than that of single infarctional dementia（33.3% vs 42.5% vs 11.7%）, and the dif- ferences were statistically significant （P=0.004,P=0.001）, and there was no obvious difference in the severe stenosis between middle cerebral artery of cerebral watershed infarction and multiple infarctional dementia, and the difference was not statistically significant （P=0.405）, and the severe stenosis between middle cerebral artery ratio of patients with perforating artery infarct and patients withPI＋LTI caused by the other causes was respectively （0.7% and 46.5%）, patients with multiple infarctional dementia （0.7% and 42.5%）, and patients with cerebral watershed infarction （0.7% and 53.3%）（P〈0.01 ）, and the differences were obvious, and the differ- ence in the severe stenosis between middle cerebral artery between different cerebral infarction models was obvious with statistical significance（P=-0.000）. Conclusion Perforating artery infarction caused by the middle cerebral artei2 stenosis is the most common, but the middle cerebral artery stenosis degree has no positive correlation with the incidence rate of perforating artery infarction, and the cerebral watershed infarction is the most common, and the severe middle cerebral artery stenosis is one of the most important factors of massive cerebral infarction.