弥散加权成像阴性脑梗死患者大血管狭窄或闭塞发生率的研究

Incidence rates of large-vessel stenosis or occlusion in patients with diffusion-weighted imaging-negative cerebral infarction

目的阐明弥散加权成像(DWI)阴性脑梗死患者大血管狭窄或闭塞发生率。方法选择在该院神经内科住院的DWI阴性脑梗死患者(DWI阴性组,46例);DWI阳性脑梗死患者(DWI阳性组,357例)。记录两组患者的临床资料和血液学检验结果、头颅磁共振血管成像(MRA)检查结果。结果与DWI阳性组患者相比,DWI阴性组患者表现为偏身运动障碍的比例高,高级皮质功能障碍的比例高,失语的比例低,差异均有统计学意义(P<0.05)。DWI阴性组和DWI阳性组D、D、D的美国国立卫生研究院卒中量表(NIHSS)评分和改良Rankin量表(mRS)评分比较,差异无统计学意义(P>0.05)。DWI阴性组的甘油三酯和叶酸水平低于DWI阳性组,差异均有统计学意义(P<0.05)。DWI阴性组的大脑前动脉、颈内动脉(C~C段)、大脑后动脉狭窄或闭塞的比例低于DWI阳性组脑梗死患者,差异均有统计学意义(P<0.05)。DWI阴性组颅内狭窄或闭塞的动脉总数与DWI阳性组患者相比,差异无统计学意义(P>0.05)。DWI阴性组颈总动脉+颈内动脉(C段)、椎动脉(V~V段)、颅外狭窄或闭塞的血管总数与DWI阳性组患者相比,差异均无统计学意义(P>0.05)。结论DWI阴性脑梗死患者发生颅内、颅外大血管狭窄或者闭塞的概率可能并不低于DWI阳性脑梗死患者。

Objective To clarify the incidence rates of large-vessel stenosis or occlusion in patients with diffusion-weighted imaging(DWI)-negative cerebral infarction.Methods A total of 46 patients with DWI-negative cerebral infarction(DWI-negative group)and 357 patients with DWI-positive cerebral infarction(DWI-positive group)who were hospitalized in the Department of Neurology of our hospital were selected.The clinical data,hematology test results,and brain magnetic resonance angiography results of these patients were recorded.Results Compared with patients in the DWI-positive group,patients in the DWI-negative group had significantly higher proportions of hemiataxia and advanced cortical dysfunction,and a significantly lower proportion of aphasia(P<0.05).There was no significant difference in National Institutes of Health Stroke Scale score and modified Rankin scale score on D,Dand Dbetween the DWI-negative group and the DWIpositive group(P>0.05).The triglyceride and folic acid levels in the DWI-negative group were significantly lower than those in the DWI-positive group(P<0.05).The proportion of anterior cerebral artery,internal carotid artery(C-Csegment),and posterior cerebral artery stenosis or occlusion in the DWI-negative group was significantly lower than that in the DWI-positive group(P<0.05).There was no significant difference in the total number of intracranial arteries with stenosis or occlusion between the DWI-positive group and the DWI-negative group(P>0.05).There was no significant difference in the total number of common carotid artery internal carotid artery(Csegment),vertebral artery(V-Vsegment)and extracranial vessels with stenosis or occlusion between the DWI-negative group and the DWI-positive group(P>0.05).Conclusions The probability of developing large intracranial and extracranial vessel stenosis or occlusion in DWI-negative cerebral infarc-tion may not be lower than in DWI-positive cerebral infarction.