急性脑梗死患者牛津郡社区卒中项目亚型脑侧支循环的形成及其对近期预后的影响

摘要

Objective To investigate the formation of collateral circulation in Oxfordshire Community Stroke Project (OCSP)subtypes of patients with acute cerebral infarction and its effects on short-term prognosis.Methods The clinical data of 352 patients with acute cerebral infarction who underwent head 256 slice spiral CT angiography during hospitalization of the affiliated hospital of North China University of Science and Technology from January 2015 to December 2016 were analyzed retrospectively.All patients were classified according to the OCSP classifications system,to analyze the formation of collateral circulation in different subtypes of OCSP classifications.The degree of neurological deficits were evaluated by national institute of health stroke scale (NIHSS) score and activities of daily living were evaluated by activities of daily living (ADL) score on the first and 14th day of admission,the effects of the formation of collateral circulation on the short-term prognosis in different subtypes of OCSP classifications were analyzed.Results ①Among 352 cases of acute cerebral infarction,41 cases of total anterior circulation (TACI) type,21 cases (51.2％) with collateral circulation,20 cases (48.8％) with no collateral circulation;141 cases of partial anterior circulation infarcts (PACI) type,97 cases of collateral circulation (68.8％),44 cases with no collateral circulation (31.2％);92 cases of posterior circulation infarcts (POCI) type,39 cases of collateral circulation (42.4％),53 cases with no collateral circulation (57.6％);78 cases of lacunar infarcts (LACI) type,40 cases of collateral circulation (51.3％) circulation was not good in 38 cases (48.7％).PACI type proportion of collateral circulation was the largest (68.8％),compared with other subtypes of collateral circulation,the difference was statistically significant (all P ＜ 0.05).②The NIHSS scores and the degree of ADL deficiency on the 14th day of admission with collateral circulation of the patients with TACI type and PACI type were significantly lower than that with no collateral circulation (all P ＜ 0.05).The differences of the NIHSS scores and the degree of ADL deficiency on the 14th day of admission between collateral circulation with no collateral circulation of the patients with POCI type and LACI type were both not statistically significant (all P ＞ 0.05).Conclusion In OCSP subtypes of patients with acute cerebral infarction,PACI type of cerebral collateral circulation formation is good up to see.The short-term prognosis of TACI type and PACI type of cerebral collateral circulation is good,the formation of POCI type and LACI type of cerebral collateral circulation had little effect on the short-term prognosis.%目的 探讨急性脑梗死患者牛津郡社区卒中项目(OCSP)亚型脑侧支循环的形成情况及其对近期预后的影响.方法 分析2015年1月～2016年12月在华北理工大学附属医院住院治疗期间行头部256层螺旋CT血管造影(CTA)检查的352例急性脑梗死患者临床资料,对急性脑梗死患者进行OCSP分型,分析各亚型脑侧支循环的形成情况.采用美国国立卫生研究院卒中量表(NIHSS)评分和日常生活活动能力(ADL)评分方法评价患者入院时及治疗第14天的神经功能缺损程度及日常生活活动能力,分析OCSP各亚型侧支循环形成对近期预后的影响.结果 ①352例急性脑梗死患者中,41例完全前循环梗死(TACI)中,有侧支循环形成者21例(51.2％),无侧支循环形成者20例(48.8％);141例部分前循环梗死(PACI)型中,有侧支循环形成者97例(68.8％),无侧支循环形成者44例(31.2％);92例后循环梗死(POCI)型中,有侧支循环形成者39例(42.4％),无侧支循环形成者53例(57.6％);78例腔隙性梗死(LACI)型中,有侧支循环形成者40例(51.3％),无侧支循环形成者38例(48.7％).PACI型有侧支循环形成的比例最大(68.8％),与其他各亚型侧支循环形成情况比较,差异均有统计学意义(均P＜0.05).②TACI型及PACI型有侧支循环形成者治疗第14天时NIHSS评分及ADL缺陷程度均明显低于无侧支循环形成者(均P＜ 0.05);POCI型及LACI型有侧支循环形成患者和无侧支循环形成者治疗第14天NIHSS评分及ADL缺陷程度差异均无统计学意义(均P＞0.05).结论 急性脑梗死患者OCSP各亚型中,PACI型脑侧支循环形成者最多见;TACI型及PACI型中有侧支循环形成者近期预后好,POCI型及LACI型中脑侧支循环形成对近期预后影响不大.