脑桥梗死不同病因机制的临床研究

Clinic Study on the Pathogenesis of Pontine Infarction

目的比较不同类型脑桥梗死的病因机制和临床特征。方法选择脑桥梗死患者75例,分为基底动脉狭窄组9例和基底动脉无狭窄组66例,其中基底动脉无狭窄组又分为穿支病变组33例和小动脉病变组33例。比较各组的临床特征与影像学变化。结果在各组的临床特征中,基底动脉狭窄组的糖尿病、冠状动脉粥样硬化性心脏病、合并其他颅内血管中重度狭窄、神经功能缺损进展发生率、入院美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、出院NIHSS评分、出院改良Rankin量表(modified Rankin Scale,m RS)评分≥3比例较其他组增高(P<0.05)。穿支动脉病变组空腹血糖、餐后2 h血糖、糖化血红蛋白、入院收缩压、梗死灶大小、入院NIHSS、出院NIHSS评分、神经功能缺损进展、出院m RS评分比例高于小动脉病变组(P<0.05)。结论脑桥梗死存在不同的病因和发病机制。脑桥旁正中动脉梗死及合并基底动脉狭窄的脑桥梗死病变以动脉粥样硬化为主,病灶大,症状重,易发生进展,预后不良。

Objective To compare the clinical features and the pathogenesis of different types of pontine infarction.Methods A total of 75 patients with pontine infarction were divided into basilar artery stenosis group（n=9） and basilar artery non-stenosis group（n=66）. Among which, basilar artery nonstenosis group were divided into perforating disease group（n=33） and small artery disease group（n=33）. The clinical features and imaging changes of each group were compared.Results The incidence of diabetes mellitus, coronary heart disease, intracranial artery atherosclerotic stenosis, admission National Institutes of Health Stroke Scale（NIHSS） score, discharged NIHSS score and modified Rankin Scale（mR S） score ≥3 were significantly higher in BA stenosis group（P〈0.05）. The incidence of fasting and 2 h postprandial plasma glucose, glycosylated hemoglobin, admission systolic pressure, the infarct size, admission NIHSS and discharged NIHSS score, and mR S score were significantly higher in basilar branch disease group than in small vascular disease group（P〈0.05）.Conclusion There are different causes and pathogenesis of pontine infarction. The lesions of paramedian pontine infarction with basilar artery stenosis are characterized by atherosclerosis, large lesion, severe symptoms, easy progression and poor prognosis.