脉络膜前动脉供血区梗死:梗死大小及其相关因素

Anterior choroidal artery territory infarction:infarct size and its related factors

目的探讨脉络膜前动脉(anterior choroidal artery,AchA)供血区梗死患者梗死灶大小及其相关因素。方法回顾性纳入2016年4月至2018年4月期间在徐州医科大学附属沭阳医院神经内科住院治疗的连续急性AchA供血区梗死患者。应用美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评估基线严重程度,通过弥散加权成像确定梗死灶侧别、部位、大小和形态。将患者分为小梗死灶组(<20 mm)和大梗死灶组(≥20 mm)。采用多变量logistic回归分析确定梗死灶大小的独立危险因素。结果共纳入100例急性AchA供血区梗死患者,小梗死组86例(86.0%),大梗死组14例(14.0%)。基于NIHSS评分,轻度卒中89例,中度卒中9例,重度卒中2例。根据弥散加权成像,前后索条状梗死灶69例(69.0%),其他形态梗死灶31例(31.0%)。大梗死组基线NIHSS评分[7.0(2.0~10.5)分对3.0(2.0~4.0)分;Z=2.353,P=0.019]以及重度卒中的患者比例(14.3%对0%;P=0.018),侧脑室旁后部(85.7%对57.0%;χ^2=4.180,P=0.041)和苍白球内侧(21.4%对4.7%;χ^2=5.206,P=0.023)梗死以及索条状梗死(92.9%对65.1%;χ^2=4.332,P=0.037)的患者比例显著高于小梗死组;白细胞计数[(7.7±1.7)×10^9/L对(6.6±1.8)×10^9/L;t=2.214,P=0.036]和血小板计数[(234.5±39.5)×10^9/L对(198.0±49.4)×10^9/L;t=2.618,P=0.010]显著高于小梗死组;存在感觉障碍的患者比例显著高于小梗死组(50.0%对24.4%;χ^2=3.908,P=0.048)。多变量logistic回归分析显示,血小板计数(优势比1.018,95%可信区间1.000~1.621;P=0.044)和卒中严重程度(优势比18.245,95%可信区间1.534~217.052;P=0.022)与梗死灶大小呈显著独立正相关。结论AchA供血区梗死患者梗死灶大小与感觉障碍、基线NIHSS评分、卒中严重程度、梗死灶形态和部位以及血白细胞和血小板计数有关,其中血小板计数和卒中严重程度与梗死灶大小的独立正相关。

Objective To investigate the infarct size and its related factors in patients with anterior choroidal artery(AchA)territory infarction.Methods From April 2016 to April 2018,consecutive patients with acute AchA territory infarction hospitalized in the Department of Neurology,the Affiliated Shuyang Hospital of Xuzhou Medical University were enrolled retrospectively.The National Institutes of Health Stroke Scale(NIHSS)was used to assess the severity of the disease at baseline,and the Diffusion-Weighted Imaging(DWI)was used to determine the side,location,size,and morphology of the infarct lesions.The patients were divided into small infarction group(<20 mm)and large infarction group(≥20 mm).Multivariate logistic regression analysis was used to determine the independent risk factors for infarct size.Results A total of 100 consecutive patients with acute AchA territory infarction were enrolled,including 86(86.0%)in small infarction group,14(14.0%)in large infarction group.Based on the NIHSS score,there were 89 patients with mild stroke,9 with moderate stroke,and 2 with severe stroke.According to DWI,69 patients(69.0%)had long cord-like infarcts and 31(31.0%)had other shapes of infarcts.The baseline NIHSS score(7.0[2.0-10.5]vs.3.0[2.0-4.0];Z=2.353,P=0.019)and the proportion of patients with severe stroke(14.3%vs.0%;P=0.018),the infarcts in posterior part of periventricular area(85.7%vs.57.0%;χ^2=4.180,P=0.041)and medial globus pallidus(21.4%vs.4.7%;χ^2=5.206,P=0.023),and cord-like infarction(92.9%vs.65.1%;χ^2=4.332,P=0.037)in patients of the large infarction group were significantly higher than those of the small infarction group;leukocyte count(7.7±1.7×10^9/L vs.6.6±1.8×10^9/L;t=2.214,P=0.036)and platelet count(234.5±39.5×10^9/L vs.198.0±49.4×10^9/L;t=2.618,P=0.010)were significantly higher than those of the small infarction group;the proportion of patients with sensory impairment was significantly higher than that of the small infarction group(50.0%vs.24.4%;χ^2=3.908,P=0.048).Multivariate logistic regression analysis showed that platelet count(odds ratio 1.018,95%confidence interval 1.000-1.621;P=0.044)and stroke severity(odds ratio 18.245,95%confidence interval 1.534-217.052;P=0.022)were significantly and positively correlated with the infarct size.Conclusion The related factors of the infarct size in patients with AchA territory infarction included sensory impairment,baseline NIHSS score,stroke severity,morphology and location of infarct lesions,and leukocyte and platelet counts,of which platelet count and stroke severity were independently positively correlated with the infarct size.