| 张海廷，王维，郭海晓，周红，张瑞云，李佳平.脑桥旁正中穿支动脉粥样硬化病临床特点分析[J].神经损伤功能重建,2025,(2):67-72 |
| 脑桥旁正中穿支动脉粥样硬化病临床特点分析 |
| Analysis of Clinical Features of Paramedian Pontine Branch Atheromatous Disease |
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| DOI： |
| 中文关键词: 穿支动脉粥样硬化性病 脑桥旁正中动脉 静脉溶栓 替罗非班 |
| 英文关键词: paramedian pontine arteries branch atheromatous disease intravenous thrombolysis tirofiban |
| 基金项目: |
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| 中文摘要: |
| 目的：探讨脑桥旁正中动脉（paramedian pontine arteries，PPA）穿支动脉粥样硬化病（branch atheromatous disease，BAD）所致脑梗死PPA-BAD的临床特点。方法：回顾性分析2018年至2024年在民航总医院神
经内科确诊PPA-BAD的患者221例，根据是否发生进展性运动功能缺损分为进展组（140例）和对照组（81
例）；根据预后情况分为预后良好组（163例）和预后不良组（58例）；根据是否接受重组组织型纤溶酶原激活
物（rt-PA）溶栓治疗分为治疗组（14例）和对照组（207例）；对于进展组患者，根据是否使用替罗非班，分为替
罗非班治疗组（42例）和对照组（98例）。对各组人口统计学、临床及影像学资料进行比较，同时探讨rt-PA
静脉溶栓及替罗非班治疗的效果。结果：①起病6 h后进展140例（63.3%），提示PPA-BAD容易出现进展加
重；进展组患者高脂血症患者及以偏瘫症状起病者比例较高，起病、达峰、出院时的NIHSS评分较高（均P＜
0.05）；进展组预后较对照组差（P＜0.05）。②Logistic多因素分析提示高龄、伴有陈旧性脑梗死、发生进展
性运动功能缺损、梗死面积大提示预后不良（均P＜0.05）；临床表现伴有头晕和共济失调的患者则更可能
呈现预后良好的趋势（P＜0.05）。③rt-PA静脉溶栓和替罗非班安全性高；用药组和对照组的预后差异无统
计学意义（P＞0.05）。结论：PPA-BAD患者容易发生进展性运动功能缺损；高龄、伴有陈旧性脑梗死、发生
进展性运动功能缺损、梗死面积大等因素易导致预后不良；目前尚缺乏有效的临床预测指标，需要针对个
体进行综合性治疗；推荐应用rt-PA静脉溶栓及替罗非班以提高疗效。 |
| 英文摘要: |
| To explore the clinical characteristics of cerebral infarction caused by paramedian
pontine arteries (PPA) branch atheromatous disease (BAD) - PPA-BAD. Methods: A retrospective analysis was
conducted on 221 patients diagnosed with PPA-BAD in the Department of Neurology, Civil Aviation General
Hospital from 2018 to 2024. According to the presence or absence of progressive motor deficits, patients were
divided into a progressive group (140 cases) and a control group (81 cases); based on prognosis, they were
classified into a good prognosis group (163 cases) and a poor prognosis group (58 cases); depending on whether
they received recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy, they were divided into a
treatment group (14 cases) and a control group (207 cases); for patients in the progressive group, based on
whether tirofiban was used, they were divided into a tirofiban treatment group (42 cases) and a control group
(98 cases). Demographic, clinical, and imaging data of each group were compared, and the effects of rt-PA
intravenous thrombolysis and tirofiban treatment were explored. Results: (1) 140 cases (63.3% ) progressed
after 6 hours of onset, indicating that PPA-BAD tends to easily progress and worsen; the proportion of patients
with hyperlipidemia and those presenting with hemiplegia symptoms was higher in the progressive group, and
the NIHSS scores at onset, peak, and discharge were higher (all P<0.05); the prognosis of the progressive group
was worse than that of the control group (P<0.05). (2) Logistic multivariate analysis indicated that advanced
age, history of old cerebral infarction, occurrence of progressive motor deficits, and large infarct size suggested
a poor prognosis (all P<0.05); clinical manifestations accompanied by dizziness and ataxia tended to show a
trend of good prognosis (P<0.05). (3) rt-PA intravenous thrombolysis and tirofiban were safe; there was no
statistically significant difference in prognosis between the medication group and the control group (P>0.05).
Conclusion: Patients with PPA-BAD are prone to developing progressive motor deficits; factors such as
advanced age, history of old cerebral infarction, occurrence of progressive motor deficits, and large infarct size
can lead to poor prognosis; currently, there is a lack of effective clinical predictive indicators, necessitating
comprehensive individualized treatment; the application of rt-PA intravenous thrombolysis and tirofiban is
recommended to improve therapeutic efficacy. |
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