Ohara Tomoyuki, Yamamoto Yasumasa, Oiwa Kaiyo, Hayashi Masamichi, Nakagawa Masanori
Department of Neurology, Kyoto Second Red Cross Hospital.
Rinsho Shinkeigaku. 2005 Jan;45(1):6-12.
A lacunar infarct is defined as the occlusion of a single perforating artery. Certain researchers have proposed that patients with lacunar infarcts can be classified into two clinically distinct entities: patients with a single, symptomatic lacunar infarct, and patients with multiple lacunar infarcts together with hypertension and leukoaraiosis. The present study attempted to delineate the characteristics of lacunar infarcts and evaluate the validity of the aforementioned hypothesis. A total of 130 consecutive patients with first-time symptomatic lacunar infarct were studied. All patients were dichotomized into two groups according to two different kinds of models as follows. Model-1: patients with a single lacune and patients with multiple lacunes; and Model-2: patients with large lacune and patients with small lacune. Associated factors for the multiple lacune group compared with the single lacune group as well as the large lacune group compared with the small lacune group, were analyzed by multivariate logistic regression analysis. Associated factors included age, sex, hypertension, diabetes mellitus, dyslipidemia, smoking, extracranial and intra-cranial vascular lesions, extent of lacunes and white matter lesions, progression status and blood pressure in the acute stage, and coagulation markers such as fibrinogen, thrombin-antithrombin complex, D-dimer, beta-thromboglobulin, platelet factor 4. Results for Model-1: hypertension (age-and sex-adjusted OR: 2.58, p = 0.017) and elevated systolic blood pressure (>160mmHg for the mean value during the first post-ictal week; OR: 2.55, p = 0.016) were significantly associated with the multiple lacune group. Large lacunes (>10mm in diameter) were negatively associated with the multiple lacune group (OR: 0.38, p = 0.017). Association between confluent white matter lesions and the multiple lacune group approached significance (OR: 2.16, p = 0.056). Results for Model-2: female sex (OR: 0.39, p = 0.021), mild stenosis of intracranial and extracranial arteries (<25%) (intracranial; OR: 5.42, p = 0.0042, extracranial; OR: 3.30, p = 0.016), progressing stroke (OR: 6.77, p<0.0001), and high levels of TAT (>3ng/ml) (OR: 2.80, p = 0.039) were significantly associated with the large lacune group. Multiple lacunes (OR: 0.38, p = 0.016) and confluent white matter lesions (OR: 0.28, p = 0.007) exhibited a significant negative association with the large lacune group. In conclusion, underlying vasculopathy in the presence of multiple lacunes may correspond to lipohyalinosis resulting from hypertension. Moreover, large lacune may correspond to microatheroma at the orifice of penetrating arteries.
腔隙性梗死被定义为单一穿支动脉的闭塞。某些研究人员提出，腔隙性梗死患者可分为两个临床特征不同的类型：单一症状性腔隙性梗死患者，以及合并高血压和脑白质疏松的多发性腔隙性梗死患者。本研究试图描述腔隙性梗死的特征，并评估上述假设的有效性。共研究了130例首次出现症状性腔隙性梗死的连续患者。所有患者根据以下两种不同模型分为两组。模型1：单发腔隙患者和多发腔隙患者；模型2：大腔隙患者和小腔隙患者。通过多因素逻辑回归分析，比较多发腔隙组与单发腔隙组以及大腔隙组与小腔隙组的相关因素。相关因素包括年龄、性别、高血压、糖尿病、血脂异常、吸烟、颅外和颅内血管病变、腔隙和白质病变的范围、急性期病情进展情况和血压，以及凝血标志物如纤维蛋白原、凝血酶 - 抗凝血酶复合物、D - 二聚体、β - 血小板球蛋白、血小板因子4。模型1的结果：高血压（年龄和性别调整后的OR：2.58，p = 0.017）和收缩压升高（发病后第一周平均值>160mmHg；OR：2.55，p = 0.016）与多发腔隙组显著相关。大腔隙（直径>10mm）与多发腔隙组呈负相关（OR：0.38，p = 0.017）。融合性白质病变与多发腔隙组之间的关联接近显著（OR：2.16，p = 0.056）。模型2的结果：女性（OR：0.39，p = 0.021）、颅外和颅内动脉轻度狭窄（<25%）（颅内；OR：5.42，p = 0.0042，颅外；OR：3.30，p = 0.016）、进展性卒中（OR：6.77，p<0.0001）和高水平的凝血酶 - 抗凝血酶复合物（>3ng/ml）（OR：2.80，p = 0.039）与大腔隙组显著相关。多发腔隙（OR：0.38，p = 0.016）和融合性白质病变（OR：0.28，p = 0.007）与大腔隙组呈显著负相关。总之，多发性腔隙存在时的潜在血管病变可能与高血压导致的脂质透明变性相对应。此外，大腔隙可能与穿支动脉开口处的微动脉粥样硬化相对应。
