作者：王光胜，鲍俊杰，胡婷，田媛媛，黄利，顾汉沛，周金金

单位：

223600江苏省沭阳县，徐州医科大学附属沭阳医院神经内科

Units：

Department of Neurology, Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang 223600, China

关键词：

脑梗死；大脑前动脉；临床特征

Keywords：

Brain infarction; Anterior cerebral artery; Clinical feature

CLC：

R 743.33

DOI：

10.12114/j.issn.1008-5971.2023.00.235

Funds：

江苏省卫生健康委科研项目（Z2019032）

摘要：

目的　分析不同侧别单纯大脑前动脉（ACA）供血区梗死患者的临床特征。方法　2019年4月至2021 年4月在徐州医科大学附属沭阳医院住院的急性缺血性脑卒中患者共790例，选取其中的单纯ACA供血区梗死患者37例 为研究对象，其梗死灶侧别：左侧23例（62.2%），右侧13例（35.1%），双侧1例（2.7%）。收集患者一般资料、临 床症状、影像学检查结果。结果　37例单纯ACA供血区梗死患者中，男16例，女21例；平均年龄（67.6±12.5）岁； 入院时美国国立卫生研究院卒中量表（NIHSS）评分3.0（1.0，6.7）分。左侧单纯ACA供血区梗死患者与右侧单纯 ACA供血区梗死患者一般资料比较，差异无统计学意义（P＞0.05）。37例单纯ACA供血区梗死患者临床症状排名前 5位分别为肢体活动障碍（29例）、言语功能障碍（20例）、抑郁（14例）、感觉障碍（9例）、尿失禁（9例）。左 侧单纯ACA供血区梗死患者精神行为异常、抑郁、偏侧忽视发生率低于右侧单纯ACA供血区梗死患者（P＜0.05）。 37例单纯ACA供血区梗死患者的责任血管主要为皮层支（16例），梗死灶部位排名前5位分别为额上回（25例）、胼 胝体（23例）、扣带回（15例）、额极（10例）、旁中央及辅助运动区（9例），梗死灶累及部位数量主要为2个（15 例）。左侧单纯ACA供血区梗死患者梗死灶部位为额极者占比低于右侧单纯ACA供血区梗死患者（P＜0.05）。结论　 单纯ACA供血区梗死多为轻型脑卒中，且左侧单纯ACA供血区梗死的发生率高于右侧；该病最常见的临床症状为肢体 活动障碍、言语功能障碍、抑郁，责任血管主要为皮层支，梗死灶部位主要为额上回、胼胝体、扣带回，梗死灶累及 部位数量主要为2个，且精神行为异常、抑郁、偏侧忽视发生率及额极梗死可能与发病侧别有关。

Abstract：

Objective To analyze the clinical features of patients with simple anterior cerebral artery (ACA) territory infarction on different sides. Methods A total of 790 patients with acute ischemic stroke were hospitalized in the Affiliated Shuyang Hospital of Xuzhou Medical University from April 2019 to April 2021. Among them, 37 patients with simple ACA territory infarction were selected as the study objects, and the side of the infarction lesion was as follows: 23 cases (62.2%) on the left, 13 cases (35.1%) on the right, and 1 case (2.7 %) on both sides. General data, clinical symptoms and imaging results of patients were collected. Results Among the 37 patients with simple ACA territory infarction, 16 were male and 21 were female; the mean age was (67.6±12.5) years; the National Institutes of Health Stroke Scale (NIHSS) score at admission was 3.0 (1.0, 6.7) . There was no significant difference in the general data between patients with left simple ACA territory infarction and patients with right simple ACA territory infarction (P > 0.05) . The top 5 clinical symptoms of 37 patients with simple ACA territory infarction were limb movement disorder (29 cases) , speech dysfunction (20 cases) , depression (14 cases) , sensory disturbance (9 cases) , and urinary incontinence (9 cases) . The incidence of abnormal mental behavior, depression and unilateral neglect in patients with left simple ACA territory infarction was lower than that in patients with right simple ACA territory infarction (P < 0.05) . In 37 patients with simple ACA territory infarction, the main responsible vessel was cortical branch (16 cases) , the top 5 infarct sites were superior frontal gyrus (25 cases) , corpus callosum (23 cases) , cingulate gyrus (15 cases) , frontal pole (10 cases) , paracentral and auxiliary motor area (9 cases) , and the number of infarct sites was mainly 2 (15 cases) . The proportion of frontal pole infarction in patients with left simple ACA territory infarction was lower than that in patients with right simple ACA territory infarction (P < 0.05) . Conclusion Simple ACA territory infarction is mostly mild stroke, and the incidence of ACA territory infarction in the left is higher than that in the right. The most common clinical symptoms of the disease are limb movement disorder, speech dysfunction and depression, the main responsible vessels are cortical branches, the main infarct sites are superior frontal gyrus, corpus callosum and cingulate gyrus, and the number of infarct sites is mainly 2, and the incidence of psychobehavioral abnormalities, depression, unilateral neglect and frontal pole infarction may be related to the side of the disease.

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