大脑中动脉狭窄患者软脑膜动脉侧支循环与脑梗死的相关性研究

Association between leptomeningeal collateral circulation and cerebral infarction in patients with middle cerebral artery stenosis

目的观察软脑膜吻合(leptomeningeal anastomoses,LMA)侧支循环在单侧大脑中动脉(middle cerebral artery,MCA)M1段狭窄患者中的代偿特点,探讨侧支循环代偿程度与是否出现新发脑梗死之间的相关性。方法采用磁共振血管成像(magnetic resonance angiography,MRA)回顾性分析单侧MCA M1段狭窄的患者114例,根据是否有新发脑梗死灶分为脑梗死组68例和非脑梗死组46例。通过MRA评价狭窄同侧大脑前动脉(anterior cerebral artery,ACA)和大脑后动脉(posterior cerebral artery,PCA)偏利现象,即LMA代偿程度,研究其对脑梗死发病的影响。结果脑梗死组与非脑梗死组患者年龄[(63.00±11.53)岁vs(68.98±10.28)岁]、ACA评分、MCA狭窄程度分级比较,差异有统计学意义(P<0.05)。多因素回归分析显示,ACA评分低(OR=0.390,95%CI:0.154~0.987,P=0.047)、MCA M1狭窄程度重(OR=2.421,95%CI:1.324~4.428,P=0.004)和年龄(OR=0.933,95%CI:0.892~0.976,P=0.003)是脑梗死的独立危险因素。结论 MCA狭窄后,ACA-MCA侧支循环建立良好的患者,MCA分布区发生脑梗死的概率低。

Objective To study the association between leptomeningeal anastomosis（LMA）collateral circulation and cerebral infarction in patients with middle cerebral artery（MCA）M1-segment stenosis by observing the compensatory characteristics of LMA collateral circulation.MethodsOne hundred and fourteen MCA M1-segment stenosis patients were divided into cerebral infarction group（n=68）and cerebral infarction-free group（n=46）.The hemilateral phenomenon of homolateral anterior cerebral artery（ACA）stenosis and posterior cerebral artery stenosis was assessed and its effect on the incidence of cerebral infarction was studied according to its magnetic resonance angiography.Results The ACA score and MCA stenosis severity were significantly different between cerebral infarction group and cerebral infarction-free group（P〈0.05）.Multivariate logistic regression analysis showed that low ACA score and MCA M1-segment stenosis were two independent risk factors for cerebral infarction（OR=0.390,95%CI：0.154-0.987;OR=2.421,95%CI：1.324-4.428,P〈0.01）.Conclusion The incidence of cerebral infarction is low in MCA M1-segment stenosis patients with good ACA collateral circulation.