摘要
目的探讨不同影像学特征的孤立性皮质下小梗死(SSSI)可能的病因机制。方法收集2016年1月至2019年12月在郑州大学第一附属医院神经内科缺血性卒中数据库登记的患者。根据磁共振弥散加权成像(DWI)上病灶最低受累层面(LS)及受累的总层数(TNS), 将SSSI分为近端型SSSI(pSSSI;LS≤2)、远端型且病灶较大的SSSI(dl-SSSI;LS>2, TNS>2)及远端型且病灶较小的SSSI(ds-SSSI;LS>2, TNS≤2), 并采用χ^(2)检验、Kruskal-WallisH检验和多元Logistic 回归分析等统计学方法比较3种不同梗死类型间临床特征及病因的差异。结果在ds-SSSI(205例)、dl-SSSI(157例)及pSSSI(166例)3组患者中, 合并冠心病比例[分别为8.3%(17/205)、14.0%(22/157)、16.9%(28/166), χ^(2)=6.44, P=0.040]、血清同型半胱氨酸(Hcy)水平[分别为18.01(13.54, 25.56)、16.03(12.50, 21.09)、14.72(11.12, 19.14)μmol/L, H=19.36, P<0.001]、合并载体动脉病(PAD)比例[分别为10.7%(22/205)、19.1%(30/157)、42.8%(71/166), χ^(2)=54.89, P<0.001]、合并重度脑白质高信号(sWMHs)比例[分别为58.0%(119/205)、43.3%(68/157)、41.0%(68/166), χ^(2)=12.94, P<0.001]及美国国立卫生研究院卒中量表(NIHSS)评分[分别为2(1, 3)、3(1, 4)、3(2, 6)分, H=39.53, P<0.001]差异有统计学意义。多元Logistic 回归分析结果显示:pSSSI患者与dl-SSSI患者相比, 合并PAD比例高(OR=3.12, 95%CI 1.86~5.24, P<0.001)的患者其影像分型更接近pSSSI;ds-SSSI患者与dl-SSSI患者相比, 血清Hcy水平高(OR=1.02, 95%CI 1.00~1.04, P=0.046)或合并sWMHs比例高(OR=1.79, 95%CI 1.12~2.86, P=0.015)的患者其影像分型更接近ds-SSSI, 合并PAD比例高(OR=0.50, 95%CI 0.27~0.93, P=0.029)或NIHSS评分高(OR=0.84, 95%CI 0.77~0.92, P<0.001)的患者其影像分型更接近dl-SSSI。结论 ds-SSSI的发病机制倾向于脑小血管病, pSSSI的发病机制与动脉粥样硬化有关, dl-SSSI具有pSSSI和ds-SSSI的中间特征, 可能具有不稳定性。
Objective To investigate the etiological mechanism in single small subcortical infarction(SSSI)with different imaging features.Methods The patients registered in a database of ischemic stroke in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019 were analyzed.According to the lowest slice(LS)and the total number of involved slices(TNS)on diffusion-weighted imaging,the SSSI was divided into 3 types:proximal SSSI(pSSSI;LS≤2),distal and large SSSI(dl-SSSI;LS>2,TNS>2)and distal and small SSSI(ds-SSSI;LS>2,TNS≤2).The clinical and imaging features among 3 different lesion patterns were compared by usingχ^(2) test,Kruskal-Wallis H test and multiple Logistic regression analysis,etc.Results In the 3 groups of ds-SSSI(n=205),dl-SSSI(n=157)and pSSSI(n=166),the prevalences of parent artery disease(PAD)[10.7%(22/205),19.1%(30/157),42.8%(71/166),respectively,χ^(2)=54.89,P<0.001],coronary artery disease[8.3%(17/205),14.0%(22/157),16.9%(28/166),respectively,χ^(2)=6.44,P=0.040]and severe white matter hyperintensities(sWMHs)[58.0%(119/205),43.3%(68/157),41.0%(68/166),respectively,χ^(2)=12.94,P<0.001],the level of serum homocysteine(Hcy)[18.01(13.54,25.56),16.03(12.50,21.09),14.72(11.12,19.14)μmol/L,respectively,H=19.36,P<0.001],and the National Institutes of Health Stroke Scale(NIHSS)score[2(1,3),3(1,4),3(2,6),respectively,H=39.53,P<0.001]showed statistically significant differences.Multiple Logistic regression analysis showed that compared with dl-SSSI patients,the lesion pattern of patients with higher proportion of PAD(OR=3.12,95%CI 1.86-5.24,P<0.001)was closer to pSSSI;the lesion pattern of patients with higher serum Hcy level(OR=1.02,95%CI 1.00-1.04,P=0.046)or higher proportion of sWMHs(OR=1.79,95%CI 1.12-2.86,P=0.015)was closer to ds-SSSI,and the lesion pattern of patients with higher proportion of PAD(OR=0.50,95%CI 0.27-0.93,P=0.029)or higher NIHSS score(OR=0.84,95%CI 0.77-0.92,P<0.001)was closer to dl-SSSI.Conclusions The pathogenesis of ds-SSSI tends to be cerebral small vessel disease.The pathogenesis of pSSSI is related to atherosclerosis.The patients with dl-SSSI have the intermediate characteristics of pSSSI and ds-SSSI and may be unstable.
作者
刘聪慧
高远
谢卫征
孙科
王安然
肖彩霞
张建刚
李玉生
Liu Conghui;Gao Yuan;Xie Weizheng;Sun Ke;Wang Anran;Xiao Caixia;Zhang Jiangang;Li Yusheng(Department of Neurology,the People′s Hospital of Anyang City,Anyang 455002,China;Department of Neurology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2023年第1期48-54,共7页
Chinese Journal of Neurology
基金
河南省医学科技攻关省部共建重大项目(SBGJ202101016)
国家自然科学基金面上项目(82171300)。
关键词
孤立性皮质下小梗死
载体动脉病
脑小血管病
脑白质高信号
Single small subcortical infarction
Parent artery disease
Cerebral small vessel disease
White matter hyperintensities
作者简介
通信作者:李玉生,Email:fccliyusheng@zzu.edu.cn。
