分水岭脑梗死与颅内外血管狭窄的关系

摘要

目的：探讨分水岭脑梗死（ CWSI）与颅内外血管狭窄的关系。方法选取65例急性CWSI患者作为研究对象，根据脑MRI结果将CWSI分成皮质型（皮质前型、皮质后型）和皮质下型；采用脑CT血管成像（ CTA）、数字减影脑血管造影术（ DSA）或脑MRI血管成像（MRA）等技术评价颅内外血管狭窄及其程度。结果65例CWSI中57例存在不同程度的颅内外血管狭窄或闭塞，占87．69％；轻度狭窄7例，中度16例，重度34例；38例（58．46％） CWSI患者存在不同程度的大脑中动脉（ MCA）狭窄或闭塞，31例（47．69％）存在颈内动脉（ ICA）狭窄或闭塞，大脑前动脉（ ACA）和大脑后动脉（ PCA）狭窄分别为19例（29．23％）和22例（33．85％）。皮质下型CWSI前循环血管的狭窄率显著高于皮质型（P＜0．05），以及皮质后型（P＜0．05）；皮质前型及皮质下型ACA、MCA狭窄率均显著高于皮质后型（均P＜0．05）。皮质前型及皮质下型前循环多支血管狭窄率均显著高于皮质后型（均P＜0．05）；且皮质前型ICA＋MCA、ICA＋ACA狭窄率均显著高于皮质后型及皮质下型（均P＜0．05）。结论分水岭脑梗死发病可能与颅内外血管狭窄关系密切；皮质前型和皮质下型CWSI与前循环血管狭窄更加密切。%Objective To explore the relationship between the subtypes of cerebral watershed infarction and intracranial and extracrani-al arterial stenosis.Methods A total of 65 patients with acute infarction admitted in the Department of Neurology of the First Hospital of Anhui Medical University,were analyzed retrospectively.All patients were underwent cerebrovascular examinations including compu-ted tomography angiography ( CTA) ,digital subtraction angiography ( DSA) or magnetic resonance angiography ( MRA ) .These data as well as the clinical data were analyzed statistically.Results The stenosis rate of anterior circulation in subcortical infarct patients were higher than cortical infarct patients(P<0.05).In posterior infarct patients showed significanthy lower arterial stenosis rate of anterior circulation in subcortical infarct patients(P<0.05).Moreover,in posterior infarct patients,the rate of multipte vascular stenosis of an-terior circulation were significanthy reduced than others.The stenosis rate of ACA,MCA in posterior infarct patients were much lowerer than sub cortical and anterior infarct patients.Compared with the anterior infarct patients,posterior and subcortical infarct patients had a lower degree of stenosis in the rate of ICA puls ACA or MCA.Conclusion The relationship between the subtypes of cerebral watershed infarction and intracranial and extracranial arterial stenosis was closely related.The stenosis rate of anterior circulation played an impor-tant role in anterior and subcortical infarct patients.