孤立性脑桥梗死的临床和影像学特征：脑桥旁正中梗死与脑桥腔隙性梗死的比较研究

发布时间：2018-03-06 16:43

  本文选题：脑桥旁正中梗死　切入点：脑桥腔隙性梗死　出处：《扬州大学》2014年硕士论文　论文类型：学位论文

【摘要】：[目的] 对比研究脑桥旁正中梗死(Paramedian Pontine Infarction, PPI)与脑桥腔隙性梗死(Lacunar Pontine Infarction, LPI)的临床和影像学特征,探讨其早期运动障碍进展及短期预后的影响因素,以及高分辨率磁共振(high-resolution magnetic resonance angiography, HRMRI)在基底动脉斑块成像方面的临床应用。 [方法] 回顾性分析了初次发病24h内的孤立性脑桥梗死患者共86例,发病后72h内完成磁共振弥散加权成像(Diffusion-Weighted Imaging, DWI)和磁共振血管成像(Magnetic Resonance Angiography, MRA),其中10例PPI患者完成基底动脉高分辨率磁共振成像。86例患者分组：①根据梗死灶最大直径及位置分组：PPI组(35例,病灶直径15mm,累及脑桥腹侧表面)；LPI组(51例,病灶直径≤15mm,位于脑桥内部)。②根据早期是否存在运动障碍进展(progressive motor deficits, PMD)分为PMD组(22例)与无PMD组(64例)。③根据发病1月时改良的Rankin残障量表(modified Rankin Scale, mRS)评分,分为转归不良组(mRS2分,35例)与转归良好组(mRS≤2分,51例)。分别比较两组的临床特点及影响因素。 [结果] 1.PPI组与LPI组比较,PPI组高脂血症比例[20/35(57.14%)]明显高于LPI组[17/51(33.33%),x2=4.80,P=0.028]；PPI组入院时NIHSS评分明显高于LPI组(6.00±2.39vs4.61±3.41,t=2.087,P=0.040)；PPI组临床表现偏瘫比例[34/35(97.14%)]明显高于LPI组[37/51(72.55%),x2=8.718,P=0.003]；PPI组基底动脉狭窄比例[16/35(45.71%)]明显高于LPI组[9/51(17.65%),x2=7.930,P=0.005]；PPI组mRS2分比例[19/35(54.29%)]明显高于LPI组[16/51(31.37%),x2=4.515,P=0.034]。 2.PMD组与无PMD组比较,PMD组入院时舒张压明显高于无PMD组(97.82±15.61vs89.55±12.23,t=2.258, P=0.031); PMD组中PPI比例[14/22(63.64%)]明显高于无PMD组[21/64(32.81%),x2=6.445,P=0.011]。PMD组基底动脉狭窄比例[13/22(59.10%)]明显高于无PMD组[12/64(18.75%),x2=12.922,P=0.000)]。 3.转归不良组与转归良好组比较,前者入院时NIHSS评分、空腹血糖值明显高于后者(6.80±2.63vs3.73±2.55, t=5.426, P=0.000;9.40±5.15vs6.56±2.69,t=2.985, P=0.004);转归不良组中PPI比例[19/35(54.29%)]明显高于LPI[16/51(31.37%),x2=4.515, P=0.034]。 Logistic回归分析发现基底动脉狭窄与PPI的发生呈正相关(OR=3.801,95%CI1.357-10.646, P=0.011);基底动脉狭窄是孤立性脑桥梗死早期运动障碍进展的独立危险因素(OR=4.571,95%CI1.214-17.214, P=0.025);入院时NIHSS评分≥5分是其短期预后不良的独立危险因素(OR=4.277,95%CI1.505-12.151, P=0.006)。 4.10例PPI患者行基底动脉HRMRI检查,其中有8例发现基底动脉有大小不一的动脉粥样硬化斑块。 [结论] 1.PPI病因主要是基底动脉分支病变,与基底动脉主干动脉粥样硬化有关。 2.孤立性脑桥梗死入院时NIHSS评分≥5分可能导致其短期预后不良。 3.孤立性脑桥梗死早期运动障碍进展及短期预后不良均可能与基底动脉病变有关。
[Abstract]:[purpose]. To compare the clinical and imaging features of Paramedian Pontine Infarction (PPII) and lacunar Pontine Infarction (LPI) in patients with paracontine infarction and lacunar Pontine Infarction (LPI), and to explore the factors influencing the progression of early motor disorders and the short-term prognosis. And the clinical application of high resolution magnetic resonance (HRMRI) in basilar artery plaque imaging. [methods]. A retrospective analysis of 86 patients with solitary pons infarction within 24 hours of initial onset was made. Diffusion-weighted imaging (DWI) and magnetic Resonance angiography (MRAA) were completed within 72 hours after onset of the disease. Among them, 10 patients with PPI completed high-resolution magnetic resonance imaging of the basilar artery. 86 patients were divided into groups: 1 according to the maximum diameter of the infarct and. Position group: PPI group: 35 cases, The lesions were 15 mm in diameter and 51 cases in the LPI group involving the ventral surface of the pontine. The lesion diameter 鈮，

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