颅内动脉狭窄对进展性卒中的影响_医学论文.docVIP

颅内动脉狭窄对进展性卒中的影响_医学论文 颅内动脉狭窄对进展性卒中的影响_医学论文 作者：王鹏飞 赵仁亮 王国峰 赵俊武 【摘要】 目的 探讨颅内动脉狭窄、闭塞及侧支循环的程度与进展性卒中的关系。方法 收集发病24 h内入院的急性脑梗死病人285例，记录病人入院时的基线资料、实验室检查资料，在入院时及入院72 h后两次评价病人的神经功能。将入院72 h后NIHSS评分增加≥2分者定义为进展性卒中。应用西门子3.0 T磁共振血管成像(MRA)评价颅内血管狭窄、闭塞及侧支循环。结果 285例病人中有57例(20.0%)为进展性卒中。多因素Logistic回归分析显示，颈内动脉狭窄或闭塞、大脑中动脉狭窄或闭塞、基底动脉狭窄或闭塞、3级侧支循环、糖尿病史是进展性卒中的独立危险预测指标。结论 进展性卒中是比较常见的卒中类型，通过MRA显示的血管狭窄、闭塞及侧支循环的程度能有效地预测进展性卒中的发生。 【关键词】 脑血管意外颈动脉狭窄大脑中动脉基底动脉侧支循环 [ABSTRACT] Objective To investigate the relationship between intracranial arterial stenosis (ICAS), arterial occlusion (AO), the extent of collateral circulation (CC) and progressive stroke (PS). Methods Data of 285 patients admitted to hospital within 24 hours of the onset of acute cerebral infarction (ACI) were collected. Baseline information, laboratory findings and neurofunction were recorded. Based on the score of National Institutes of Health Stroke Scale (NIHSS) for patients hospitalized after 72 hours plus ≥2 marks were defined as PS. 3.0 T magnetic resonance angiography was used for assessment of ICAS, AO and CC. Results Of the 285 patients, 57 (20.0%) were diagnosed as PS. Multivariate logistic regression analysis showed that stenosis/occlusion in internal carotid artery, in middle cerebral artery, in basilar artery, 3rddegree CC and a history of diabetes mellitus were independent risk predictors of PS. Conclusion PS is a relatively common type of stroke, intracranial arterial stenosis/ occlusion and the extent of collateral circulation showed in magnetic resonance angiography imaging may predict the occurrence of this condition. 　　[KEY WORDS] cerebrovascular accident carotid stenosis middle cerebral artery basilar artery collateral circulation 　　急性脑梗死病人在发病急性期经常出现神经功能缺损进展性加重，文献报道其发生率约为16%～43%[12]，约半数病人进展加重是在入院24 h内发生的[3]。以往有关进展性卒中的研究主要关注于生物化学和临床指标如血糖、血脂、血压、体温等方面，但迄今为止尚未得到能有效的应用于临床的预测指标。有研究表明，颅内动脉狭窄和侧支循环在急性缺血性脑卒中发生、发展过程中起重要的作用[4]。本研究探讨颅内动脉狭窄、闭塞及侧支循环的程度与进展性卒中的关系。现将结果报告如下。 　　1 资料和方法1.1 研究对象 　　2008年6月—2009年6月，选择威海市立医院神经内科病房连续收治的