【摘要】：目的:觀察不同類型腦分水嶺梗死(CWI)患者的臨床、DWI及顱內(nèi)外血管狹窄情況,分析不同類型CWI影像學(xué)特點(diǎn)與不同部位血管狹窄和早期預(yù)后的關(guān)系,旨為CWI患者臨床合理化治療提供理論依據(jù),改善預(yù)后。方法:入選發(fā)病7天內(nèi)住院治療且經(jīng)頭顱磁共振(MRI)+擴(kuò)散加權(quán)成像(DWI)檢查證實(shí)為CWI患者,分為皮質(zhì)分水嶺梗死(CWSI)、內(nèi)分水嶺梗死(IWSI)、混合型分水嶺梗死(MWSI)三組。記錄年齡、性別、高血壓病、糖尿病、冠心病、卒中史、吸煙及飲酒史、入院時(shí)血壓及化驗(yàn)結(jié)果。所有患者均行顱外段頸內(nèi)動脈(ICA)彩超檢查和顱內(nèi)腦血管MRA檢查,并于入院時(shí)和入院后14天進(jìn)行NIHSS評分、修正的Rankin評分,分析不同類型CWI影像學(xué)特點(diǎn)與不同部位血管狹窄和早期預(yù)后的關(guān)系。結(jié)果:1.入選120例CWI,包括CWSI 18例,IWSI 48例,MWSI 54例。三組間的年齡、性別、高血壓病、糖尿病、冠心病、卒中、吸煙及飲酒史發(fā)生率,差異無統(tǒng)計(jì)學(xué)意義(P0.05);三組間的入院時(shí)血壓及化驗(yàn)結(jié)果情況,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.120例CWI患者病灶側(cè)血管狹窄:ICA 48例(40.0%,其中顱外段22例、顱內(nèi)段39例)、ACA 24例(20.0%)、MCA 86例(71.7%)、PCA 40例(33.3%)、椎基底動脈35例(29.2%)、ICA+MCA 36例(30.0%);不同類型CWI之間病灶側(cè)ICA、MCA、ICA+MCA狹窄發(fā)生率不同。3.CWSI多伴發(fā)病灶側(cè)ICA狹窄(OR值為0.022;95%CI為0.002~0.230;P=0.001);IWSI多伴發(fā)病灶側(cè)MCA狹窄(OR值為40.164;95%CI為3.861~417.810;P=0.002);MWSI多伴發(fā)病灶側(cè)MCA狹窄(OR值為9.586;95%CI為2.776~33.126;P=0.000);MWSI多伴發(fā)病灶側(cè)ICA+MCA狹窄(OR值為7.481;95%CI為2.541~22.022;P=0.000)。4.不同類型CWI的病灶側(cè)伴發(fā)皮質(zhì)小梗死和/(或)深穿支梗死情況不同,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。CWSI伴發(fā)皮質(zhì)小梗死概率較高;IWSI伴發(fā)深穿支梗死概率較高;MWSI伴發(fā)皮質(zhì)小梗死+深穿支梗死概率較高。5.不同類型CWI的早期預(yù)后有所不同,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。14天病情轉(zhuǎn)歸:好轉(zhuǎn)——CWSI所占比率較高,穩(wěn)定——IWSI所占比率較高,加重——MWSI所占比率較高;14天預(yù)后:CWSI預(yù)后良好的發(fā)生率較高,MWSI預(yù)后不良的發(fā)生率較高。結(jié)論:1.不同類型CWI之間病灶側(cè)ICA、MCA、ICA+MCA狹窄發(fā)生率不同。CWSI多伴發(fā)病灶側(cè)ICA狹窄,IWSI多伴發(fā)病灶側(cè)MCA狹窄,MWSI多伴發(fā)病灶側(cè)ICA+MCA狹窄。2.不同類型CWI的病灶側(cè)伴發(fā)皮質(zhì)小梗死和/(或)深穿支梗死情況不同,CWSI伴發(fā)皮質(zhì)小梗死概率較高;IWSI伴發(fā)深穿支梗死概率較高;MWSI伴發(fā)皮質(zhì)小梗死+深穿支梗死概率較高。3.不同類型CWI的早期預(yù)后不同。CWSI病情好轉(zhuǎn)概率較高;IWSI病情穩(wěn)定概率較高;MWSI病情加重概率較高。CWSI預(yù)后良好的概率較高,MWSI預(yù)后不良的概率較高。
[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 鹵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 鹵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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R743.3

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