Nahas Nevine El, Shokri Hossam, Abdulghani Osama, Zakaria Magd, Kamel Taha, Fahmi Nagia, Khayat Naglaa, Shalash Aly, Basiony Ahmed El, Reda Ramez, Farag Sherine, Tork Mohamed, Elbokl Ahmed, Abdelbaset Ihab, Aref Hany
Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Stroke Cerebrovasc Dis. 2019 May;28(5):1178-1184. doi: 10.1016/j.jstrokecerebrovasdis.2019.01.003. Epub 2019 Jan 17.
In this research we wanted to highlight the importance of defining Borderzone infarctions (BZI) as a separate subtype in stroke classifications. We thus studied cases of isolated BZI, small vessel disease (SVD), and large vessel disease (LVD), to identify their points of similarities and difference in a sample of Egyptian patients.
This is a cross-sectional (observational) study. Consecutive 637 acute ischemic stroke patients were recruited over a 2 year period, from 2 stroke units of Ain Shams University hospitals in Egypt. Medical history and laboratory investigations were done to identify risk factors. National Institute of Health Stroke Scale (NIHSS) was performed on admission, and modified Rankin scale (mRS) on admission, and after 3 months. MRI brain was done to identify stroke subtype; MRA and carotid duplex were used to define vascular status.
Among the studied group of patients, 72 (11.3%) had BZI, 145 (22.8%) had SVD, 165 (26%) had LVD, and 255 were excluded as they had either undetermined, or mixed etiology. BZI showed significantly older age, early confluent lesions, more disease severity by NIHSS, and worst outcome by mRS (P < 0.05). SVD had more microbleeds than BZI and LVD. LVD showed lower prevalence of hypertension and lower high-density lipoprotein levels.
Isolated BZI, SVD, and LVD infarctions have characteristic risk factors and clinical patterns. Further studies are needed to identify if they are different from cases with mixed pathology. This could have an impact on the selection of primary and secondary preventive measures appropriate to each type.
在本研究中，我们希望强调在中风分类中将边缘带梗死（BZI）定义为一个单独亚型的重要性。因此，我们研究了孤立性BZI、小血管疾病（SVD）和大血管疾病（LVD）的病例，以确定埃及患者样本中它们的异同点。
这是一项横断面（观察性）研究。在两年时间里，从埃及艾因夏姆斯大学医院的两个中风单元招募了637例连续的急性缺血性中风患者。进行病史和实验室检查以确定危险因素。入院时进行美国国立卫生研究院卒中量表（NIHSS）评估，入院时以及3个月后进行改良Rankin量表（mRS）评估。进行脑部MRI以确定中风亚型；使用MRA和颈动脉双功超声来定义血管状况。
在研究的患者组中，72例（11.3%）患有BZI，145例（22.8%）患有SVD，165例（26%）患有LVD，255例因病因未确定或为混合病因被排除。BZI患者显示年龄明显更大、早期融合性病变、NIHSS评估的疾病严重程度更高以及mRS评估的预后更差（P < 0.05）。SVD的微出血比BZI和LVD更多。LVD显示高血压患病率较低且高密度脂蛋白水平较低。
孤立性BZI、SVD和LVD梗死具有特征性的危险因素和临床模式。需要进一步研究以确定它们是否与混合病理情况的病例不同。这可能会对适合每种类型的一级和二级预防措施的选择产生影响。
