大脑后动脉区梗死与后循环血管状态及危险因素关系

目的探讨大脑后动脉区梗死与后循环血管状态及危险因素的关系。方法回顾性收集2010年1月-2014年6月在首都医科大学宣武医院神经内科住院的经头部MRI证实的首次新发大脑后动脉区梗死的患者192例,其中171例行CT血管成像,21例行DSA,排除有可疑心源性栓子来源的患者。根据头部MRI将梗死部位分为A(中脑组)、B(丘脑组)、C(颞叶内侧组)、D(胼胝体压部组)、E(枕叶组)、F(多部位梗死组)6组。比较PCA区梗死与后循环血管状态及危险因素的关系。结果 (1)PCA区梗死病变分布:192例患者中A、B、C、D、E、F组分别为12例(6.3%)、74例(38.5%)、15例(7.8%)、11例(5.7%)、28例(14.6%)、52例(27.1%)。(2)椎-基底动脉系统血管状态:椎动脉病变66例(34.4%)合并大脑后动脉狭窄13例,基底动脉病变27例(14.1%)合并大脑后动脉狭窄2例,大脑后动脉病变45例(23.4%),未发现血管病变69例(35.9%)。(3)对PCA区梗死病变分布与后循环血管病变行单因素卡方检验:B组与基底动脉病变相关(χ~2=5.318,P=0.021);E组与PCA P4段病变相关(χ~2=18.556,P0.001);F组与椎动脉、基底动脉病变相关(χ~2=4.386,7.059;P=0.036,0.008)。(4)血管病变组与无血管病变组比较:合并高血压病差异有统计学意义(11.126,P=0.001)。结论大脑后动脉区梗死与后循环血管病变关系密切,尤其合并导致血管病变的危险因素时,更应重视血管检查,减少卒中再发。

Relationship on the posterior cerebral artery territory infarction and the condition of posterior circulation vascular and risk factors

Objective To investigate the relationship on the posterior cerebral artery (PCA) territory infarctions and the condition of posterior circulation arteries and risk factors.Methods We retrospectively collected the data of 192 patients with acute first cerebral infarction in PCA territory confirmed by brain MRI who were enrolled at the inpatient of Xuanwu Hospital,Capital Medical University between January 2010 and June 2014,171 of whom underwent computerized tomography angiography (CTA) and 21 DSA.Patients with suspected cardiac embolism were excluded from the study.All the cases were then divided into six groups according to the results of MRI:A(midbrain group);B(thalamus group);C(medial temporal lobe group);D(splenium of corpus callosum group);E(occipital lobe group) and F(multiple cerebral infarction group).Analysis the relationship on the PCA territory infarctions and the condition of posterior circulation arteries and risk factors.Result (1)Distribution of PCA territory infarctions:In all 192 cases,12 cases (6.3%) were in group A,74 cases (38.5%) in group B,15 cases (7.8%) in group C,11 cases (5.7%) in group D,28 cases (14.6%) in group E and 52 cases (27.1%) in group F.(2)Condition of posterior circulation arteries:66 cases (34.4%) (13 cases accompanying PCA stenosis) had lesions of vertebral artery,27 cases (14.1%) (2 cases accompanying PCA stenosis) had lesions of basilar artery and 45 cases (23.4%) had PCA lesions,69 cases (35.9%) had unimpaired posterior circulation arteries.(3)Using single factor Chi-square test between the PCA territory infarction distribution and the condition of posterior circulation arteries:Group B was associated with basal artery lesions (x2=5.318,P=5.318).Group E was associated with PCA P4 segment artery lesions (x2=18.556,P<0.001);Group F was associated with vertebral artery lesions and basilar artery lesions (x2=4.386,4.386;P=0.036,0.008 respectively).(4)There was a significant difference in hypertension between artery lesions group and no artery lesions group in posterior circulation arteries (x2=11.126,P=0.001).Conclusion There is a close relationship between the condition of posterior circulation arteries and infarctions in PCA territory.The physicians are suggested to perform the vascular imaging examination in patients with infarctions in PCA territory,especially who is accompanied by risk factors for vascular lesions,so as to achieve the purpose of reducing the recurrence of stroke.