大脑中动脉深穿支急性脑梗死后进展性运动功能缺损的临床研究

目的探讨大脑中动脉深穿支动脉梗死模式与脑梗死后进展性运动功能缺损(PMD)的相关性。方法前瞻性纳入24h内入院的大脑中动脉深穿支急性脑梗死患者154例,根据诊断分为PMD组44例和稳定组110例。磁共振弥散加权成像将梗死模式分为内分水岭(IBZ)梗死和穿支动脉梗死,穿支动脉梗死再以直径分为大穿支动脉梗死(≥20mm)和小穿支动脉梗死(<20mm)。比较2组患者临床、实验室资料及梗死模式差异,分析梗死模式与大脑中动脉深穿支动脉梗死后PMD的相关性。结果 PMD组IBZ梗死和大穿支动脉梗死比例明显高于稳定组,小穿支动脉梗死比例明显低于稳定组(25.0%vs 10.0%,38.6%vs 20.9%,36.4%vs 69.1%,P<0.01)。logistic回归分析显示,IBZ梗死(OR=4.622,95%CI:1.697¹2.593,P=0.003)和大穿支动脉梗死(OR=3.283,95%CI:1.42412.593,P=0.003)和大穿支动脉梗死(OR=3.283,95%CI:1.424⁷.566,P=0.005)是发生PMD的独立预测因素。结论大脑中动脉深穿支动脉梗死模式与脑梗死后PMD存在显著相关性,IBZ梗死与大穿支动脉梗死是大脑中动脉深穿支动脉梗死后PMD的重要预测因素。

Correlation between middle cerebral artery deep perforating infarction pattern and progressive motor deficits after ischemic stroke

Objective To study the correlation between middle cerebral artery(MCA)deep perforating infarction pattern and progressive motor deficits(PMD)after ischemic stroke.MethodsOne hundred and fifty-four patients with MCA deep perforating acute ischemic stroke within 24h after admission to our hospital were divided into PMD group(n=44)and stable PMD group(n=110).The infarction was classified as internal border zone(IBZ)infarction and perforating artery infarction(PAI)according to the MR diffusion-weighted imaging.The PAI was divided into large PAI with its diameter≥20mm and small PAI with its diameter<20mm.Their clinical and laboratory data and infarction pattern were compared.Correlation between infarction pattern and PMD after MCA deep perforating ischemic stroke was analyzed by univariate and multivariate logistic regression analysis,respectively.Results The incidence of IBZ infarction and large PAI was significantly higher whereas that of small PAI was significantly lower in PMD group than in stable PMD group(25.0%vs 10.0%,38.6%vs 20.9%,36.4%vs 69.1%,P<0.01).Logistic regression analysis showed that IBZ infarction and large PAI were the independent risk factors for PMD(OR=4.622,95%CI:1.697-12.593,P=0.003;OR=3.283,95%CI:1.424-7.566,P=0.005).Conclusion MCA deep perforating infarction pattern is significantly correlated with PMD after ischemic stroke.IBZ infarction and large PAI are the important risk factors for PMD after MCA deep perforating ischemic stroke.