頭顱MRI—DWI病灶數量及部位對腦梗死復發預測意義

劉然

摘 要：目的 探討頭顱磁共振彌散加權成像病灶數量及部位對腦梗死復發的預測意義。方法 收集我院神經內科確診的124例首發急性腦梗死患者的臨床資料及實驗數據。根據病灶的數量分為：多發病灶（87例）與單發病灶（37例）；根據部位分為：①單發皮層病灶（1例）與單發深部病灶（36例）；②相同供血區多發病灶（38例）與不同供血區多發病灶（49例）；根據是否復發分為復發組及未復發組，每組62例。將患者一般資料、癥狀性顱內外動脈狹窄、LDL-C、HDL-C、T-C、TG、NIHSS評分、抗血小板藥物應用及他汀應用行單因素及多因素Logistic回歸分析。結果 經單因素分析提示，多發病灶與單發病灶2年內復發情況比較，差異具有統計學意義（P<0.05）。單發皮層病灶與單發深部病灶比較，差異無統計學意義（P>0.05）；不同供血區多發病灶與相同供血區多發病灶比較，差異具有統計學意義（P<0.05）。經多因素Logistic回歸分析提示多發病灶（P<0.05）、不同供血區多發病灶（P<0.05）、糖尿病及癥狀性顱內外動脈狹窄可能對首發急性腦梗死患者2年內復發具有預測意義。結論 多發病灶、不同供血區多發病灶、癥狀性顱內外動脈狹窄及糖尿病可能對首發急性腦梗死患者2年內復發具有一定預測意義。

關鍵詞：急性腦梗死；彌散加權成像；復發；病灶數量；病灶部位

中圖分類號：R743 文獻標識碼：A DOI：10.3969/j.issn.1006-1959.2018.22.052

文章編號：1006-1959（2018）22-0172-03

The Significance of the Number and Location of MRI-DWI Lesions in Predicting the Recurrence of Cerebral Infarction

LIU Ran

（Department of Neurology，Tianjin Huanhu Hospital，Tianjin 300350，China）

Abstract：Objective To investigate the predictive significance of the number and location of brain diffusion-weighted imaging lesions in predicting the recurrence of cerebral infarction.Methods The clinical data and experimental data of 124 patients with acute cerebral infarction diagnosed by neurology in our hospital were collected.According to the number of lesions： multiple lesions （87 cases） and single lesions （37 cases）；According to the location：① single cortical lesion （1 case） and single deep lesion （36 cases）；②Multiple lesions in the same blood supply area （38 cases） and multiple lesions in different blood supply areas （49 cases）.The patients were divided into recurrence group and non-recurrence group according to whether they recurred， 62 cases in each group.Univariate and multivariate Logistic regression was performed on general data， symptomatic extracranial artery stenosis， LDL-C，HDL-C，T-C，TG，NIHSS score， antiplatelet drug use and statins.Results Single factor analysis showed that the recurrence of multiple lesions was significantly different from that of single lesions within 2 years，the difference was statistically significant（P<0.05）. There was no significant difference between single cortical lesions and single deep lesions（P>0.05）.Compared with multiple lesions in the same blood supply area， the statistical significance was significant （P<0.05）.Multivariate Logistic regression analysis showed that there were multiple lesions（P<0.05） and multiple lesions in different blood supply areas（P<0.05），diabetes mellitus and symptomatic extracranial artery stenosis might predict the recurrence of acute cerebral infarction within 2 years. Conclusion Multiple lesions， multiple lesions in different blood supply areas， symptomatic extracranial artery stenosis and diabetes may be useful in predicting recurrence in the first acute cerebral infarction patients within 2 years.

Key words：Acute cerebral infarction；Diffusion-weighted imaging；Recurrence；Number of lesions； Location of lesions

急性腦梗死（acute cerebral infarction，ACI）是一種高發病率、高致殘率及高復發率的疾病[1]。復發性腦梗死患者較首發患者的住院時間延長、神經功能缺損程度明顯加重。因此，充分認識腦梗死復發影響預測因素，對指導ACI患者的二級預防具有重要的臨床意義。目前國內外學者對ACI患者復發的影響因素，如高血壓，糖尿病，高同型半胱氨酸血癥[2，3]等進行的研究表明頭顱MRI-DWI病灶與近期復發存在密切關系，且與梗死體積相比臨床應用更方便、效果更佳。同時，美國神經病學學院的研究者制定的90 d復發風險網絡評分量表中，DWI病灶也是其中一項重要的評價指標。……