青年与中老年患者颅内大动脉粥样硬化性缺血性卒中影像学特点比较研究

doi:10.3969/j.issn.1673-5765.2021.05.010

摘要/Abstract

摘要：

目的基于DWI 影像对比青年和中老年大动脉粥样硬化性缺血性卒中（i schemi c stroke，I S）患者病变分布特征的差异。方法回顾性分析伴有颅内大动脉粥样硬化性狭窄/闭塞的IS患者颅脑DWI上IS病变的影像学数据。基于DWI上梗死灶分布特征，将病变分为单发、单区域多发和多区域多发IS病变，同时评估累及前后循环的情况。患者分为青年组（18～50岁）和中老年组（51～80岁）。比较两组患者的病灶数目及位置分布特征差异。应用单因素和多因素logistic回归分析年龄组与IS病变分布特征的相关性。结果共纳入146例患者，其中青年组69例（47.3%），平均年龄40.5±8.4岁，男性54例（78.3%）；中老年组77例（52.7%），平均年龄62.4±7.1岁，男性42例（54.5%）。两组在病灶数目及分布特征上有差异（P =0.033），青年患者主要表现为多区域多发病变（50.7%），中老年患者主要表现为单区域多发病变（37.7%）。单因素l ogi sti c回归分析显示，青年组相比于中老年组更易发生多区域多发I S病变（OR 2.72，95%CI 1.17～6.29，P =0.020），校正临床混杂因素（高血压史、降压药及他汀的使用情况）和颅内动脉狭窄率后，两组多区域多发IS病变发生率差异仍具有统计学意义（OR 2.73，95%CI 1.04～7.12， P =0.041）。在前、后循环病变分布特征上，两组未见明显差异，青年和中老年组均以单纯前循环病变为主（69.6% vs 75.3%），且单纯前循环病变以皮层下分布为主（56.2% vs 55.2%）；在单纯后循环病变，两组均最常见脑干受累（81.2% vs 89.5%）。结论对于伴有症状性颅内大动脉粥样硬化性狭窄/闭塞的IS患者，青年患者较中老年患者更容易发生多区域多发性梗死。两组人群均最常见单纯前循环供血域受累，且以皮层下分布为主；在单纯后循环病变，以脑干受累为主。

文章导读： 在伴有颅内大动脉粥样硬化性狭窄/闭塞的症状性缺血性卒中患者中，分析梗死灶在DWI影像上的分布特征发现，青年患者主要表现为多区域多发性梗死，而中老年患者主要表现为单区域多发性梗死；两组患者梗死病灶其他分布特征无明显差异。

关键词: 缺血性卒中; 青年卒中; 弥散加权成像; 影像分布特征

Abstract:

Objective To compare the distribution pattern of infarct lesions in large artery atherosclerotic ischemic stroke (IS) based on DWI in young and elderly patients. Methods The imaging data of IS lesions on DWI of the patients with symptomatic intracranial large artery atherosclerotic stenosis or occlusion were retrospectively analyzed. The distribution pattern of IS lesions on DWI were classified as single lesion, multiple lesions in one vascular territory and multiple lesions in multiple vascular territories. The condition of involved anterior and posterior circulation was also investigated. All patients were divided into young patient group (18-50 years) and elderly patient group (51-80 years). The number and location distribution patterns of IS lesions were compared between the two groups. Univariate and multivariate logistic regression analysis were performed to investigate the association between age group and the distribution pattern of IS lesions. Results A total of 146 patients were included, including 69 (47.3%) young patients [mean age: 40.5±8.4 years, 54 (78.3%) men] and 77 (52.7%) elderly patients [mean age: 62.4±7.1 years, 42 (54.5%) men]. There were significant differences in the number and vascular territory distribution pattern between the two groups (P =0.033), young patients mainly showed multiple IS lesions in multiple vascular territories (50.7%), while elderly patients mainly had multiple IS lesions in one vascular territory (37.7%). Univariate logistic regression analysis showed young patients were more prone to have multiple IS lesions in multiple vascular territories compared to elderly patients (OR 2.72, 95%CI 1.17-6.29, P =0.020), after adjusting for confounding factors including history of hypertension, antihypertension medication, statin use and stenosis rate of intracranial artery, the difference in the prevalence of multiple IS lesions in multiple vascular territories between the two group remained statistically significant (OR 2.73, 95%CI 1.04-7.12, P =0.041). No significant difference was found in the distribution of anterior and posterior circulation territory between the two groups, the only anterior circulation involved was most common in both young and elderly patients (69.6% vs 75.3%), most of which were subcortical lesions (56.2% vs 55.2%); for the only posterior circulation territory involved, the most involved region was the brainstem in the two groups (young: 81.2%, elderly: 89.5%). Conclusions For IS patients with symptomatic intracranial large artery atherosclerotic stenosis or occlusion, young patients were more prone to have multiple IS lesions in multiple vascular territories compared to elderly patients. The only anterior circulation territory involved and subcortical lesions were most common in both young and elderly patients, and the brainstem was the most involved region for the only posterior circulation territory involved.

Key words: Ischemic stroke; Young stroke; Diffusion-weighted imaging; Image distribution pattern

杨丹丹，韩永军，李东野，乔会昱，韩华璐，沈睿，宁梓涵，赵锡海. 青年与中老年患者颅内大动脉粥样硬化性缺血性卒中影像学特点比较研究[J]. 中国卒中杂志, 2021, 16(05): 475-481.

YANG Dan-Dan, HAN Yong-Jun, LI Dong-Ye, QIAO Hui-Yu, HAN Hua-Lu, SHEN Rui, NING Zi-Han, ZHAO Xi-Hai. Comparison of Imaging Characteristics of Large Artery Atherosclerotic Ischemic Stroke between Young and Elderly Patients[J]. Chinese Journal of Stroke, 2021, 16(05): 475-481.

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