分支动脉粥样硬化病与大动脉粥样硬化型和小动脉闭塞型脑梗死的临床差异

Difference of clinical findings between branch atheromatous disease,large-artery atherosclerosis and small-artery occlusion cerebral infarction

目的:比较分支动脉粥样硬化病(BAD)与大动脉粥样硬化型(LAA)和小血管闭塞型(SAO)脑梗死的临床特征和预后的差异,探讨三者预后的情况。方法:选取2014年9月至2016年11月在武汉大学中南医院神经内科住院的358例急性脑梗死患者为研究对象,分别入选BAD、LAA和SAO组。收集患者的基线临床资料、实验室检查及影像学特征;mRS评分评估6个月预后。比较BAD与LAA、SAO患者的临床资料,观察BAD与LAA及SAO脑梗死患者临床特征和预后的差异。结果:最终共纳入358例患者,包括176例(49.16%)BAD、124例(34.64%)LAA和58例(16.20%)SAO脑梗死患者。临床特征方面,BAD与LAA、BAD与SAO组患者在饮酒史和脑白质高信号的差异均具有统计学差异,其他危险因素的差异无统计学意义。预后方面,BAD组的mRS显著高于SAO组(P<0.001),低于LAA组(P=0.029)。另外,发现BAD组的NIHSS显著高于SAO组(P<0.001)。结论:通过比较分析发现,BAD临床特征不同于LAA和SAO脑梗死,其临床预后介于两者之间。BAD是缺血性脑卒中的一种特殊亚型。

Objective:To expole the difference of clinical features and outcomes between branch atheromatous disease(BAD),large-artery atherosclerosis(LAA)and small-artery occlusion(SAO)cerebral infarction.Methods:In this study,358 patients with acute cerebral infarction admitted to the Department of Neurology,Zhongnan Hospital of Wuhan University from September 2014 to November 2016 were selected,and they were recruited into the BAD,LAA and SAO groups.We collected clinical data,laboratory tests and imaging features of the patients,and prognosis were evaluated after 6months post-stroke,and the clinical features and outcomes were compared between the three groups.Results:A total of 358 patients were recruited,including 176(49.16%)BAD,124(34.64%)LAA and 58(16.20%)SAO patients with cerebral infarction.Except for the risk factors of drinking history and cerebral white matter hyperintensities(WMHs),no significant difference was found in other risk factors between BAD and LAA,or BAD and SAO.In terms of outcome,the modified Rankin scale(mRS)in the BAD group was significantly higher than that in the SAO group(P<0.001)and lower than that in the LAA group(P=0.029).In addition,it was found that the NIHSS of the BAD group was significantly higher than that of the SAO group(P<0.001).Conclusion:The clinical features of BAD are different from LAA and SAO cerebral infarction,and the BAD’s clinical prognosis falls in between the two types of cerebral infarction.BAD-related stroke is a special subtype of cerebral infarction.