同侧大脑后动脉偏侧优势与大脑中动脉供血区缺血性卒中患者转归的相关性

Correlation between ipsilateral posterior cerebral artery laterality and outcome in patients with acute ischemic stroke in the middle cerebral artery territory

目的 ：探讨同侧大脑后动脉偏侧优势（posterior cerebral artery laterality,PCAL）与大脑中动脉（middle cerebral artery,MCA）供血区缺血性卒中患者转归的相关性.方法 纳入2015年6月至2016年12月期间在合肥市第二人民医院住院的MCA供血区急性缺血性卒中患者,应用磁共振血管造影评估PCAL,在发病后3个月时采用改良Rankin量表进行转归评价,0～2分定义为转归良好,〉2分定义为转归不良.应用多变量logistic回归分析确定转归的独立影响因素.结果 共纳入111例MCA供血区缺血性卒中患者,其中47例（42.3％）存在PCAL,30例（27.0％）转归不良.PCAL组基线NIHSS评分显著低于非PCAL组[（5.13±3.29）分对（7.03±5.676）分;t=2.058;P=0.042].转归良好组糖尿病（29.6％ 对10.0％;χ2=4.583,P=0.032）、PCAL（51.9％ 对16.7％;χ2=11.101,P=0.001）和吸烟（25.9％ 对13.3％;χ2=4.943,P=0.026）患者的构成比以及年龄[（63.9±11.8）岁对（71.0±6.7）岁;t=2.688,P=0.007]、基线舒张压[（89±13）mmHg对（82±10）mmHg;t=-2.249,P=0.025;1 mmHg=0.133 kPa]和基线NIHSS评分[（5.02±3.67）分对（9.47±6.20）分;t=3.883,P〈0.001]与转归不良组差异有统计学意义.多变量logistic回归分析显示,PCAL与转归良好独立相关[优势比（odds ratio,OR）0.272,95％ 可信区间（confidence interval,CI）0.083～0.888;P=0.031],而高龄（OR 1.088,95％CI 1.022～1.157;P=0.008）和高基线NIHSS评分（OR 1.224,95％CI 1.077～1.391;P=0.002）与转归不良独立相关.结论 PCAL与大脑中动脉供血区缺血性卒中患者转归良好独立相关.

Objective To investigate the correlation between ipsilateral posterior cerebral artery laterality （PCAL） and the outcomes in patients with ischemic stroke in the middle cerebral artery （MCA） territory. Methods From June 2015 to December 2016, patients with acute ischemic stroke in the MCA territory admitted to the Second People＇s Hospital of Hefei were enrolled. Magnetic resonance angiography （MRA） was used to assess PCAL. The outcome was evaluated by the modified Rankin scale at 3 months after onset. 0-2 was defined as good outcome and 〉 2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results A total of 111 patients with ischemic stroke in MCA territory were enrolled, including 47 （42. 3%） PCAL and 30 （27. 0%） poor outcomes. The baseline NIHSS score in the PCAL group was significantly lower than that in the non-PCAL group （5. 13 ± 3. 29 years vs. 7. 03 ± 5. 676 years, t = 2. 058; P = 0. 042）. There were significantly differences in the proportion of diabetes mellitus （29. 6% vs. 10. 0%; χ2 = 4. 583, P = 0. 032）, PCAL （51. 9% vs. 16. 7%;χ2 = 11. 101, P = 0. 001） and smoking （25. 9% vs. 13. 3%; χ2 = 4. 943, P = 0. 026）, as well as age （63. 9 ± 11. 8 years vs. 71. 0 ± 6. 7 years; t = 2. 688, P = 0. 007）, baseline diastolic blood pressure （89 ± 13 mmHg vs. 82 ± 10 mmHg; t = -2. 249, P = 0. 025; 1 mmHg = 0. 133 kPa） and baseline NIHSS score （5. 02 ± 3. 67 vs. 9. 47 ± 6. 20; t = 3. 883, P 〈 0. 001） between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that PCAL was associated independently with good outcome （odds ratio [OR] 0. 272, 95% confidence interval [CI] 0. 083-0. 888; P = 0. 031）, while advanced age （OR 1. 088, 95% CI 1. 022-1. 157; P = 0. 008） and high baseline NIHSS score （OR 1. 224, 95% CI 1. 077-1. 391; P = 0. 002） were associated independently with poor outcome. Conclusion PCAL is associated independently with good outcome in patients with ischemic stroke in MCA territory.