郭婷婷， 田 英， 辛 岳， 王 健， 王玉洁

不伴基底动脉狭窄的脑桥旁正中梗死部位与发病机制的关系

郭婷婷1， 田 英2， 辛 岳1， 王 健1， 王玉洁1

目的探讨不伴基底动脉狭窄的脑桥旁正中梗死(PPI-BAS)部位与发病机制的关系。方法回顾性分析脑桥旁正中梗死(PPI)患者150例，将PPI-BAS按梗死部位分为累及脑桥腹侧表面组(vPPI-BAS)及未累及脑桥腹侧表面组(dPPI-BAS)，以伴基底动脉狭窄的脑桥旁正中梗死(PPI+BAS)为对照，比较其年龄、性别、吸烟、饮酒、高脂血症、高同型半胱氨酸血症、冠心病、糖尿病、颅内颈内动脉系狭窄(ICAS)、颅外动脉粥样硬化(EAAS)、基底动脉高信号、梗死灶层面数≥2层、早期神经功能恶化(END)、高血压、腔隙性脑梗死(LI)和脑白质疏松(LA)是否有差异。结果150例患者中dPPI-BAS 组41例(27.3%)，vPPI-BAS 组65例(43.3%)，PPI+BAS组44例(29.3%)，三组之间年龄、性别、吸烟、饮酒、高脂血症、高同型半胱氨酸血症差异无统计学意义(P>0.05)，三组之间冠心病、糖尿病、高血压、LA分级、LI分级、ICAS、EAAS、基底动脉高信号、梗死灶层面数≥2层及END的差异有统计学差异(P<0.05)。vPPI-BAS组与PPI+BAS组各因素之间差异均无统计学差异(P>0.05)。与PPI+BAS组比较，dPPI-BAS组冠心病、糖尿病、ICAS 、EAAS、基底动脉高信号、梗死灶层面数≥2和END的发生率低，而高血压、LA 、LI 的发生率高(P<0.05)。vPPI-BAS组与dPPI-BAS组比较，vPPI-BAS组ICAS、EAAS、梗死灶层面数≥2层和END发生率高，dPPI-BAS组高血压、LA和LI发生率高(P<0.05)。多因素logistic回归分析结果显示：LA分级是dPPI-BAS的独立危险因素。结论vPPI-BAS多由动脉粥样硬化机制引起，dPPI-BAS多由小血管病机制引起。

脑桥旁正中梗死； 动脉粥样硬化； 小血管病

Abstract：ObjectiveTo analyze the correlation between the location of infarctions and pathogenesis among patients of paramedian pontine infarction without basilar artery stenosis.MethodsWe selected 150 patients with acute phase paramedian pontine infarction (PPI)，the patients without basilar artery stenosis were divided into two groups: dPPI-BAS and vPPI-BAS. PPI+BAS were chosen as control group. Age，sex，smoking，alcohol drinking，hyperlipidaemia，hyperhomocysteinemia，coronary atherosclerotic heart disease，diabetes，ICAS，EAAS，basal artery high signal，infarcts level ≥2 layers，END，hypertension，lacunars cerebral infarction and leukoaraiosis were compared between groups.Results150 patients were enrolled，among them 41 patients with dPPI-BAS (27.3%)，65 patients with vPPI-BAS (43.3%)，44 patients with PPI+BAS (29.3%). Age，sex，smoking，alcohol drinking，hyperlipidaemia and hyperhomocysteinemia weren’t have statistically significant differences between groups(P>0.05)，coronary atherosclerotic heart disease，diabetes，hypertension，LA scales，ICAS，EAAS，basal artery high signal，Infarcts level ≥2 layers and END had statistically significant differences(P<0.05). All the factors weren’t have statistically significant between vPPI-BAS group and PPI+BAS group(P>0.05). Compared to PPI + BAS group，the dPPI-BAS group had lower prevalences of coronary atherosclerotic heart disease，diabetes，ICAS，EAAS，basal artery high signal，infarcts level ≥2 layers and END，but had higher prevalences of hypertension，LA and LI(P<0.05). Between vPPI-BAS group and dPPI-BAS group，vPPI-BAS group had higher prevalences of ICAS，EAAS，Infarcts level ≥2 layers and END，while dPPI-BAS group had higher prevalences of hypertension，LA and LI (P<0.05). Multi-factor Logistic regression analysis shows: LA scales was independent prognostic factor for dPPI-BAS.ConclusionThe mechanism of vPPI-BAS was more likely atherosclerosis，and the mechanism of dPPI-BAS was more likely small vessel disease.

Keywords： Paramedian pontine infarction； Atherosclerosis； Small vessel disease

脑桥旁正中梗死(PPI)为脑桥旁正中动脉(基底动脉的穿支动脉-前内侧动脉[1])的供血区域发生的梗死，在脑桥梗死中占有绝大部分比例[2]。PPI的发病机制主要分以下三种：基底动脉粥样硬化，脑桥旁正中动脉开口粥样硬化，脑桥旁正中动脉纤维玻璃样变(即小血管病)[3～5]。根据TOAST分型，伴基底动脉狭窄的脑桥旁正中梗死(PPI+BAS)多由基底动脉粥样硬化引起[6]。由于……