无症状性脑梗死患者首发症状性急性脑卒中的临床特征及相关危险因素

目的了解无症状性脑梗死患者在首发症状性急性脑卒中发生、发展中的作用。方法选择2013年6月-2015年6月入住哈励逊国际和平医院神经内科200例首发症状性急性脑梗死患者,通过头颅CT或MRI检查,将其分为急性缺血性脑卒中合并无症状性脑梗死组(SCI组)及急性缺血性脑卒中未合并无症状性脑梗死组(非SCI组),两组患者均根据脑卒中临床神经功能缺损程度评分将神经功能缺损程度分为轻、中、重三组。根据头颅CT计算脑梗死面积,根据面积大小分为小梗死灶组、中梗死灶组、大梗死灶组。并均按急性缺铁性脑血管病的治疗原则治疗4w,对其转归进行评估,分为基本痊愈组、进步组、无变化组、恶化组。两组患者均测定糖化血红蛋白(HBA1c)、同型半胱氨酸(Hcy)、溶血磷脂酸(LPA)、血脂系列、尿酸(UA)等,比较各因素在两组间的差异。并对两组梗死部位分类,比较各组间在梗死部位分布的差异。结果SCI组在神经功能缺损中重度组较非SCI组多,轻度组较少,差异有统计学意义;在小梗死灶及大梗死灶组间存在差异,基本痊愈、恶化组及无变化组间存在差异有统计学意义。且HBA1c、Hcy、LPA、低密度脂蛋白(LDL)、总胆固醇(TC)在两组间存在差异。两组在梗死部位分布上无明显差异。结论合并无症状性脑梗死的首发症状性急性脑梗死者病情重,梗死面积大,预后差,可能为症状性脑梗死的危险因素之一。HBA1c、Hcy、TC、LDL为无症状性脑梗死的危险因素,可为脑血管病的预防和治疗提供一个新途径。

The clinical features and risk factors of acute symptomatic stroke in patients with silent cerebral infarction

Objective To explore the role of silent cerebral infarction (SCI) in occurrence and development of the first episode of acute stroke.Method We studied 200 participants enrolled in Har-Rison International Peace Hospital of Hengshui in June, 2013 to June, 2015, who initial acute stroke were assigned to initial acute stroke with SCI group (SCI group) or initial cute stroke without SCI group (non-SCI group) according to the results of MRI or CT. All participant were classified as mild, moderate or severe group on the basis of clinic neurological function deficit scale and were categorized as small, moderate or large infarction in line with brain CT. All were treated in terms of acute cerebral vessel disease for 4 weeks, followed by prognosis evaluation. Thus, essentially recovered, improved, unchanged or deterioration group were sorted. HBA1c, Hcy, LPA, blood fat series and UA of all were detected and analysed between SCI group and non-SCI group. And the two groups were classified according to the location of infarction, and the difference of the distribution of different groups was compared between the groups.Results On the aspect of neurological function deficit, SCI group shares more severe group and less mild group than non-SCI group significantly. SCI group and non-SCI group have significant differences on the following aspects;① Small vs large infarction group;② Essentially recovered, unchanged and deterioration group. Moreover, HBA1c, Hcy, LPA, LDL and TC differs between SCI and non-SCI group. There was no significant difference in the distribution of infarction area between the two groups.Conclusion nitial acute stroke with SCI presented with more severe manifestations, larger infarction area and poorer prognosis demonstrating that SCI may be one risk factor for symptomatic stroke. HBA1c, Hcy, LPA, TC and LDL are risk factors for asymptomatic stroke, which provides an access to the prevention and management of cerebral vessel disease.