急性血栓形成性和栓塞性大脑中动脉闭塞的临床和影像学特点比较——基于弥散加权成像的回顾性研究

摘要

目的 探讨急性血栓形成性和栓塞性大脑中动脉闭塞的临床和影像学差异.方法 发病24 h内经弥散加权成像(diffusion-weighted imaging DWI)和磁共振血管造影(magnetic resonance angiography,MRA)证实为急性大脑中动脉主干闭塞的脑梗死患者,根据TOAST分型标准分为大动脉粥硬化血栓形成组(large artery atherosclerosis,LAA)和心源性栓塞组(cardioembolism,CE),在均未接受溶栓治疗的情况下,比较DWI所示病灶体积、形态特征以及人院时和14 d时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分的变化.结果 共纳入急性大脑中动脉主干闭塞的脑梗死患者102例,CE组年龄显著大于LAA组[(67.60±9.62)岁对(62.57±10.18)岁,P=0.017],而且有更多患者存在冠心病(27.27％对2.90％,P=0.001).LAA组病灶体积[ (31.96±39.20)ml对(65.66±84.74) ml,P=0.005]、人院时NIHSS评分[(6.42±3.38)分对(11.67±8.50)分,P=0.007)和病情改善程度(即入院时与14 d时NIHSS评分差值)[(1.55±6.43)分对(5.75±9.28)分,P=0.027)均显著小于CE组,但14 d时NIHSS评分两组无显著差异[(4.87±6.61)分对(5.97±3.60)分,P=0.324).梗死体积与14 d时NIHSS评分显著相关(CE组:r =0.625,P=0.001;LAA组:r=0.295,P=0.014).LAA组以多发性梗死为主(71.01％),而CE组以单发性梗死为主(54.55％) (P=0.016).结论 LAA组和CE组梗死病灶形态存在差异.CE导致的大脑中动脉主干闭塞在发病初期病情更重,梗死体积更大,但部分患者在发病后短时间内可自然显著改善.%Objective To investigate the clinical and imaging differences in acute thrombotic and embolic middle cerebral artery occlusion.Methods The cerebral infarction patients with acute middle cerebral artery trtmk occlusion confirmed by diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) within 24 hours of onset were divided into large artery atherosclerosis (LAA) group and the cardioembolism (CE) group according to the TOAST classification criteria.Under the circumstances of not receiving thrombolytic therapy,the infarct volume on DWI,morphological characteristics and the changes of the National Institutes of Health Stroke Scale (NIHSS) scores both at admission and day 14 were compared.Results A total of 102 cerebral infarction patients with acute middle cerebral artery trunk occlusion were included.The age of the CE group was significantly older than that of the LAA group (67.60 ± 9.62 years vs.62.57 ± 10.18 years,P =0.017),and more patients with coronary heart disease (27.27％ vs.2.90％,P=0.001 ).The infarct volume (31.96 ±39.20 ml vs.65.66 ±84.74 ml,P =0.005),the NIHSS score at admission (6.42 ± 3.38 vs.11.67 ±8.50,P=0.007),and the improvement of the disease (i.e.the difference of NIHSS scores between admission and day 14) (1.55 ± 6.43 vs.5.75 ± 9.28,P =0.027) in LAA group were significantly lower than those in the CE group.However,there was no significant difference in the NIHSS score between the 2 groups at day 14 (4.87 ± 6.61 vs.5.97 ± 3.60,P =0.324).The infarct volume was significantly correlated with the NIHSS scores at day 14 (CE group:r=0.625,P=0.001; LAA group:r=0.295,P=0.014).The LAA group was mostly the multiple lesions (71.01％),and the CE group was mostly the single lesions (54.55％) (P =0.016).Conclusion There were differences in morphology of cerebral lesion between the LAA and CE groups.In the early stage after onset,CE caused middle cerebral artery trunk occlusion was more serious and had larger infarct volume,but some patients could naturally significantly improve within a short time after onset.