大脑中动脉供血区缺血性轻型卒中回顾性研究

Retrospective study of mild ischemic stroke in supply area of middle cerebral artery

目的探讨非大脑中动脉(MCA)狭窄的豆纹动脉梗死发生早期神经功能恶化(END)的特点,为预测该类患者发生早期神经功能恶化提供依据。方法222例脑梗死患者,根据住院最初7 d是否发生END分为END组(44例)和非END组(178例)。回顾性分析两组患者在高血压病、糖尿病、血脂、吸烟、大量饮酒、年龄、脂蛋白相关磷脂酶A2(Lp-PLA2)、脑梗死灶特点(单发/多发)、早期抗血小板治疗(<6 h)等方面是否存在差异,并应用Logistic回归分析,查找非MCA狭窄的豆纹动脉梗死发生END的预测因素。结果通过单因素分析显示,END组患者的高血压病、糖尿病、早期双抗血小板(<6 h)、单发梗死灶占比分别为61.4%、36.4%、72.7%、68.2%,均高于非END组的42.7%、20.8%、56.2%、38.2%,Lp-PLA2水平(49.5±4.4)μg/ml高于非END组的(35.4±7.8)μg/ml,差异具有统计学意义(P<0.05)。经过多因素Logistic回归分析,早期双抗血小板(<6 h)、Lp-PLA2、单发梗死灶为发生END的影响因素(P<0.05)。结论非MCA狭窄的MCA供血区的轻型卒中或者短暂性脑缺血发作(TIA)患者,早期双抗血小板治疗(<6 h)能更好地减少END发生;单发脑梗病灶和Lp-PLA2水平升高是该类型轻型卒中发生END的预测因素。

Objective To discuss the characteristics of early neurological deterioration(END)in nonmiddle cerebral artery(MCA)stenosis of the lenticulostriate artery infarction,and provide a basis for predicting the early neurological deterioration of such patients.Methods 222 patients with cerebral infarction were divided into END group(44 cases)and non-END group(178 cases)according to whether END occurred in the first 7 d of hospitalization.The differences in hypertension,diabetes mellitus,blood lipid,smoking,heavy drinking,age,lipoprotein associated phospholipase A2(Lp-PLA2),characteristics of cerebral infarction(single/multiple),and early antiplatelet therapy(<6 h)between the two groups were analyzed retrospectively.Logistic regression analysis to find the predictive factors of END in non-MCA stenosis of the lenticulostriate artery infarction.Results Univariate analysis showed that the proportions of hypertension,diabetes mellitus,early dual antiplatelet(<6 h)and single infarct in END group were 61.4%,36.4%,72.7%and 68.2%respectively,which were higher than those of non-END group 42.7%,20.8%,56.2%,38.2%,and Lp-PLA2 level(49.5±4.4)μg/ml was higher than that of non-END group(35.4±7.8)μg/ml,the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that early dual antiplatelet therapy(<6 h),Lp-PLA2 and single infarction were the influencing factors for END(P<0.05).Conclusion In patients with mild stroke or transient ischemic attack(TIA)in the MCA blood supply area without MCA stenosis,early dual antiplatelet therapy(<6 h)can better reduce the occurrence of END.Single cerebral infarction and elevated Lp-PLA2 level are the predictors of end in this type of mild stroke.