两种不同类型单侧孤立脑桥梗死发病机制

目的 探讨脑桥旁正中梗死(PPI)和脑桥深部梗死(SDPI)的可能发病机制.方法 选择2012年10月—2016年2月收治的急性脑桥梗死90例,其中PPI 58例,SDPI 32例.对两组进行影像学检查,比较两组基底动脉狭窄程度、基底动脉粥样硬化斑块和脑微出血发生情况.结果 PPI组女性比例明显高于SDPI组(P<0.05);PPI合并糖尿病史的比例高于SDPI组(P<0.05).PPI组总胆固醇、低密度脂蛋白胆固醇、纤维蛋白原及美国国立卫生院神经功能缺损量表(NIHSS)评分均高于SDPI组(P<0.05).PPI组基底动脉斑块发生率高于SDPI组,梗死灶最大直径大于SDPI组(P<0.01).两组基底动脉狭窄程度比较差异无统计学意义(P>0.05).两组脑深部、幕下区域微出血分级比较差异有统计学意义(P<0.05).结论 PPI发病机制可能为主要基底动脉分支口病变,其次为大动脉粥样硬化改变,而SDPI发病机制考虑为小穿支动脉闭塞.

Pathogenesis of Isolated Unilateral Pontine Infarction of Two Different Types

Objective To investigate the possible pathogenesis of paramedian pontine infarction ( PPI ) and small deep pontine infarction (SDPI). Methods A total of 90 patients with acute pontine infarction during October 2012 and February 2016 were recruited in this study, including 58 PPI patients and 32 SDPI patients. The iconography examination was performed for all the patients, and then conditions of basilar artery stenosis, basilar artery atherosclerosis plaque and cerebral microbleeds in the two groups were compared. Results In PPI group, female percentage was higher (P<0. 05), while the percentage of PPI combined with diabetes mellitus was higher than those in SDPI group (P<0. 05). The levels of total cholesterol, low-density lipoprotein, fibrinogen and National Institute of Health Stroke Scale (NIHSS) score in PPI group were higher than those in SDPI group (P<0. 05). In PPI group, the incidence rate of basi-lar artery atherosclerosis was higher, and the maximum diameter of infarction location was larger than those in SDPI group (P>0. 01). In the two groups, there was no significant difference in the degree of basilar artery stenosis (P>0. 05);there were significant differences in deep and infratentorial cerebral microbleeds grades (P<0. 05). Conclusion The possible pathogenesis of PPI is mainly lesions in protruding into the orifice of basilar artery branches, and the second may be resulted from changes of large artery atherosclerosis, while possible pathogenesis of SDPI may be attributed to the oc-clusion of small perforating arteries.