大脑中动脉深穿支单发小梗死病灶形态与早期功能预后的关系

目的探讨大脑中动脉深穿支单发小梗死的病灶形态与早期神经功能恶化(END)及30d功能预后的关系。方法连续收集因大脑中动脉深穿支单发小梗死住院患者145例,根据病灶在MRI弥散加权成像上的形态特征,分为规则病灶组95例和不规则病灶组50例。采用美国国立卫生研究院卒中量表(NIHSS)评估患者的神经功能缺损情况;以30d的改良Rankin量表(mRS)评估患者早期的临床功能预后。结果与不规则病灶组比较,规则病灶组END、基线收缩压、基线NIHSS评分明显降低,病灶直径明显缩小(P<0.05,P<0.01);其中END 27例(18.6%),脑卒中30d后预后不良31例(21.4%)。与预后不良比较,预后良好患者不规则病灶、END、基线收缩压、基线NIHSS评分明显降低,病灶直径明显缩小(P<0.05,P<0.01)。logistic回归分析显示,不规则病灶(OR=3.949,95%CI:1.331~11.716,P=0.013)是END的独立危险因素,基线NIHSS评分(OR=2.211,95%CI:1.473~3.319,P=0.007)和END(OR=6.136,95%CI:3.043~12.428,P=0.001)是30d预后不良的独立危险因素。结论穿支供血区病灶不规则的单发小梗死患者住院期间易发生END,并且短期功能预后表现较差。

Relation between morpholy of SSI in perforating territory of middle cerebral artery and early prognosis of neurological function

Objective To study the relation of the morphology of SSI in perforating territory of middle cerebral artery with early neurological deterioration(END)and prognosis of neurological function.Methods One hundred and forty-five patients with SSI in perforating territory of middle cerebral artery were divided into regular SSI group(n=95)and irregular SSI group(n=50)according to the morphology of SSI on diffusion-weighted MRI.Their neurological function dificits were assessed according to the NIHSS and the prognosis of their neurological function was assessed according to the mRS.Results The END was significantly worse,the baseline SBP and NIHSS score were significantly lower,the diameter of SSI was significantly shorter in regular SSI group than in irregular SSI group(P<0.05,P<0.01).END and poor prognosis were observed in27(18.6%)and 31(21.4%)out of the 145 patients.Logistic regression analysis showed that irregular SSI was the independent risk factor for END(OR=3.949,95%CI:1.331-11.716,P=0.013)while baseline NIHSS score and END were the independent risk factors for the poor prognosis of neurological function(OR=2.211,95%CI:1.473-3.319,P=0.007;OR=6.136,95%CI:3.043-12.428,P=0.001).Conclusion END is easy to occur in patients with irregular SSI in the perforating territory of middle cerebral artery with a poor prognosis of neurological function.