不同分型分水岭脑梗死的CT脑灌注情况及VEGF、VIP水平变化的研究

Cerebral perfusion and changes of VEGF and VIP in patients with different types of watershed cerebral infarction

目的探讨不同分型分水岭脑梗死的CT脑灌注情况及VEGF、VIP水平变化情况。方法选取2015年1月～2017年6月本院收治的148例分水岭脑梗死(cerebral watershed infarction,CWI)患者作为研究对象,其中内分水岭脑梗死(internal watershed infarction,IWSI) 62例,皮层分水岭脑梗死(cortical watershed infarction,CWSI) 86例,对比两组患者的影像学特点、临床特征及外周血细胞因子VEGF、VIP水平。结果 148例CWI患者中有63例(其中IWSI 42例,CW-SI 21例)患者在分水岭梗死区域周围出现大面积异常灌注。与镜像对侧比较,CWI周围异常灌注的TTP、MTT明显延迟,CBF明显降低,均有P <0. 01; CBV比较差异无统计学意义,P> 0. 05。IWSI组周围异常灌注、梗死病灶呈条索状或串珠状、大脑中动脉闭塞或狭窄程度≥50%所占比例明显高于CWSI组,P <0. 05;两组患者在颈内动脉闭塞或狭窄程度≥50%及前、后交通动脉开放比例比较差异无统计学意义,P> 0. 05。出院时,IWSI组患者的NIHSS评分明显高于CWSI组,住院时间长于CWSI组,均有P <0. 05。发病后3个月,IWSI组有22例预后不良,其中有20例进展为同侧大面积脑梗死,CWSI组仅有5例预后不良,两组比较,P <0. 05。治疗后,IWSI组的VEGF水平明显低于CWSI组,VIP水平明显高于CWSI组,P <0. 05。结论检测分水岭脑梗死患者的CT脑灌注情况及外周血VEGF、VIP水平对判断患者的预后具有重要的参考价值。

Objective To investigate the CT cerebral perfusion and the changes of VEGF and VIP in patients with different types of watershed cerebral infarction. Methods From January 2015 to June 2017, 148 patients with cerebral water flow infarction （CWI） admitted to our hospital were enrolled. Among them, 62 cases were internal watershed infarction （IWSI）, 86 were cortical watershed Cerebral infarction （crtical watershed infarction, CWSI）. We compared imaging features, clinical features and peripheral blood cytokines VEGF, VIP levels of patients in two groups. Results Sixty-three of 148 patients with CWI （including 42 with IWSI and 21 with CWSI） developed extensive abnormal perfusion around the watershed infarct. Compared with the opposite side of the mirror image, TTP and MTT of abnormal perfusion around CWI were significantly delayed, CBF was significantly reduced, both P 〈0.01; CBV was no significant difference （ P 〉0.05）. IWSI group appeared the abnormal perfusion, infarction lesions were cord-like or beaded, middle cerebral artery occlusion or stenosis ≥ 50% of the proportion was significantly higher than the CWSI group, P 〈0.05; two groups of patients presented with carotid artery occlusion or stenosis. No significant difference was found in the proportion of ≥50% and the ratio of anterior and posterior was communicating artery opening, P 〉0.05. At discharge, NIHSS scores were significantly higher in IWSI patients than in CWSI patients and longer in hospital than in CWSI patients （ P 〈0.05）. Three months after onset, 22 patients in the IWSI group had a poor prognosis, 20 of them developed ipsilateral large-area cerebral infarction, and only 5 patients in the CWSI group had a poor prognosis （ P 〈0.05）. After treatment, VEGF level in IWSI group was significantly lower than that in CWSI group, VIP level was significantly higher than that in CWSI group, P 〈0.05. Conclusion CT cerebral perfusion and peripheral blood levels of VEGF and VIP in patients with watershed cerebral infarction have important reference value in judging the prognosis of patients.