单侧孤立基底节区腔隙性脑梗死早期神经功能恶化的多因素分析及缺血耐受的相关性研究

摘要

目的探讨单侧孤立的基底节区腔隙性脑梗死早期神经功能恶化（early neurological deterioration， END）的相关因素及其与脑缺血耐受（brain ischemic tolerance，BIT）机制的研究。n　　方法回顾性分析经磁共振证实的167例单侧新发孤立的基底节区腔隙性脑梗死患者的临床资料，并排除大动脉狭窄患者。根据卒中发生后1周内动态的美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分情况将167例患者分为END阳性及END阴性两组，使用Logistic回归分析研究与脑梗死早期神经功能恶化有关的因素。n　　结果167例患者中42例发生END，125例未发生END。多因素分析结果显示病灶累及内囊后肢侧脑室旁放射冠后部是预测E N D的独立危险因素，两组比较差异有显著性（P<0.01）；而发病年龄、脑梗死病史、糖尿病史、入院收缩压及脑白质病变与END有相关性，且比较差异有显著性（P<0.05）。分别以有无合并糖尿病、不同病灶位置进行分层并层间的单因素及多因素分析，结果显示，有无合并糖尿病、病灶部位的不同不影响年龄、卒中史、脑白质与END阳性的关系，END与既往脑梗死病史、脑白质病变、发病年龄存在相关性，比较差异有显著性（P<0.05）。n　　结论单侧孤立基底节区腔隙性脑梗死早期END与病灶是否累及内囊后肢侧脑室体旁后部密切相关，同时也与是否合并脑白质病变、既往脑梗死病史、糖尿病史、年龄等因素相关。年龄≥65岁、收缩压高、卒中史、脑白质病变是END阳性的保护因素。缺血不耐受为腔隙性脑梗死发生END的主要机制。%Objective To investigate the related factors of early neurological deterioration (END) in patients with unilateral isolated basal ganglia lacunar cerebral infarction and the related mechanism of brain ischemic tolerance (BIT) and END. n Methods Retrospective analysis were made upon clinical data of 167 patients who were diagnosed with unilateral isolated basal ganglia lacunar cerebral infarction conifrmed by magnetic resonance imaging (MRI) excluding artery stenosis diagnosed. According to the score of National Institutes of Health Stroke Scale (NIHSS) of the stroke within 1 week, 167 patients were divided into two groups: positive END and negative END. Multivariate logistic regression analysis was associated to analyze factors related to the early neurologic deterioration of cerebral infarction. n Results Among 167 patients, 42 (25.15%) patients suffered END and 125 patients didn’t have END. Multiple factor analysis indicated that lesions located in the internal capsule hind legs radial posterior lateral ventricle were independent risk factors for END and there were signiifcant difference between two groups (P<0.01). The age of onset, history of cerebral infarction, history of diabetes, systolic blood pressure at admission and lesions of cerebral white matter were associated with END, which had significant differences (P<0.05). Single factor and multi-factors analysis of with or without diabetes and difference lesion location at different layer and inter-layers showed that with or without diabetes and difference lesion location didn’t affect the association between age, history of stroke, white matter and positive ENT. END correlates with previous history of stroke, pathological changes of white matter, and age of onset, which had signiifcant difference (P<0.05). n Conclusion END in patients with unilateral isolated basal ganglia lacunar cerebral infarction is closely related to the lesion, other related factors such as lesions of cerebral white matter, history of cerebral infarction, history of diabetes and age, etc. Age of 65 years old and above, systolic hypertension, history of stroke, and lesions cerebral white matter are protective factors for positive END. Brain ischemia intolerance is the main mechanism for END.