急性脑桥旁正中梗死运动功能缺损进展的预测因素

Predictive factors for progressive motor deficits in acute paramedian pontine infarction.

目的探讨脑桥旁正中梗死急性期运动功能缺损进展(progressive motor deficits,PMDs)的危险因素。方法2017年12月至2020年12月,在本院连续入组发病24 h内的脑桥梗死患者。入院后1周内每日行美国国立卫生院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分,若其中运动项目评分较入院增加≥1分则纳入进展组,反之为非进展组。比较两组患者人口统计学、临床资料和影像学特征,采用单因素分析及多因素logistic回归分析。结果共纳入脑桥旁正中梗死患者109例,31例出现PMDs。单因素分析提示:进展组与非进展组在入院时吞咽障碍[14(45.1%)vs.14(17.9%)]、最大梗死灶位置处于脑桥下部[19(61.3%)vs.25(32.1%)]、病灶累及腹侧[19(61.3%)vs.22(28.2%)]及病因分型[小动脉疾病11(35.5%)vs.52(66.7%)、基底动脉分支动脉疾病16(51.6%)vs.19(24.4%)]方面,差异具有统计学意义(P<0.05)。多因素logistic回归分析提示病灶累及脑桥腹侧(OR=3.453,95%CI:1.402~8.505,P=0.007)、最大梗死灶位置处于脑桥下部(OR=2.795,95%CI:1.134~6.887,P=0.026)是发生PMDs的危险因素。结论病灶累及脑桥腹侧、最大梗死灶位置处于脑桥下部可预测脑桥旁正中梗死患者运动缺损进展。

Objective Paramedian pontine infarction(PPI)is the most common subtype of pontine stroke.Some of the patients with PPI experienced progressive motor deficits(PMDs)during hospitalization.This study was designed to explore the risk factors of PMDs in patients with PPI.Methods This is a prospective single-center cohort study,which enrolled consecutive patients with PPI admitted within 24 hours after onset to Guangzhou Panyu District He Xian Memorial Hospital,from December,2017 to December 2020.Magnetic resonance images(composed of T1 weighted image,T2 weighted image,T2-FLAIR,diffusion-weighted imaging,and apparent diffusion coefficient)were used to evaluate the infarct site.According to the changes of motor scores in National Institutes of Health Stroke Scale(NIHSS),patients were divided into PMD group and non-PMD group.If the motor scores of NIHSS increased by≥1 point within 1 week after hospitalization,compared to the one on admission,the patient would be in PMD group.Demographics,clinical data and imaging features of the two groups were compared,and single factor analysis and multivariate logistic regression analysis were used to investigate the independent risk factors of PMDs in acute paramedian pontine infarction.Results A total of 109 patients with PPI were enrolled,of which 31 cases(28.4%)experienced PMDs.Univariate analysis showed that there were no significant differences between the PMD group and the non-PMD group in demographics,clinical data,NIHSS score on admission,and complication of vertebrobasilar dolichoectasia(VBD)(P>0.05).Meanwhile,there were statistically significant differences in dysphagia on admission[14(45.1%)vs 14(17.9%)],the location of the largest infarct core[19(61.3%)vs 25(32.1%)],whether base of the pons was involved[19(61.3%)vs 22(28.2%)]and etiological classification(small artery disease[11(35.5%)vs 52(66.7%)]、basilar artery branch disease[16(51.6%)vs 19(24.4%)])between two groups(P<0.05).Multivariate logistic regression analysis indicated that base of the pons involvement(OR=3.453,95%CI:1.402~8.505,P=0.007)and the location of largest infarct core(OR=2.795,95%CI:1.134~6.887,P=0.026)were independent risk factors of PMDs in patients with PPI.Conclusion Involvement of base of the pons and largest infarct core in the lower part of the pons can be used to predict PMDs in patients with PPI.