脉络膜前动脉脑梗死的临床分析

摘要

Objective To observe patients with acute ischemic infarct in the anterior choroidal artery (AchA) territory and to investigate stroke evolution in patients with AchA infarction.Methods A prospective series of 96 patients with acute iscbemic lesion in the AchA territory.Within 1 week of admission,according to national institute of health stroke scale (NIHSS) score a total of 96 patients were divided into two groups:neurological deterioration group (group A,42 cases) and no deterioration groups (group B,54 cases).All patients underwent doppler ultrasonography of the cervical arteries,computed tomography angiography or magnetic resonance angiography.Two groups were compared regarding carotid atherosclerosis and vascular stenosis.Results In patients of AchA territory,the two groups were characterized by hypertension.The constituent ratio of diabetes and hyperlipidemia in group A [35.7％ (15/42),59.5％ (25/42)] was higher than that in group B [14.8％ (8/54),37.0％ (20/54)].There were 30 cases (71.4％)with unstable plaque in group A,significantly more than that in group B [21 (38.9％)] (x2 =4.42,P =0.036).The proportions of cerebrovascular steno-occlusion in group A (33 cases,78.6％) was significantly higher than that in group B(31 cases,57.4％) (x2 =4.76,P =0.029).27 patients of group A with ipsilateral internal carotid artery(ICA) and/or middle cerebral artery(MCA) steno-occlusion (64.3％) were significantly more than those in group B (x2 =6.10,P =0.014).After 3 months 12 patients (30.0％) in group A had improvement,which was much lower than that (28 cases,54.9％) in group B(x2 =5.64,P =0.01 8).Conclusion Diabetes and hyperlipidemia may be the important factors affecting the progress of AChA infarcts.%目的 探讨进展性脉络膜前动脉(AchA)供血区新发脑梗死的可能机制以及预后.方法 连续性前瞻性分析96例局限于AchA供血区新发脑梗死患者,根据入院后1周内美国国立卫生研究院卒中量表(NIHSS)评分将患者分为2组:病情进展组(42例)和病情非进展组(54例).所有患者均进行颈动脉血管超声、头部CT血管造影(CTA)或磁共振血管造影(MRA)等检查.比较2组患者颈动脉粥样硬化和血管狭窄程度的差别.随访3个月,比较2组患者的预后.结果 所有局限于AchA供血区脑梗死患者中均以高血压为特征,在病情进展组其糖尿病病史、高脂血症构成比[35.7％ (15/42)、59.5％(25/42)]明显高于病情非进展组[14.8％ (8/54)、37.0％ (20/54)].病情进展组共检出不稳定斑块71.4％(30例),明显高于病情非进展组38.9％(21例)(x2=4.42,P=0.036).病情进展组有血管狭窄比例78.6％(33例)明显高于病情非进展组57.4％(31例)(x2=4.76,P=0.029).其中病情进展组同侧颈内动脉或大脑中动脉狭窄率64.3％(27例)明显高于病情非进展组38.9％(21例)(x2=6.10,P=0.014).并且病情进展组同侧颈内动脉或大脑中动脉中重度狭窄-闭塞的比率(47.6％,20例)明显高于病情非进展组(16.7％,9例)(x2=4.81,P =0.028).随访3个月后病情进展组有12例(30.0％)好转,明显低于病情非进展组的28例(54.9％)(x2=5.64,P=0.018).结论 糖尿病、高脂血症可能是进展性AchA脑梗死的重要影响因素.进展性AchA脑梗死可能存在明显的颈内动脉或大脑中动脉中重度狭窄-闭塞病变,其预后差、复发率高.