新发孤立性脑桥梗死的临床特点及危险因素分析

Clinical features and risk factors of new-onset isolated pontine infarction

目的分析新发孤立性桥脑梗死的临床特点及危险因素。方法选择2017年9月至2019年9月丽水市中医院收治的新发孤立性脑桥梗死患者81例,其中脑桥旁正中梗死(PPI组)28例,脑桥腔隙性梗死(LPI组)53例。根据美国国立卫生研究院卒中量表(NIHSS)评分变化分为急性期神经功能缺损进展组(n=27)和非进展组(n=54)。比较各组的临床资料和影像学特点。采用logistic回归分析PPI发病及急性期神经功能缺损进展的独立危险因素。结果PPI组高脂血症、偏瘫、基底动脉狭窄比例、梗死直径及入院和出院时NIHSS评分均高于LPI组,差异均有统计学意义(均P<0.05)。进展组舒张压、PPI比例、梗死直径、基底动脉狭窄比例及合并颅内动脉狭窄比例及入院及出院时NIHSS评分高于非进展组,差异均有统计学意义(均P<0.05)。logistic多因素分析显示,高脂血症和基底动脉狭窄是PPI发病的独立危险因素(均P<0.05)。梗死直径和入院时NIHSS评分是孤立性脑桥梗死患者出现急性期神经功能缺损进展的独立危险因素(均P<0.05)。结论高血脂症和基底动脉病变是孤立性PPI发生和进展的主要因素有关。

Objective To analyze the clinical features and risk factors of new-onset isolated pontine infarction.Methods A total of 81 IPI patients admitted to Lishui Hospital of Traditional Chinese Medicine from September 2017 to September 2019 were retrospectively enrolled,including 28 cases with paramedian pontine infarction(PPI)and 53 cases with lacunar pontine infarction(LPI).According to changes in scores of National Institutes of Health Stroke Scale(NIHSS),they were divided into acute neurological deficit progression group(progression group,27 cases)and non-progression group(54 cases).The clinical data and imaging features were compared between different groups.Logistic analysis was used to analyze the risk factors related to PPI and acute neurological deficit progression.Results The proportions of hyperlipemia,hemiplegia and basilar artery stenosis,infarct diameter and NIHSS scores at admission and discharge in PPI group were higher than those in LPI group(all P<0.05).Diastolic blood pressure,PPI proportion,infarct diameter,proportions of basilar artery stenosis and intracranial artery stenosis,and NIHSS scores at admission and discharge in progression group were higher than those in non-progression group(all P<0.05).Logistic analysis showed hyperlipidemia and basilar artery stenosis were independent risk factors of PPI(all P<0.05).The infarct diameter and NIHSS score at admission were independent risk factors for the progression of acute neurological deficits in patients with isolated pontine infarction(all P<0.05).Conclusion Hyperlipidemia and basilar artery stenosis are the main factors related to onset and progression of isolated PPI.