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目的比较分析分支动脉粥样硬化病(branch atheromatous disease,BAD)和小动脉闭塞(small artery occlusion,SAO)性梗死患者临床及影像学特点的差异,并探讨两者早期神经功能恶化和短期预后的情况。方法连续收集210例皮质下小卒中(small subcortical stroke,S3)患者的临床资料(年龄、性别、高血压、糖尿病、吸烟、同型半胱氨酸、脑白质疏松和静息性腔隙性梗死等),采用美国国立卫生院神经功能评分(NIHSS)标准对所有患者入院当天、发病5 d、10 d进行神经功能评分。根据头部DWI的梗死灶的位置、形态等将其分为SAO组(n=83)和BAD组(n=127),比较分析两组患者临床、影像学特点的差异及治疗期间早期神经功能恶化(early neurological deterioration,END)和神经功能改善情况。结果 SAO组和BAD组相比,脑白质疏松比例、脑白质疏松分数、静息性腔隙性梗死比例、静息性腔隙性梗死数目有统计学意义(均P<0.05)。BAD组比SAO组患者入院当天NIHSS评分更高,比较有统计学意义(P<0.001);BAD组患者END发生率高于SAO组,两组比较有统计学意义(P=0.030);发病10 d神经功能改善程度和神经功能改善率比较无统计学差异(均P>0.05)。结论 SAO组患者脑白质疏松和静息性腔隙性梗死比例更高且程度更严重,BAD组患者入院时神经功能缺损更严重,且END发生率更高,但两者短期神经功能恢复无差异。
Objective To compare the clinical features and imaging features of patients with branch atheromatous disease (BAD) and small artery occlusion (SAO) infarction and to explore the relationship between early neurological deterioration and short-term prognosis Happening. Methods The clinical data of 210 patients with small subcortical stroke (S3) were collected continuously (age, gender, hypertension, diabetes, smoking, homocysteine, leukoaraiosis and rest lacunar infarction ). All patients were admitted to hospital on the day of onset of neurological deficits (NIHSS). The scores of neurological function were evaluated on the 5th and 10th day after onset of illness. According to the location and shape of infarction in DWI, the patients were divided into SAO group (n = 83) and BAD group (n = 127). The difference of clinical and imaging features between the two groups was compared and the early neurological function Early neurological deterioration (END) and neurological improvement. Results Compared with BAD group, the number of leukoaraiosis, the percentage of white matter, the proportion of resting lacunar infarction and the number of resting lacunar infarction in SAO group were statistically significant (all P <0.05). The NIHSS scores of patients in BAD group were higher than those in SAO group on the day of admission (P <0.001). The incidence of END in BAD group was higher than that in SAO group (P = 0.030) There was no significant difference between the improvement of neurological function and the improvement of neurological function (all P> 0.05). Conclusions The incidence of white matter and rest lacunar infarction in SAO group is higher and more severe. The incidence of neurological deficits in patients with BAD is more serious and the incidence of END is higher, but there is no difference between the two groups in short-term neurological function recovery .