豆纹动脉区分支动脉粥样硬化病和腔隙性脑梗死早期神经恶化的临床研究-东南大学学报医学版

豆纹动脉区分支动脉粥样硬化病和腔隙性脑梗死早期神经恶化的临床研究

单位：江苏省连云港市第二人民医院神经内科, 江苏连云港 222000

分类号：R743

出版年·卷·期（页码）：2017·36·第五期（822-827）

摘要：

目的：探讨豆纹动脉区（LSA）分支动脉粥样硬化疾病（BAD）和腔隙性脑梗死（LI）早期神经恶化（END）危险因素及预后。方法：收集2013年03月至2016年10月期间住院，经头颅MRI检查证实存在LSA急性脑梗死患者76例。按头颅MRI结果分为BAD组（40例），LI组（36例）。入院72 h内根据美国国立卫生研究院卒中量表（NIHSS）评分变化划分为END组（28例），非END组（48例）。收集基线资料、临床资料，进行比较。结果：（1） BAD组糖尿病史、HbA_1C、Hcy、入院时NIHSS、偏瘫发生率、发病1个月mRS评分均显著高于LI组；（2）发病3个月mRS评分BAD组与LI组之间无显著性差异；（3） BAD组与LI组比较更易发生END；（4） BAD组中END患者糖尿病史、HbA_1C、Hcy、入院时NIHSS、发病1个月mRS评分均高于非END患者；（5）多因素Logistic回归分析示HbA_1C、Hcy是BAD组END的危险因素。结论：LSA供血区BAD患者病情重，易进展，HbA_1C、Hcy是END的危险因素；BAD组及LI组患者3个月预后均较好。

Objective:To discuss the risk factors and outcomes of early neurological deterioration (END) between prognosis branch atheromatous disease (BAD) and lacunar infarction (LI) in the lenticulostriate artery territory (LSA). Methods:A total of 76 patients of acute cerebral infarction according to the results of craniocerebral MRI were enrolled from March 2013 to October 2016. Patients were divided into BAD (40 cases) and LI (36 cases). According to the increase of NIHSS scores within 72 hours of admission, they were divided into END (28 cases) and non-END (48 cases). Baseline data and clinical data was collected and compared. Results:(1) Diabetes mellitus, HbA1C, Hcy, admission NIHSS and mRS one month from onset showed significant differences between BAD and LI. (2) There was no significant difference of mRS onset three month between BAD and LI. (3) The BAD compared with the LI is more prone to END. (4) Diabetes mellitus, HbA1C, Hcy, admission NIHSS and onset one month mRS were higher in END than those in non-END. (5) Multivariate logistic regression analysis showed that HbA1C and Hcy were the risk factors of END in BAD. Conclusion:HbA1C and Hcy are the risk factors of END in BAD of LSA. All patients of BAD and LI have a good prognosis in three months from onset.

参考文献：

[1] MIYAMOTO N,TANAKA Y,UENO Y,et al.Demographic,clinical,and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2013,22(3):205-210.
[2] NAKASE T,YOSHIOKA S,SASAKI M,et al.Clinical evaluation of lacunar infarction and branch atheromatous disease[J].J Stroke Cerebrovasc Dis,2013,22(4):406-412.
[3] TAKAHASHI Y,YAMASHITA T,MORIHARA R,et al.Different characteristics of anterior and posterior branch atheromatous diseases with or without early neurologic deterioration[J].J Stroke Cerebrovasc Dis,2017,26(2):1-7.
[4] KWAN M W,MAK W,CHEUNG R T,et al.Ischemic stroke related to intracranial branch atheromatous disease and comparison with large and small artery diseases[J].J Neurol Sci,2011,303(1):80-84.
[5] DEGUCHI I,HAYASHI T,KATO Y,et al.Treatment outcomes of tissue plasminogen activator infusion for branch atheromatous disease[J].J Stroke Cerebrovasc Dis,2013,22(7):e168-e172.
[6] NAKASE T,YAMAMOTO Y,TAKAGI M,et al.The impact of diagnosing branch atheromatous disease for predicting prognosis[J].J Stroke Cerebrovasc Dis,2015,24(10):2423-2428.
[7] LIU Y,FAN YT,LIU YM,et al.A retrospective study of branch atheromatous disease:Analyses of risk factors and prognosis[J].J Huazhong Univ Sci Technolog:Med Sci,2017,37(1):93-99.
[8] Rost NS,ALEX B,JIN-MOO L,et al.Stroke severity is a crucial predictor of outcome:An international prospective validation study[J].J Am Heart Assoc,2016,5(1):2433-2435.
[9] YAMAMOTO Y,OHARA T,HAMANAKA M,et al.Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits[J].J Neurol Sci,2011,304(1-2):78-82.
[10] KWON HM,LEE YS,BAE HJ,et al.Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke[J].Stroke,2014,45(3):871-873.
[11] MEN X,LI J,ZHANG B,et al.Homocysteine and C-reactive protein associated with progression and prognosis of intracranial branch atheromatous disease[J].PLoS ONE,2013,8(9):e73030.
[12] NⅡMI M,ABO M,MIYANO S,et al.Comparison of functional outcome between lacunar infarction and branch atheromatous disease in lenticulostriate artery territory[J].J Stroke Cerebrovasc Dis,2016,25(9):2271-2275.
[13] SIEGLER J E,BOEHME A K,KUMAR A D,et al.What change in the national institutes of health stroke scale should define neurologic deterioration in acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2013,22(5):675-682.

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