摘要
目的:总结非栓塞性卒中影像模式的急性多发腔隙性脑梗死的危险因素、临床特点、影像学特征，探讨引起脑小血管病变快速进展的可能因素。方法:连续收集解放军总医院第一医学中心2008年1月１日至2017年12月31日经影像证实的、非栓塞特征的、急性的、不同主干血管终末支缺血性脑梗死患者的（10例）资料。研究资料包括基线资料（年龄、性别、体质量指数）、危险因素（高血压、糖尿病、冠状动脉粥样硬化性心脏病/心肌梗死、高脂血症、脑血管病史、吸烟史、饮酒史、家族史）和脑小血管病评价指标（脑白质Fazekas量表评分、腔隙性梗死病灶、血管周围间隙、微出血）。采用Fisher检验与既往报道我国脑梗死人群的脑小血管病评价数据进行比较。结果:与既往报道的总体脑小血管病数据比较，腔隙性梗死的发生比例显著增高（80.0% vs 44.1%），差异具有统计学意义（P=0.028）。虽然基线资料和危险因素比较，差异均无统计学意义（P均＞0.05），但数据显示本病例组患者存在更高的危险因素负荷（多重危险因素叠加，危险因素管控不佳），更高的脑小血管病负荷（白质高信号和腔隙性梗死增多）。结论:多重危险因素管理不佳可能是脑小血管病同时发生多发性腔隙性梗死的重要因素。更严格的危险因素管理，对于多发脑小血管病患者可能获益更多。
Abstract
Objective:To summarize the risk factors, clinical and imaging features of acute multiple lacunar infarctions in non-embolic stroke imaging mode, and to explore the possible factors causing the rapid progress of cerebral small vessel disease.Methods:The clinical data of eligible patients from January 1, 2008 to December 31, 2017 in the First Medical Center of PLA General Hospital were collected. The imaging inclusion criteria were non-embolic, acute ischemic cerebral infarction in different terminal branch. The information of interest included baseline information (age, gender, body mass index), risk factors (hypertension, diabetes, coronary heart disease / myocardial infarction, hyperlipidemia, cerebrovascular history, smoking history, drinking history, and family history), and the imaging manifestations of cerebral small vessel disease (white matter Fazekas Scale score, lacunar infarct lesion, perivascular space, and microbleeds). Fisher’s exact test was used to compare the evaluation data of cerebral microangiopathy reported on cerebral infarction in China.Results:The incidence of lacunar infarction was significantly higher than the previously reported data of overall cerebrovascular disease (80.0% vs 44.1%, P=0.028). Although there was no significant difference of baseline information and risk factors (P＞0.05), the data showed that this group of patients had higher load of risk factors (multiple risk factors superimposed, poor risk factor control) and higher load of cerebral small vessel disease (more intensive white matter signal and increased lacunar infarction).Conclusion:Poor management of multiple risk factors may be an important factor for the simultaneous occurrence of multiple lacunar infarctions in cerebral small vessel disease disease. More strict management of risk factors may be of benefit to the patients with multiple cerebral small vessel disease.
万方数据