无症状脑梗死的临床研究(1)
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[摘要] 目的：了解无症状脑梗死的发生率、梗死部位及相关的危险因素。方法：2006年7月～2007年12月在干诊科住院及门诊体检的65岁以上老年患者214例，平均年龄为77.34岁，所有患者均无明确的神经系统病变，根据头部CT和(或)头部MRI检查，明确114例为无症状脑梗死，分析无症状脑梗死的部位和大小以及无症状脑梗死相关的危险因素。结果：114例确诊为无症状脑梗死的患者，梗死多发部位依次为基底节、侧脑室旁、深部脑白质、丘脑、脑干，病灶大小大多在5～15 mm之间，多部位病灶的发生率占44.55%。结论：通过对老年无症状脑梗死患者的调查及危险因素的分析，发现年龄、高血压和糖尿病是无症状脑梗死的主要相关危险因素。
[关键词] 无症状脑梗死；危险因素
[中图分类号] R743.33[文献标识码]A [文章编号]1673-7210(2009)01(b)-013-03
Clinical study on the silent cerebral infarction
MAO Shan-shan1, ZHANG Chao-dong2
(1.The First People's Hospital of Shenyang, Shenyang110042，China; 2.China Medical University, Shenyang 110001, China)
[Abstract] Objective: To investigate the incidence, the infarction position of silent cerebral infarction and its relevant risk factors. Methods: 214 patients older than 65 years(the average age is 77.34 years) were selected from the clinic physical examination and hospitalized patients from July 2006 to December 2007. Allpatients didn't have any explicit nerve system organic diseases. 114 patients were confirmed as silent cerebral infarction by using cranial CT and/or MRI. Then the position and area of silent cerebral infarction as well as its relevant factors were analyzed. Results: A total amount of 114 patients were diagnosed as silent cerebral infarction, the most frequent positions of infarction in turn was basal ganglion, lateral ventricle, deep white matter of brain, thalamus and brainstem. The majority of lesions sizes lied between 5-15 mm, and the incidence of multiple lesions were 44.55%. Conclusion: Age, hypertension and diabetes were found to be the significant factors for silent cerebral infarction by the investigation and analysis of old patients with silent cerebral infarction.
[Key words] Silent cerebral infarction; Risk factors
在临床上，一些老年患者经常有如下自觉症状：头痛、眩晕、肢体沉重和麻木、抑郁等，既往有高血压、糖尿病、高血脂、吸烟等脑血管病危险因素，但无脑卒中史或其他神经系统器质性疾病史，体检时无任何神经系统客观体征。随着CT和MRI在临床中的广泛应用，这些患者脑白质内发现有不同程度的无症状脑损害[1]。1990年美国国立神经疾病和脑卒中研究所(NINCDS)的脑血管分类Ⅲ中将这种无症状脑损害定义为无症状脑梗死(silent cerebral infarction， SCI)，并将其列为脑梗死的一个类型，同时也将其作为脑梗死的危险因素之一[2]。1995年我国修订的脑血管疾病分类新增加了无症状脑梗死(SCI)，即无脑卒中病史，无明确神经系统定位体征，由影像学或尸检发现的缺血灶或梗死灶。
流行病学资料表明，SCI在老年人较为常见，由于采用的检查设备、评定SCI的量表及研究对象的来源不一致，其患病率各家报道不一[3]。在健康老年人中应用CT检查，SCI发生率最高达21%，而应用MRI检查其发生率最高达100%[1] ......
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