快速和缓慢进展型脑干梗死的影响因素

Influencing factors for rapidly or slowly progressive brainstem infarction

目的探讨基底动脉重度狭窄或闭塞患者其缓慢进展型脑干梗死和快速进展型脑干梗死的影响因素。方法回顾性纳入2013年1月—2022年12月连续就诊于郑州大学人民医院经HR-MRI证实为基底动脉重度狭窄或闭塞后首发脑干梗死患者501例。手工计算脑干梗死的核心体积,分析各组脑干梗死体积的分布。根据脑干梗死体积和从卒中发作到成像的时间将其分为缓慢进展型脑干梗死组(0~<1 ml,6~24 h)和快速进展型脑干梗死组(>5 ml,0~<6 h),比较两组的危险因素及侧支循环情况。结果501例基底动脉重度狭窄或闭塞患者的平均年龄为(66.14±10.37)岁,其中男性占39.13%。根据预先设定的阈值,29(16.29%)例基底动脉重度狭窄或闭塞患者在0~<6 h时间窗内为快速进展型脑干梗死,56(17.34%)例患者在6~24 h时间窗内为缓慢进展型脑干梗死。两组患者的年龄、性别、NIHSS评分、高血压、糖尿病、高脂血症、心房颤动史、冠状动脉疾病史、吸烟史等危险因素差异无统计学意义。经Pearson相关性分析,基底动脉重度狭窄或闭塞患者侧支循环与快速进展型脑干梗死之间呈负相关(r=-0.619,P<0.001)。结论基底动脉重度狭窄或闭塞后其侧支循环良好的患者常出现缓慢进展型脑干梗死,而侧支循环不良的患者常出现快速进展型脑干梗死。

Objective To investigate the influencing factors for slowly progressive brainstem infarction and rapidly progressive brainstem infarction in patients with severe stenosis or occlusion of basilar artery.Methods A retrospective analysis was performed for 501 patients who attended Zhengzhou University People's Hospital from January 2013 to December 2022 and were diagnosed with first-episode brainstem infarction after severe stenosis or occlusion of basilar artery by HR-MRI.The core volume of brainstem infarction was manually calculated,and the distribution of brainstem infarct volume was analyzed.According to brainstem infarct volume and the time from stroke attack to imaging,the patients were divided into slowly progressive brainstem infarction group(0–<1 ml,6–24 hours)and rapidly progressive brainstem infarction group(>5 ml,0–<6 hours),and the two groups were compared in terms of risk factors and collateral circulation.Results The 501 patients with severe stenosis or occlusion of basilar artery had a mean age of 66.14±10.37 years,among whom 39.13%were male patients.According to predefined thresholds,29 patients(16.29%)with severe stenosis or occlusion of basilar artery in the time window of 0–<6 hours were diagnosed with rapidly progressive brainstem infarction,and 56 patients(17.34%)in the time window of 6–24 hours were diagnosed with slowly progressive brainstem infarction.There were no significant differences between the two groups in the risk factors such as age,sex,NIHSS score,hypertension,diabetes,hyperlipidemia,and history of atrial fibrillation,coronary artery disease,and smoking.The Pearson correlation analysis showed that collateral circulation in patients with severe stenosis or occlusion of the basilar artery was negatively correlated with rapidly progressive brainstem infarction(r=−0.619,P<0.001).Conclusions After severe stenosis or occlusion of the basilar artery,patients with good collateral circulation often have slowly progressive brainstem infarction,while patients with poor collateral circulation often have rapidly progressive brainstem infarction.