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| 大动脉粥样硬化与心源性栓塞急性缺血性脑卒中特征差异对比研究 |
| 田冰1△,王铁功1△,杨鹏飞2,尹伟1,许兵1,陈录广1,刘崎1,刘建民2,陆建平1* |
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(1. 海军军医大学(第二军医大学)长海医院影像医学科, 上海 200433;
2. 海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探究大动脉粥样硬化与心源性栓塞急性缺血性脑卒中（AIS）梗死特征的差异。方法 回顾性纳入2016年10月至2018年6月于我院急诊入院治疗，且入院后、治疗前均行多模态计算机断层扫描（CT）检查的AIS患者99例，其中大动脉粥样硬化46例，心源性栓塞53例。比较两组患者的入院时美国国立卫生研究院卒中量表（NIHSS）评分和格拉斯哥昏迷量表（GCS）评分、梗死核心区和缺血半暗带体积及二者差值以及后循环血管闭塞率、颅内大动脉闭塞率。结果 大动脉粥样硬化组AIS患者入院时NIHSS评分低于心源性栓塞组[9.5（2.0，16.0）分vs 15.0（6.0，24.0）分，Z=2.31，P<0.001]，GCS评分高于心源性栓塞组[（13.52±2.69）分vs（11.60±3.31）分，t=1.04，P=0.002]。心源性栓塞组梗死核心区和缺血半暗带体积分别为1（0，22）mL和64（30，126）mL，均大于大动脉粥样硬化组[分别为0（0，1）mL和10（0，70）mL；Z=3.85、3.43，P均<0.001]；但心源性栓塞组和大动脉粥样硬化组缺血半暗带与梗死核心区体积的差值差异无统计学意义[46（4，103）mL vs 10（0，64）mL，Z=1.92，P>0.05]。大动脉粥样硬化组颅内大动脉闭塞率和后循环血管闭塞率分别为30.43%（14/46）和36.96%（17/46），与心源性栓塞组[分别为50.94%（27/53）和9.43%（5/53）]相比差异均有统计学意义（χ2=11.82、6.77，P均<0.001）。结论 大动脉粥样硬化与心源性栓塞AIS患者的临床症状、脑组织改变及颅内大动脉改变不同，基于临床及多模态CT检查的病因学评估有助于精确评估AIS患者缺血状态。 |
| 关键词: 急性缺血性脑卒中 大动脉粥样硬化 心源性栓塞 缺血半暗带 梗死核心 |
| DOI：10.16781/j.0258-879x.2018.09.1047 |
| 投稿时间：2018-08-09修订日期：2018-08-30 |
| 基金项目:上海市市级医院新兴前沿技术联合公关项目（SHDC12013110）. |
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| Characteristics of large artery atherosclerosis and cardioembolism acute ischemic stroke: a comparative study |
| TIAN Bing1△,WANG Tie-gong1△,YANG Peng-fei2,YIN Wei1,XU Bing1,CHEN Lu-guang1,LIU Qi1,LIU Jian-min2,LU Jian-ping1* |
(1. Department of Medical Imaging, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China;
2. Stroke Center, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the difference in infarction characteristics between large artery atherosclerosis and cardioembolism acute ischemic stroke (AIS). Methods A retrospective study was done on 99 AIS patients, who were admitted to Emergency Room of our hospital and underwent multi-modal computed tomography (CT) after admission and before treatment. Forty-six of 99 AIS patients had large artery atherosclerosis and 53 had cardioembolism. The NIHSS score and GCS score on admission, infraction core and ischemic penumbra volumes and the volume difference, and vascular occlusion rates of posterior circulation and large artery were compared between the two groups. Results Compared with the cardioembolism group, the NHISS score was significantly lower and the GCS score was significantly higher in the large artery atherosclerosis group (9.5[2.0, 16.0] vs 15.0[6.0, 24.0], Z=2.31, P<0.001; 13.52±2.69 vs 11.60±3.31, t=1.04, P=0.002). The volumes of infarction core and ischemic penumbra in the cardioembolism group were 1 (0, 22) mL and 64 (30, 126) mL, respectively, and were both significantly larger than those in the large artery atherosclerosis group (0[0, 1] mL and 10[0, 70] mL; Z=3.85 and 3.43, both P<0.01). However, the volume difference of ischemic penumbra and infraction core was not significantly different between the cardioembolism and large artery atherosclerosis groups (46[4, 103] mL vs 10[0, 64] mL, Z=1.92, P>0.05). The large artery occlusion rate and posterior circulation occlusion rate were both significantly different between the large artery atherosclerosis and cardioembolism groups (30.43%[14/46] vs 50.94%[27/53] and 36.96%[17/46] vs 9.43%[5/53]; χ2=11.82 and 6.77, both P<0.001). Conclusion The clinical symptoms, cerebral changes and intracranial large artery changes are different in AIS patients with large artery atherosclerosis and cardioembolism. Etiology evaluation based on clinical features and multi-modal CT examination can help to accurately assess the ischemic state of AIS patients. |
| Key words: acute ischemic stroke large artery atherosclerosis cardioembolism ischemic penumbra infarction core |
