脑小血管病与大血管病变所致腔隙性脑梗死的预后比较

目的 比较脑小血管病（SVD）与大血管病变所致腔隙性脑梗死（LI）的预后.方法 选择124例急性LI患者,均通过头颅MRI检查确诊,按其病因分为2组：大血管严重粥样斑块或（和）严重狭窄、闭塞者53例（大血管组）、SVD 71例（小血管组）,对2组患者均按常规给予对症治疗.比较2组治疗前、治疗2周后神经功能缺损评分（NIHSS评分）变化及治疗1年后2组脑梗死的复发率.结果 大血管组治疗前NIHSS评分显著高于小血管组（P＜0.05）,大血管组治疗前后NIHSS评分改善程度显著高于小血管组（P＜0.05）.治疗后小血管组脑梗死复发率较大血管组显著减少（49.3％比74.5％,P＜0.05）.结论 大血管病变所致LI患者神经功能缺损较SVD所致者严重,但功能恢复较SVD所致者好;治疗后SVD所致LI患者脑梗死的复发率较大血管病变所致者低.

Comparison of Prognosis of Lacunar Infarction Caused by Cerebral Small and Large Vessel Disease

Objective To compare the prognosis of lacunar infarction （LI） cause by small vessel disease （SVD） and large vessel disease （LVD）.Methods A total of 124 patients with acute LI confirmed by cranial MRI were divided into two groups： LVD group （severe atheromatous plaques and/or stenosis and occlusion of large cerebral vessels, n=53） and SVD group （n=71）. All patients received conventional symptomatic treatment. NIHSS scores before and after treatment and recurrence rates of cerebral infarction after treatment for 1 year were compared between the two groups.Results Compared with SVD group, NIHSS scores were significantly increased before treatment and were obviously improved after treatment in LVD group （P〈0.05）.Compared with LVD group, the recurrence rate of cerebral infarction signifieanfly decreased in SVD group （49.3% vs 74.5% ,P〈0.05）. Cortelttsion LVD can cause severer neurological impairment than SVD in patients with LI. However, LVD patients have better recovery than SVD patients. In addition, patients with SVD-caused LI have lower recurrence rate of cerebral infarction than patients with LVD-caused LI.