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不同类型脑分水岭梗死临床与影像学分析

发布时间:2018-11-26 11:08
【摘要】:目的:观察不同类型脑分水岭梗死(CWI)患者的临床、DWI及颅内外血管狭窄情况,分析不同类型CWI影像学特点与不同部位血管狭窄和早期预后的关系,旨为CWI患者临床合理化治疗提供理论依据,改善预后。方法:入选发病7天内住院治疗且经头颅磁共振(MRI)+扩散加权成像(DWI)检查证实为CWI患者,分为皮质分水岭梗死(CWSI)、内分水岭梗死(IWSI)、混合型分水岭梗死(MWSI)三组。记录年龄、性别、高血压病、糖尿病、冠心病、卒中史、吸烟及饮酒史、入院时血压及化验结果。所有患者均行颅外段颈内动脉(ICA)彩超检查和颅内脑血管MRA检查,并于入院时和入院后14天进行NIHSS评分、修正的Rankin评分,分析不同类型CWI影像学特点与不同部位血管狭窄和早期预后的关系。结果:1.入选120例CWI,包括CWSI 18例,IWSI 48例,MWSI 54例。三组间的年龄、性别、高血压病、糖尿病、冠心病、卒中、吸烟及饮酒史发生率,差异无统计学意义(P0.05);三组间的入院时血压及化验结果情况,差异无统计学意义(P0.05)。2.120例CWI患者病灶侧血管狭窄:ICA 48例(40.0%,其中颅外段22例、颅内段39例)、ACA 24例(20.0%)、MCA 86例(71.7%)、PCA 40例(33.3%)、椎基底动脉35例(29.2%)、ICA+MCA 36例(30.0%);不同类型CWI之间病灶侧ICA、MCA、ICA+MCA狭窄发生率不同。3.CWSI多伴发病灶侧ICA狭窄(OR值为0.022;95%CI为0.002~0.230;P=0.001);IWSI多伴发病灶侧MCA狭窄(OR值为40.164;95%CI为3.861~417.810;P=0.002);MWSI多伴发病灶侧MCA狭窄(OR值为9.586;95%CI为2.776~33.126;P=0.000);MWSI多伴发病灶侧ICA+MCA狭窄(OR值为7.481;95%CI为2.541~22.022;P=0.000)。4.不同类型CWI的病灶侧伴发皮质小梗死和/(或)深穿支梗死情况不同,差异有统计学意义(P0.05)。CWSI伴发皮质小梗死概率较高;IWSI伴发深穿支梗死概率较高;MWSI伴发皮质小梗死+深穿支梗死概率较高。5.不同类型CWI的早期预后有所不同,差异有统计学意义(P0.05)。14天病情转归:好转——CWSI所占比率较高,稳定——IWSI所占比率较高,加重——MWSI所占比率较高;14天预后:CWSI预后良好的发生率较高,MWSI预后不良的发生率较高。结论:1.不同类型CWI之间病灶侧ICA、MCA、ICA+MCA狭窄发生率不同。CWSI多伴发病灶侧ICA狭窄,IWSI多伴发病灶侧MCA狭窄,MWSI多伴发病灶侧ICA+MCA狭窄。2.不同类型CWI的病灶侧伴发皮质小梗死和/(或)深穿支梗死情况不同,CWSI伴发皮质小梗死概率较高;IWSI伴发深穿支梗死概率较高;MWSI伴发皮质小梗死+深穿支梗死概率较高。3.不同类型CWI的早期预后不同。CWSI病情好转概率较高;IWSI病情稳定概率较高;MWSI病情加重概率较高。CWSI预后良好的概率较高,MWSI预后不良的概率较高。
[Abstract]:Objective: to observe the clinical, DWI and intracranial and extracranial vascular stenosis in patients with cerebral watershed infarction (CWI), and to analyze the relationship between the imaging features of different types of CWI and vascular stenosis and early prognosis in different locations. To provide theoretical basis for rational clinical treatment of CWI patients and improve prognosis. Methods: patients with CWI were admitted to hospital within 7 days of onset and confirmed by (MRI) diffusion weighted imaging (DWI). They were divided into cortical watershed infarction and (CWSI), watershed infarction (IWSI),. Mixed watershed infarction (MWSI) group 3. Record age, sex, hypertension, diabetes, coronary heart disease, stroke history, smoking and drinking history, admission blood pressure and laboratory results. All the patients were examined by color Doppler ultrasonography of extracranial internal carotid artery (ICA) and intracranial cerebrovascular MRA (MRA). The NIHSS score and modified Rankin score were evaluated on admission and 14 days after admission. To analyze the relationship between the imaging features of different types of CWI and vascular stenosis and early prognosis. Results: 1. There were 18 cases of CWSI, 48 cases of IWSI and 54 cases of MWSI. The incidence of age, sex, hypertension, diabetes, coronary heart disease, stroke, smoking and alcohol consumption were not significantly different among the three groups (P0.05). There was no significant difference in blood pressure and laboratory results among the three groups at admission (P0.05). In 2.120 patients with CWI, there were 48 cases of ICA (40.0%), including 22 cases of extracranial segment and 39 cases of intracranial segment. ACA was found in 24 cases (20.0%), MCA, 86 cases, 71.7%), PCA, 40 cases (33.3%), vertebrobasilar artery 35 cases (29.2%), ICA MCA, 36 cases, 30.0%); The incidence of ICA,MCA,ICA MCA stenosis was different among different types of CWI. 3.CWSI with ICA stenosis (OR = 0.022 95 CI = 0.002 卤0.230) P0. 001); IWSI with multiple focal side MCA stenosis (OR = 40.164); 95%CI was 3.861 ~ 417.810 ~ (10); MWSI with MCA stenosis (OR = 9.586 ~ (95) CI = 2.776 ~ 33.126 ~ 0.000); MWSI with ICA MCA stenosis at the lesion side (OR = 7.481 卤95CI = 2.541n = 22.022); P0. 000). The incidence of small cortical infarction and / or deep perforating branch infarction in different types of CWI was different, and the difference was statistically significant (P0.05) the probability of cortical small infarction associated with). CWSI was higher, that of IWSI with deep perforating branch was higher than that of IWSI. The probability of deep perforating branch infarction in MWSI complicated with small cortical infarction was higher. The early prognosis of different types of CWI was different, and the difference was statistically significant (P0.05). After 14 days, the rate of improvement-CWSI was higher, the ratio of stable-IWSI was higher, and the ratio of MWSI was higher. 14 days prognosis: the incidence of good prognosis in CWSI was higher than that in MWSI. Conclusion: 1. The incidence of ICA,MCA,ICA MCA stenosis was different among different types of CWI. CWSI was associated with ICA stenosis, IWSI with MCA stenosis and MWSI with ICA MCA stenosis. 2. The incidence of small cortical infarction and / or deep perforating branch infarction was different in different types of CWI, and the probability of cortical small infarction in CWSI was higher than that in IWSI with deep perforating branch. The probability of deep perforating branch infarction in MWSI complicated with small cortical infarction was higher than that of deep perforating branch. 3. 3. The early prognosis of different types of CWI is different. The probability of improving the condition of CWSI is higher; the probability of stable condition of IWSI is higher; the probability of exacerbation of MWSI is higher; the probability of good prognosis of CWSI is higher; the probability of poor prognosis of MWSI is higher.
【学位授予单位】:大连医科大学
【学位级别】:硕士
【学位授予年份】:2015
【分类号】:R743.3

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