分支动脉粥样硬化病患者进展性脑梗死的发生及其急性期转归的观察

目的探讨豆纹动脉（LSA）及脑桥旁正中动脉（PPA）供血区分支动脉粥样硬化病（BAD）进展性脑梗死的发生率及急性期的转归情况。方法采用前瞻性研究的方法,连续收集2011年4—12月北京大学人民医院神经内科LSA及PPA供血区急性脑梗死病例共62例,分为BAD组（29例）及非BAD组（33例）。对两组患者出院时行改良Rankin评分（mRS）。分析两供血区脑梗死患者BAD的发生率、进展性脑梗死发生率及急性期的转归情况。结果 BAD组与非BAD组患者在脑血管病危险因素方面差异无统计学意义。①LSA供血区脑梗死43例,占69.4%;PPA供血区脑梗死19例,占30.6%。全组BAD发生率为46.8%（29/62）,其中LSA和PPA供血区脑梗死患者中,BAD发生率分别为46.5%（20/43）和47.4%（9/19）。BAD组和非BAD组患者中,进展性脑梗死的发生率分别为51.7%（15/29）和18.2%（6/33）,差异有统计学意义（P〈0.01）。②BAD组和非BAD组患者出院时转归良好者（mRS≤2分）分别为51.7%（15/29）和93.9%（31/33）,差异有统计学意义（P〈0.01）。结论在LSA和PPA供血区脑梗死患者中,BAD发生率高,BAD患者脑梗死急性期病情容易进展,临床转归欠佳。

Observation of progressive cerebral infarction and acute phase outcomes in patients with arterial branch atheromatous disease

Objective To investigate progressive cerebral infarction and acute phase outcomes of arterial branch atheromatous disease(BAD) in the territories of the lenticulostriate arteries(LSA) and pontine paramedian arteries(PPA).Methods A total of 62 consecutive patients with acute cerebral infarction in the territories of LSA and PPA were recruited with a method of prospective study.They were divided into either a BAD group(n=29) or a non-BAD group(n=33).The modified Rankin scale(mRS) was used to evaluate the patients in both groups at discharge.The incidences of BAD and progressive cerebral infarction and the acute phase outcomes in the two blood supply territories in patients with cerebral infarction were analyzed.Results There were no significant differences in the risk factors for cerebrovascular disease between the BAD group and non-BAD group.①There were 43 patients(69.4%) with LSA cerebral infarction,accounting for 69.4%;there were 19 patients(30.6%) with PPA cerebral infarction,accounting for 30.6%.The incidence of BAD was 46.8%(29/62) in the whole group,and the incidences of BAD in patients with LSA and PPA cerebral infarction were 46.5% and 47.4% respectively.The incidence of progressive stroke in the BAD group was 51.7%(15/29);while it was 18.2%(6/33)in the non-BAD group.There was significant difference(P<0.01).②The patients with good clinical outcome at discharge(mRS ≤2) was 51.7%(15/29) in the BAD group,and it was 93.9%(31/33) in the non-BAD group.There was significant difference(P<0.01).Conclusion The incidence of arterial branch atheromatous disease is high in patients with lenticulostriate arteries and pontine paramedian arteries cerebral infarction,the patients with acute phase arterial branch atheromatous disease are easy to progress and their clinical outcomes are poor.