| Objective:Worldwide,the incidence,disability and mortality of stroke are obviously increasing year by year,and the onset age tends to be younger.Stroke includes ischemic stroke and hemorrhagic stroke,in which cerebral infarction(CI)refers to ischemic stroke,and its clinical incidence is about 70%-80% of all stroke.The main cause of cerebral infarction is due to atherosclerosis,leading to severe stenosis or occlusion of the neck or intracranial vessels,especially middle cerebral artery(MCA)stenosis is the most common in Asia.Computed tomography angiography(CTA)is a non-interventional angiography technique that can display cerebral angiography clearly and accurately,and has high sensitivity to determine intracranial artery stenosis and occlusion.Diffusion weighted imaging(DWI)is a functional magnetic resonance imaging technique based on the Brownian motion of water molecules,and it is sensitive to the positioning,qualitative and the size of cerebral infarction.Ischemic lesions can be found in DWI within minutes of cerebral infarction.DWI is the most effective method for measuring infarction in the early stage of cerebral infarction.At present,the study of CI is no longer limited to diagnosis,people pay more attention to the prognosis of patients.In this study,we explored the risk factors affecting the prognosis of patients with cerebral infarction in MCA blood supply area,and whether CTA and DWI can be used to predict the prognosis of cerebral infarction in MCA blood supply area,so as to lay the foundation for the establishment of methods to predict the prognosis of cerebral infarction and provide reference for clinical work in the future.Material And Methods:1.We observed those patients who were in hospital in the Department of Neurology,Affiliated Hospital of Hebei University from September 2016 to October 2017,due to cerebral infarction in middle cerebral artery blood supply area.And we selected 102 patients with no previous history of cerebrovascular disease and definite onset time(all within 72 hours).2.(1)Collect general data of patients: age,sex,smoking,drinking;Basic disease and laboratory data: hypertension,diabetes,heart disease,dyslipidemia,hyperhomocysteinemia,fibrinogen.(2)After admission,patients were examined by cranialMRI(including DWI),and calculated the volume of cerebral infarction according to Pullicino formula.The patients were divided into three groups according to the volume of cerebral infarction: small infarct volume group,middle infarct volume group and large infarct volume group.(3)At the same time,the patients were routinely examined by head and neck CTA after admission.The diagnostic criteria of CTA stenosis were according to the North American symptomatic carotid endarterectomy trial.All patients were divided into three groups : no stenosis group,stenosis group and occlusion group.Meanwhile the stenosis group were further divided into mild stenosis group,moderate stenosis group and severe stenosis group.(4)All patients' neurological function were scored with the National Institutes of Health Stroke Scale(NIHSS)3 months after admission and discharge,and the recovery rate of neurological function was calculated.All patients were divided into three groups according to the neurological functional recovery ratio: basic healing group,improvement group,ineffective group.3.We statistic the date by SPSS 21.0.Results:1.The univariate analysis showed that age,NIHSS score at admission,infarct volume,blood vessel status and sex were correlated with the prognosis of cerebral infarction in middle cerebral artery blood supply area(P<0.05),while hypertension,diabetes,heart disease,hyperlipidemia,hyperhomocysteinemia,fibrinogen increase,smoking and drinking were not correlated with the prognosis of cerebral infarction in middle cerebral artery blood supply area(P>0.05).Multivariate logistic regression analysis showed that age,infarct volume and blood vessel status were correlated with the prognosis of cerebral infarction in middle cerebral artery blood supply area(P<0.05).Age,infarct volume and blood vessel status were risk factors for the prognosis of cerebral infarction in middle cerebral artery blood supply area.2.Infarct volume was positively correlated with vascular status(r=0.826,P<0.001),the worse the state of blood vessels,the more serious the stenosis,the larger the infarct volume.3.There was statistically significant difference in neurological deficit score between the group without MCA stenosis and the group with MCA stenosis or occlusion(Z=4.597,P<0.001),the extent of neurological deficit in the patients without MCA stenosis was less than that in the patients with MCA stenosis or occlusion.Conclusion:The prognosis of cerebral infarction in MCA blood supply area is affected by many factors,among which age,infarction volume and vascular status are the risk factors.And through this study,we can draw a conclusion that there is a positive correlation between the degree of vascular stenosis and infarction volume.The more serious the stenosis is,the larger the infarct volume is.The admission NIHSS score of the patients was related to the vascular state,MCA stenosis or occlusion was higher than that of the patients without MCA stenosis at admission,that is,the degree of neurological impairment of the patients with MCA stenosis or occlusion was heavier than that of the patients without MCA stenosis,and the vascular state of the patients could be estimated according to the NIHSS score at the initial admission of the patients.CTA and DWI can be used to judge the prognosis of cerebral infarction patients with middle cerebral artery blood supply area. |
PDF Full Text Request