高龄脑梗死患者不同程度脑白质病变的临床特征分析

目的探索高龄脑梗死患者不同程度脑白质病变的临床特征。方法选择2009年4月～2010年8月广东省汕头市潮阳区大峰医院神经内科住院的脑梗死患者102例。根据T2加权和FLAIR序列图像及Fazekas分级法评估脑白质病变严重程度。纳入分析的临床资料包括年龄、性别、并发症、美国国立卫生研究院卒中量表评分（NIHSS）、既往史、牛津郡社区脑卒中项目（OCSP）分型、TOAST分型、部分治疗措施以及存活情况;比较不同脑白质病变程度的累计存活率。结果①所有患者均有不同程度的脑白质病变,Fazekas 3级患者比例最高（39.2%）。高血压对不同脑白质病变程度的影响较小,差异无统计学意义（P=0.101）。②在OCSP分型中,脑白质病变1级的患者以部分性前循环梗死比例最高,2级患者以后循环梗死和腔隙性脑梗死比例最高,3级以腔隙性脑梗死比例最高。在TOAST分型中,脑白质病变1级的患者以大动脉粥样硬化比例最高,2级和3级的患者以大动脉粥样硬化和小动脉闭塞比例最高,但三组间的差异无统计学意义（P〉0.05）。③高龄脑梗死患者不同脑白质病变程度的整体病死率差异无统计学意义（P=0.478）。结论高龄脑梗死患者中重度脑白质病变的发生率较高,其与轻度脑白质病变的发病机制和预后可能不同。

Analysis of clinical characteristics of white matter changes in the elderly subjects with ischemic stroke

Objective To explore the clinical features of the elderly ischemic stroke subjects according to different severity of white matter changes.Methods 102 patients with ischemic stroke in Dafeng Hospital of Chaoyang District in Shantou City from April 2009 to August 2010 were selected.All subjects owned MR images and severity of white matter changes were assessed on fluid-attenuated inversion recovery or T2-weighted sequences using the Fazekas visual scales.The clinical feathers including age,sex,complications,NIHSS,past history,OCSP and TOAST subtypes,treatments and survival were concerned;cumulative survival rate of different degree of cerebral white matter lesions were compared.Results ① Different degree of cerebral white matter lesions were found in all patients,the highest proportion was found in patients with Fazekas 3 grade（39.2%）.The differences of hypertension in different degree of cerebral white matter lesions as not statistically significant（P = 0.101）.② In the OCSP types,the proportion of partial anterior circulation infarct was the highest in white matter lesions of grade 1;the proportion of posterior circulation infarct and lacunar infarction were the highest in white matter lesions of grade 2;the proportion of lacunar infarction was the highest in white matter lesions of grade 3.In the TOAST types,the proportion of artery atherosclerosis was the highest in white matter lesions of grade 1;the proportion of artery atherosclerosis and Small artery occlusion were the highest in white matter lesions of grade 2 and 3,but the difference were not statistically significant（P〈0.05）.③The difference of overall case fatality rate in different degree of cerebral white matter lesions in elderly patients with cerebral infarction were not statistically significant（P〈0.05）.Conclusion Among the elderly patients with ischemic stroke,there is a large proportion of subjects with severe white matter changes,it is different with mild white matter changes in pathogenesis and prognosis.score of 1 may have differences in risk factors,pathogenesis and outcome with those with Fazekas score of 2 and 3.