摘要目的 探讨不同部位梗死灶对早期神经功能恶化(END)的预测价值.方法 收集2016年10月至2017年10月的116例急性缺血性卒中患者的临床资料,根据梗死灶部位分为前循环皮质、基底节区、放射冠区以及后循环梗死.根据是否出现END,分为进展组和非进展组,通过单因素和多因素分析梗死部位对END的预测价值.结果 116例患者中END 31例,非END 85例,其中前循环皮质、基底节区、放射冠区以及后循环梗死分别为55、29、21和10例.多因素分析结果显示年龄>60岁(OR=1.257,95％CI 1.117～2.426,P=0.031)、糖尿病病史>6年(OR=1.342,95％CI 1.121～2.162,P=0.022)、收缩压<100 mmHg(1 mmHg=0.133 kPa)(OR=1.264,95％CI 1.254～2.209,P=0.033)、梗死灶部位>2个(OR=1.153,95％CI 1.064～1.528,P=0.041)、基线美国国立卫生研究院卒中量表(NIHHS)>12分(OR=1.634,95％CI 1.248～1.688,P=0.029)是影响END发生的独立危险因素;以前循环皮质作为参照进行相关危险度分析,基底节区、放射冠区以及后循环梗死发生END的概率显著降低,即使经年龄、收缩压等因素校正后,此种趋势依然存在.结论 END的发生受多重因素的影响,梗死灶部位是其独立危险因素之一,尤其是前循环皮质梗死患者更易出现进展.

abstractsObjective To explore the role of cerebral infarction regions in predicting the progressive cerebral infarction (PCI). Methods One hundred and sixteen patients with cerebral infarction from Oct 2016 to Oct 2017 were selected. Patients were classified into cortical, basal gangliaon, coronaradiata and posterior circulation infarction according different regions. The patients were divided into non-PCI group and PCI group according to their clinical manifestations. The role of cerebral infarction regions in predicting the progressive cerebral infarction was conducted by unitary analysis and multivariate analysis. Results Eighty-five cases of non-PCI and 31 cases of PCI were included. The number of cases of cortical, basal gangliaon, coronaradiata and posterior circulation infarction were 55, 29, 21 and 10. Multivariate analysis showed that age (OR=1.257, 95％CI 1.117-2.426, P=0.031), history of diabetes (OR=1.342, 95％CI 1.121-2.162, P=0.022), systolic pressure (OR=1.264, 95％ CI 1.254- 2.209, P=0.033), location of infarct (OR=1.153, 95％ CI 1.064-1.528, P=0.041), baseline NIHHS score (OR=1.634, 95％ CI 1.248- 1.688, P=0.029) were independent risk factors affecting the occurrence of progressive cerebral infarction. The frequency of progression was significantly increased in cortical infarction , compared with that in other subtypes of cerebral infarction. The trend was still significant even after adjustment for age and systolic pressure. Conclusions The occurrence of progressive cerebral infarction is influenced by multiple factors, and the location of the infarct is one of its independent risk factors, especially for patients with cortical infarction.