Xiao Han, He Zi-Yan, Li Xue-Ming, Mao Jing, Zhou Yun
Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China.
Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China.
Neurol Sci. 2025 Jul 12. doi: 10.1007/s10072-025-08347-9.
Large hemispheric infarction (LHI) of the middle cerebral artery (MCA) is linked to high mortality and morbidity. This study aims to investigate the characteristics of large artery atherosclerosis (LAA) and cardioembolism subtypes of LHI in MCA.
This retrospective cohort study included 70 patients with LHI hospitalized at the Second Affiliated Hospital of Anhui Medical University from May 2019 to May 2021. Patients were classified according to the TOAST classification into LAA and cardioembolism subtypes.
Among the 70 patients, 44 were identified with the LAA subtype (aged 76.00 years, 50% were male) and 26 with cardioembolism (aged 71.50 years, 57.1% were male). The LAA group exhibited significantly higher rates of hyperhomocysteinemia (18.2% vs. 0%, P = 0.022) and diabetes (38.6% vs. 15.4%, P = 0.042). In contrast, atrial fibrillation prevalence was higher in the cardioembolism group (84.6% vs. 20.5%, P < 0.001), as was the rate of decompressive craniectomy (15.4% vs. 2.3%, P = 0.041), while, hypertension prevalence, thrombectomy, and rehabilitation scores, showed no significant differences (all P > 0.05). Additionally, multivariable linear regression analysis showed that, after adjusted the confounders, LAA (vs. CE) subtype was independently associated with higher mRS scores (β = 0.86, 95%CI: 0.61-1.22), higher NIHSS (β = 4.85, 95%CI: 0.19-9.89), higher Visual Analog Scale (VAS) (β = 0.86, 95%CI: 0.66-1.12), and higher GCS (β = 0.62, 95%CI: 0.09-4.00) (all P < 0.05).
Patients with the LAA subtype of LHI in MCA are more likely to have hyperhomocysteinemia and diabetes, while atrial fibrillation and the need for decompressive craniectomy are more prevalent in the cardioembolism subtype. LHI subtypes may significantly impact patient rehabilitation outcomes.
大脑中动脉（MCA）的大面积半球梗死（LHI）与高死亡率和高发病率相关。本研究旨在调查MCA区域LHI的大动脉粥样硬化（LAA）和心源性栓塞亚型的特征。
这项回顾性队列研究纳入了2019年5月至2021年5月在安徽医科大学第二附属医院住院的70例LHI患者。根据TOAST分类将患者分为LAA和心源性栓塞亚型。
在70例患者中，44例被确定为LAA亚型（年龄76.00岁，50%为男性），26例为心源性栓塞（年龄71.50岁，57.1%为男性）。LAA组高同型半胱氨酸血症（18.2%对0%，P = 0.022）和糖尿病（38.6%对15.4%，P = 0.042）的发生率显著更高。相比之下，心源性栓塞组心房颤动患病率（84.6%对20.5%，P < 0.001）以及减压颅骨切除术的发生率（15.4%对2.3%，P = 0.041）更高，而高血压患病率、血栓切除术和康复评分无显著差异（均P > 0.05）。此外，多变量线性回归分析显示，在调整混杂因素后，LAA（对比CE）亚型与更高的改良Rankin量表（mRS）评分（β = 0.86，95%置信区间：0.61 - 1.22）、更高的美国国立卫生研究院卒中量表（NIHSS）（β = 4.85，95%置信区间：0.19 - 9.89）、更高的视觉模拟量表（VAS）（β = 0.86，95%置信区间：0.66 - 1.12）以及更高的格拉斯哥昏迷量表（GCS）（β = 0.62，95%置信区间：0.09 - 4.00）独立相关（均P < 0.05）。
MCA区域LHI的LAA亚型患者更易发生高同型半胱氨酸血症和糖尿病，而心房颤动以及减压颅骨切除术的需求在心源性栓塞亚型中更为普遍。LHI亚型可能对患者的康复结局产生显著影响。
