大脑中动脉分布区脑梗死模式的分析研究

目的：探索影像学梗死模式在判定动脉粥样硬化性大脑中动脉分布区梗死的责任血管及发生机制中的临床价值。 方法：选取2015年1月—2016年12月在我院神经内科住院的缺血性脑卒中患者105例，分为颈内动脉（ICA）梗死组68例，大脑中动脉（MCA）梗死组37例，比较两组患者的临床资料及病变血管的狭窄程度，并对不同狭窄程度下的脑梗死模式进行统计分析。 结果：ICA梗死组的低密度脂蛋白水平高于MCA梗死组，差异具有统计学意义（2.34±0.70）mmol/L vs.（2.08±0.49）mmol/L，t=2.00，P<0.05]；两组间的临床病史、侧支循环情况、单双侧梗死、单发及多发梗死、三酰甘油、高密度脂蛋白、同型半胱氨酸、血压的差异均无统计学意义。105例脑梗死患者共累及108支血管。其中37支为MCA病变所致，71支为ICA病变所致。ICA组中轻度狭窄血管的比例高于MCA组，差异有统计学意义（42.3% vs. 8.1%，P<0.05）；两组中、重度狭窄和闭塞血管的比例差异无统计学意义。ICA梗死组和MCA梗死组发生大面积梗死分别为1/0例，散在皮层梗死2/2例，单独内分水岭梗死3/13例，单独外分水岭梗死7/9例，单独穿动脉梗死7/13例，散在皮层及内分水混合梗死4/16例，穿动脉及内分水岭混合梗死4/8例，穿动脉、散在皮层及内分水岭混合梗死9/10例；轻度、中度及重度狭窄程度的ICA与MCA两组间梗死模式差异无统计学意义；闭塞的MCA组中发生穿动脉梗死的比例高于闭塞的ICA组（4/13 vs. 0/16，P=0.03），差异有统计学意义。 结论：影像学梗死模式在临床判定责任血管的价值依赖于后期更严谨的研究设计，此类依靠管腔狭窄程度作为分组指标的方法可能是影响研究结果的重要因素。

Analysis on cerebral infarction mode in middle cerebral artery area

Objective:To explore the clinical value of imaging infarction mode in determination of the responsible vessel and mechanism of atherosclerotic middle cerebral artery area infarction. Methods:The ischemic stroke patients (105 cases) in department of neurology were continuously reviewed from January 2015 to December 2016, among which 68 cases were ICA infarction group and other 37 cases were MCA infarction group. The clinical data and vessel stenosis degree were compared, and then the cerebral infarction modes of ICA and MCA groups in different stenosis degree were analyzed. Results:The level of low density lipoprotein in ICA group was higher than that in MCA group, and the difference was statistically significant (2.34±0.70) mmol/L vs. (2.08±0.49) mmol/L, t=2.00, P<0.05]. There was no significant difference between the two groups in clinical history, collateral circulation, single and bilateral infarction, single and multiple infarction, and three triacylglycerol, high-density lipoprotein, and homocysteine. Totally 108 vessels were involved in 105 cerebral infarction patients, and 37 vessels of them were caused by MCA lesions, and other 71 vessels were caused by ICA lesions. The composition of mild stenosis arteries in ICA and MCA groups had statistically significant difference (42.3% vs. 8.1%, P<0.05) , and the composition of moderate stenosis, severe stenosis and occlusion vessel had no significant differences between two groups. The infarction modes of MCA and ICA groups including large area infarction (1/0 cases) , scattered cortical infarction (2/2 cases) , internal watershed infarction (3/13 cases) , external watershed infarction (7/9 cases) , single perforating artery infarction (7/13 cases) , mixed scattered cortex and internal water infarction (4/16 cases) , mixed perforating artery and internal water infarction (4/8 cases) , mixed internal watershed, perforating artery and scattered cortex infarction (9/10 cases) . The infarction modes of light, moderate and severe stenosis vessels in ICA and MCA groups have no statistical differences. The perforating artery infarct occurred higher in MCA occlusion group than that in ICA group (4/13 vs. 0/16, P=0.03) . Conclusions:The value of imaging infarction mode in clinical diagnosis of responsible vessels depends on a more rigorous study design, and the method using stenosis degree as grouping indicator may greatly influencd the study outcome.