大脑中动脉分布区缺血性卒中患者的临床和影像学特征及复发危险因素

目的 分析大脑中动脉（middle cerebral artery，MCA）分布区非心源性缺血性卒中患者的临床和影像 学特征及复发的危险因素。 方法 连续入选发病7 d以内的MCA分布区非心源性缺血性卒中患者。收集患者的人口学信息、血管 病的危险因素和发病时的主要症状及体征，评价患者的头颅磁共振影像包括急性梗死灶的部位、 数量、分布特征、责任动脉有无狭窄、缺血性卒中的病因分型。随访患者1年内有无缺血性卒中或短暂 性脑缺血发作（transient ischemic attack，TIA）复发，通过多元Logistic回归分析患者复发的危险因素。 结果 研究共入组926例患者，责任MCA狭窄≥70%的患者（447例）常见多发梗死灶（338例，75.6%） 和分水岭梗死（317例，70.9%），而责任MCA无狭窄或狭窄程度<70%患者（479例）常见MCA穿支分 布区单发梗死灶（247例，55.3%）。冠状动脉粥样硬化性心脏病比值比（odds ratio，OR）7.55，95%可 信区间（confidence interval，CI）2.85～20.0，P <0.001]、缺血性卒中病史（OR 3.49，95%CI 1.52～8.01， P =0.003）、缺血性卒中发病前3个月内反复TI A史（OR 22.7，95%CI 8.35～61.6，P <0.001）、新发梗死 灶为多发（OR 5.26，95%CI 1.33～20.8，P =0.018）是患者1年内缺血性卒中或TIA复发的危险因素。 结论 对于非心源性缺血性卒中患者，MCA分布区梗死灶的分布特征与MCA狭窄程度有关。新发梗 死灶为多发、既往有缺血性心脑血管病病史的患者1年缺血性卒中或TIA复发风险高。

Clinical and Imaging Features of Ischemic Stroke in Middle Cerebral Artery Territory and Risk Factors for Recurrence

Objective To analyze the clinical and imaging features of noncardiogenic Ischemic Stroke (IS) in
middle cerebral artery (MCA) territory, and risk factors of recurrent IS.
Methods Noncardiogenic IS patients in MCA territory with onset of symptoms <7 days were
enrolled consecutively. Demographic information, risk factors for vascular diseases, main admission
symptoms and signs, topographical distribution of acute infarcts, number and topographical
distribution of acute infarcts, and stenosis degree of responsible MCA were assessed. Multivariate
logistic regression analysis was used to identify risk factors associated with recurrent IS or TIA
within the year following IS.
Results A total of 926 patients were enrolled into study. Patients (n =447) with ≥70% degree stenosis
in MCA most often had multiple acute infarcts (n =338, 75.6%) and watershed infarcts (n =317, 70.9%),
while patients (n =479) without obvious stenosis or with <70% degree stenosis in MCA most oftenhad single infarct (n =247, 55.3%) in the territory of MCA penetrating artery. Multivariate Logistic
regression analysis identified history of coronary heart disease odds ratio (OR) 7.55, 95% confidence
interval (CI) 2.85-20.0, P <0.001], history of IS (OR 3.49, 95%CI 1.52-8.01, P =0.003), repeated TIAs
within 3 months before the stroke (OR 22.7, 95%CI 8.35-61.6, P <0.001), and newly onset multiple
acute infarcts (OR 5.26, 95%CI 1.33-20.8, P =0.018) as independent predictors of recurrent IS or TIA.
Conclusion For patients with noncardiogenic IS, topographical distribution of acute infarcts is
related with stenosis degree in MCA, and patients with multiple acute infarcts and history of ischemic
cardiovascular or cerebrovascular disease had a higher recurrence risk of IS or TIA within 1 year.