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目的心源性栓塞是心房纤颤(AF)患者发生急性缺血性脑卒中(AIS)最主要病因。大脑中动脉(MCA)支配区AIS是最常见的。研究MCA狭窄(MCAS)与AF患者发生的MCA支配区AIS发病机制的关系。方法选择AIS同时伴有AF的患者232例,其中男性140例,女性92例;年龄57~85岁,平均年龄74.2岁。根据MCA狭窄程度,将AIS患者分为MCAS组(MCA狭窄率≥70%)与大脑中动脉非狭窄(MCANS)组,分别比较两组患者的基本信息、危险因素、临床特点和影像学特点。结果 MCAS患者27例,MCANS患者205例。与MCANS患者相比,MCAS患者高血压发病率较高(P<0.01),而心脏病发病率偏低(P<0.05)。MCANS组入院时美国国立卫生院卒中量表(NIHSS)评分(P=0.01)、出院时改良Rankin量表(m RS)评分(P<0.01)及左心房前后径(LAD;P=0.03)皆高于MCAS组。腔隙性AIS在MCAS组中更多见(P=0.04),而多发性AIS在MCANS组中更普遍(P<0.01)。结论 AF患者发生MCA支配区AIS时,MCA动脉硬化病变可能与AIS不同分型存在相关性。MCA轻中度狭窄时发生心源性AIS中的概率更高。MCA严重狭窄时动脉粥样硬化性AIS的发生率更高。
Purpose Cardiac embolism is the leading cause of acute ischemic stroke (AIS) in patients with atrial fibrillation (AF). Middle cerebral artery (MCA) dominated area AIS is the most common. To investigate the relationship between MCA stenosis (MCAS) and the pathogenesis of AIS in MCA-dominated AIS. Methods A total of 232 AIS patients were selected, including 140 males and 92 females. The mean age was from 57 to 85 years with a mean age of 74.2 years. According to the degree of MCA stenosis, AIS patients were divided into MCAS group (MCA stenosis≥70%) and MCANS group. The basic information, risk factors, clinical features and imaging features of the two groups were compared. Results There were 27 MCAS patients and 205 MCANS patients. Compared with patients with MCANS, MCAS patients had a higher prevalence of hypertension (P <0.01) and a lower incidence of heart disease (P <0.05). The National Institutes of Health Stroke Scale (NIHSS) score (P = 0.01), the discharged Rankin Scale (m RS) score at discharge (P <0.01) and the anteroposterior diameter of left atrium (LAD; P = 0.03) Higher than the MCAS group. Lacustrial AIS was more common in the MCAS group (P = 0.04), while multiple AIS was more common in the MCANS group (P <0.01). Conclusions The pathological changes of atherosclerotic lesions of MCA may be related to the different types of AIS in AF patients with AIS of MCA. Patients with mild to moderate MCA have a higher probability of developing cardiogenic AIS. The incidence of atherosclerotic AIS is higher in patients with severe MCA stenosis.