大脑中动脉狭窄程度与不同急性脑梗死模式的相关性研究

目的探讨大脑中动脉(MCA)狭窄程度与不同急性脑梗死病变模式的关系。方法回顾性分析324例急性脑梗死患者,根据头颅磁共振弥散加权成像(DWI)和磁共振血管成像(MRA),MCA狭窄程度分为轻、中、重度,患者梗死模式分为:单发性梗死(包括小的穿支动脉供血区梗死、大的穿支动脉供血区梗死、皮质分支动脉供血区梗死和大面积梗死)、分水岭梗死(CWI)和多发性梗死。比较不同模式的急性脑梗死患者的MCA病变情况。结果 324例急性脑梗死患者中,MCA狭窄致穿支动脉(PAI)梗死最为多见,占137例(42.28%);PAI患者MCA重度狭窄率与其他单发性梗死、多发性梗死和内分水岭梗死(IWI)患者相比较,差异具有统计学意义(P0.01)。内分水岭梗死、多发性梗死和大面积梗死的MCA重度狭窄率高于小穿支动脉梗死、大穿支动脉梗死、皮质穿支动脉梗死和外分水岭梗死(P0.05),而内分水岭梗死、多发性梗死和大面积梗死之间的MCA重度狭窄率相比差异无统计学意义(P0.05)。结论 MCA狭窄致PAI最为多见,但是MCA重度狭窄并非是PAI的重要原因;MCA重度狭窄易导致CWI(尤其是IWI)和多发性梗死;MCA重度狭窄也是导致LTI重要原因之一。

An analysis of relationship between degree of middle cerebral artery stenosis and different patterns of acute cerebral infarction

Objective To analyze the relationship between the degree of middle cerebral artery (MCA) stenosis and different patterns of acute cerebral infarction.Methods Three hundred and twenty-four patients were analyzed retrospectively. According to magnetic resonance diffusion-weighted imaging and magnetic resonance angiograph, the degree of MCA stenosis was divided into mild, moderate, and severe, and the patterns of cerebral infarction included single cerebral infarction including: small perforating artery infarction (SPAI), large perforating artery infarction (LPAI), pial infarction (PI), and large territory infarction (LTI)), cerebral watershed infarction (CWI), and multiple cerebral infarction (MCI). The degree of MCA stenosis was compared between patients with different patterns of acute cerebral infarction.Results Perforating artery infarction (PAI) caused by MCA stenosis was most common in the 324 patients, accounting for 42.28% (137 cases). There was a significant difference in the incidence of severe MCA stenosis between patients with PAI and patients with the other patterns of single cerebral infarction, MCI, or internal watershed infarction (IWI) (P<0.01). The incidence of severe MCA stenosis in patients with IWI, MCI or LTI was significantly higher than that in patients with SPAI, LPAI, PI, or external watershed infarction (P<0.05); however, there was no significant difference in the incidence of severe MCA stenosis between patients with IWI, MCI, and LTI (P>0.05).Conclusions MCA stenosis-induced PAI is most common, but severe MCA stenosis is essential for PAI. Severe MCA stenosis is likely to induce CWI (especially IWI) or MCI, and it is also one of the important reasons for LTI.