摘要
目的探讨分水岭脑梗死(watershed infarction,WSI)的发病机制及Willis环血流代偿对WSI发病机制的影响。方法回顾性分析2005年1月—2007年1月吉林大学第一医院神经内科收治的行脑血管检查(包括颈部血管超声和经颅多普勒超声、磁共振血管成像、CT血管成像、数字减影血管造影等)的前循环脑梗死患者278例,再通过统计学分析脑梗死患者行以上检查的影像学和临床资料。结果WSI(143例)、非WSI大面积脑梗死(66例)、腔隙性脑梗死(69例)3类脑梗死有颈内动脉(internal carotid artery,ICA)或大脑中动脉(middle cerebral artery,MCA)重度狭窄或闭塞者分别为61.5%(88/143例)、53%(35/66例)、7.2%(5/69例)。皮质下上型WSI(48例)、混合型WSI(52例),ICA和MCA的狭窄多于皮质型WSI(43例),而有颈动脉斑块的比例与此相反。各类型WSI在ICA、MCA血管狭窄分布上无明显差别,但皮质后型WSI(33例)合并后循环血管狭窄比例高(8例,24.2%)。WSI与非WSI组Willis环血流代偿无差别。各类型WSI Willis环血流代偿亦无差别。结论①WSI最重要的发病机制是ICA或MCA在严重狭窄基础上发生血流动力学变化,低灌注对皮质上下型WSI的影响重于皮质型WSI。②各类型WSI之间ICA、MCA血管狭窄发生率无明显差异,但皮质后型WSI提示ICA或MCA狭窄合并后循环血管狭窄。③相对于血管狭窄,Willis环血流代偿在WSI的发病机制中居次要作用。
Objective To investigate the pathogenesis of cerebral watershed infarction （WSI） and the compensatory effect of colleteral ability of Willis circle on it. Methods A total of 278 patients with anterior circulation infarction admitted in the Department of Neurology of the First Hospital of Jilin University, from January 2005 to January 2007 were analyzed retrospectively. All patients were underwent cerebrovascular examinations including neck carotid artery uhrasonography and transcranial Doppler （TCD） , magnetic resonance angiography （MRA） , computed tomography angiography （CTA） , digital subtraction angiography （DSA） , and magnetic resonance imaging （MRI） ,These data as well as the clinical data were analysis statistically. Results The patients with severe stenosis of internal carotid artery （ICA） or middle cerebral artery （MCA） or occlusion in the WSI （ 143 ） , non-WSI massive cerebral infarction （66） and lacunar cerebral infarction （69） groups were 61.5%, 53% , and 7.2%, respectively. ICA and MCA stenosis in subcortical internal WSI group（IWSI） （48） and mixed-type WSI group （MWSI） （52） were more than those of cortical WSI group（CWSI） （43）, while the proportion in patients with carotid plaque was on the contrary. There were no significant differences in all types of WSI in the distribution of ICA or MCA stenosis, but the proportion of posterior cortical WSI （PWSI） （33） with posterior circulation vascular stenosis was higher （ 8, 24.2% ）. There was no difference in Willis circle colleteral ability between the WSI and non-WSI groups. Conclusions The most important pathogenetic factor of WSI is the hemodynamic changes of ICA or MCA on the basis of severe stenosis. The effect of hypoperfusion on IWSI is greater than that of CWSI. The incidence of MCA and ICA stenosis has no significant differences among all types of WSI, however, PWSI suggested that the ICA or MCA stenosis complicated posterior circulation vascular stenosis. Compared to vascular stenosis, The colleteral ability of Willis circle plays a secondary role in the pathogenesis of WSI.
出处
《中国脑血管病杂志》
CAS
2008年第3期102-106,共5页
Chinese Journal of Cerebrovascular Diseases
关键词
脑梗塞
大脑动脉环
发病机制
Brain infarction
Willis circle
Pathogenesis
