首发急性脑梗死中无症状性脑梗死的临床分析

发布时间：2018-09-19 11:02

【摘要】：目的分析首发急性脑梗死中无症状脑梗死的患病率、危险因素、临床表现、头部MRI特征及临床意义。 方法收集2011年3月至2012年12月在吉林大学第二临床医院住院的首发急性脑梗死患者130例。所有患者均否认既往曾患脑血管病、头部外伤、占位等病史，均为首次发生神经系统缺失症状及体征，且均符合全国第四届脑血管病学术会议制定的无症状性脑梗死诊断标准，依据头部MRI将其分为研究组（同时存在急性脑梗死责任病灶与非责任病灶者）88例，其中男50例，女38例，和对照组(仅有急性脑梗死责任病灶者）42例，男32例，女10例。详细询问患者病史、查体，并行血糖、血脂、心电图、头部MRI、头颈部血管超声等相关检查。明确患者的脑血管病的危险因素，包括年龄、吸烟、饮酒史、血脂、血压、血糖，有无心房纤颤、动脉粥样硬化斑块及动脉狭窄情况，对上述危险因素进行统计分析，比较两组的危险因素及临床意义，并总结分析研究组临床表现及头部MRI特点。 结果1、首发急性脑梗死患者中，SCI患病率为67.7%；2、性别：首发急性脑梗死患者中，男性SCI患病率为61.0%，女性SCI患病率为79.2%，女性SCI的患病率高于男性，且P0.05；年龄：研究组，60的患者比率为49.3%，≥60的患者比率为89.8%，对照组60的患者比率为50.7%，≥60的患者比率为10.2%，≥60的患者患SCI的比率高于60的患者，且P0.05；3、吸烟、饮酒、高血压、糖尿病、高脂血症、心房纤颤：研究组上述危险因素的比率依次为：55.7%、28.4%、55.7%、23.9%、56.8%、2.3%，对照组上述危险因素的比率依次为54.8%、40.5%、42.3%、16.7%、64.3%，7.1%。两组之间比较P0.05，，均无统计学意义；动脉狭窄、不稳定斑块：研究组比率分别为54.5%、75%，对照组比率分别为35.7%、54.8%，研究组有动脉狭窄、不稳定斑块的比率明显高于对照组，P0.05，有统计学意义。4、临床表现：SCI无确切的神经系统定位症状与体征，主要表现为一些非特异性症状及体征。本研究统计如下：头痛、头晕、头昏、主观感觉异常；注意力不集中、记忆力减退及计算力下降；抑郁、焦虑等。多数患者具有以上两种或两种以上症状组合。5、SCI共发现非责任病灶382个，其中，基底节区127个，放射冠区96个，内囊65个，丘脑32个，脑干23个，小脑7个，脑叶32个。病灶直径在≤1.5cm的327个（85.6%），1.5cm病灶≤3.0cm的病灶47个（12.3%）,3.0cm病灶≤5.0cm的病灶8个（2.1%）。 结论首发急性脑梗死中无症状性脑梗死患病率高；女性及年龄≥60岁人群更容易患无症状性脑梗死；具有动脉狭窄或不稳定斑块的患者容易患无症状性脑梗死；无症状性脑梗死主要表现为一些非特异性症状，无确切的神经系统定位症状与体征；无症状性脑梗死病灶以腔隙性梗死为主，病灶分布以基底节、放射冠及内囊多见。
[Abstract]:Objective to analyze the prevalence, risk factors, clinical manifestations, MRI features and clinical significance of asymptomatic cerebral infarction in patients with acute cerebral infarction. Methods from March 2011 to December 2012, 130 patients with acute cerebral infarction who were hospitalized in the second Clinical Hospital of Jilin University were collected. All the patients denied that they had suffered from cerebrovascular disease, head injury, space occupying, etc. All of them had the first symptom and sign of nervous system deficiency, and all of them were in accordance with the criteria for the diagnosis of asymptomatic cerebral infarction established by the fourth National Conference on Cerebrovascular Disease. According to head MRI, 88 cases were divided into study group (including 50 males and 38 females), and 42 cases (32 males and 10 females) in the control group (only responsible for acute cerebral infarction) in which there were both responsible and non-responsible lesions of acute cerebral infarction (ACI) in the study group (50 males and 38 females). The patient's history, body examination, blood glucose, blood lipid, electrocardiogram, head MRI, head and neck vascular ultrasound, etc. To determine the risk factors of cerebrovascular disease, including age, smoking, drinking history, blood lipid, blood pressure, blood sugar, atrial fibrillation, atherosclerotic plaque and arterial stenosis. The risk factors and clinical significance of the two groups were compared, and the clinical manifestations and MRI features of the head in the study group were summarized and analyzed. Results 1. The prevalence rate of sci was 67.7% in the first acute cerebral infarction patients. Sex: in the first acute cerebral infarction patients, the prevalence rate of SCI was 61.0 in males and 79.2 in females. The prevalence rate of SCI in females was higher than that in males (P0.05). Age: the study group had 49.3% of the patients with SCI, 89.8 with 鈮

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