大脑中动脉供血区单发皮质下小梗死患者的临床特征分析

Characteristics of single subcortical small infarction in the middle cerebral artery territory

目的探讨大脑中动脉(MCA)供血区不同类型单发皮质下小梗死(SSSI)的临床特征及可能机制。方法回顾性分析自2016年1月至2017年12月在郑州人民医院神经内科住院治疗的MCA供血区SSSI患者的临床和影像学资料。根据载体动脉MCA是否狭窄及轴位DWI-MRI上梗死病灶是否累及基底节最底部,将SSSI分为不同梗死类型,比较不同类型患者的临床及影像学差异。结果91例患者中,伴载体动脉病变(PAD)的SSSI(SSSIPAD)24例(26.37%),不伴PAD的近端SSSI(pSSSI-PAD)28例(30.77%),不伴PAD的远端SSSI(dSSSI-PAD)39例(42.86%)。三组间比较,年龄、高血压、糖尿病、吸烟、NIHSS评分、低密度脂蛋白胆固醇(LDL-C)、梗死层数≥3层、白质高信号、腔隙性梗死、扩大的血管周围间隙、微出血、伴发颅内、外动脉狭窄差异有统计学意义(均P<0.05)。与SSSIPAD(-)相比,SSSIPAD(+)组吸烟、近端SSSI、伴发颅内、外动脉狭窄的比率更高,NIHSS评分和LDL-C更高,梗死直径更大(均P<0.05)。结论MCA供血区不同类型SSSI患者的临床和影像学特征不同。SSSIPAD是SSSI的一种重要类型,pSSSI-PAD具有SSSIPAD和dSSSI-PAD的中间特征,对于此类患者要积极寻找动脉粥样硬化证据。

Objective To investigate the characteristics and possible mechanisms of differtent stroke patterns of single subcortical small infarction(SSSI)in the middle cerebral artery(MCA)territory.Methods The clinical and imaging data of patients with acute SSSI in MCA territory admitted to the Neurology Department of People′s Hospital of Zhengzhou City from January 2016 to December 2017 were retrospectively analyzed.According to the presence of MCA stenosis and whether the lesion sites on axial DWI-MRI involved the lowest basal ganglia,SSSl were divided into different patterns.The clinical and imaging characteristics of patients with different stroke patterns were compared.Results Of the 91 patients,24(26.37%)were SSSI with parental artery disease(SSSIPAD),28(30.77%)were proximal SSSI without PAD(pSSSI-PAD)and 39(42.86%)were distal SSSI without PAD(dSSSI-PAD).There were significant differences in age,hypertension,diabetes mellitus,smoking,NIHSS score,low density lipoprotein cholesterin(LDL-C)level,infarct layers≥3,lesion diameter,white matter hyperintensity,lacunar infarction,enlarged perivascular space,cerebral microbleed,concomitant intracranial and extracranial atherosclerotic stenosis among the three groups(all P<0.05).Compared with SSSIPAD(-),patients with SSSIPAD(+)had significantly higher prevalence of smoking,proximal SSSI,ICAS,ECAS,NIHSS score,LDL-C level and larger lesion diameter(all P<0.05).Conclusions The clinical characteristics and imaging features were different among different SSSI stroke patterns.SSSIPAD is an important infarct type.pSSSI-PAD may showed intermediate features of SSSIPAD and dSSSI-PAD,and evidence of atherosclerosis should be carefully searched for such patients.