基于细粒度情感信息的语料标注及其应用
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摘要
目的：研究单侧颈内动脉（internal carotid artery，ICA）重度狭窄或闭塞性脑梗死患者的梗死模式特点及侧支代偿情况。
方法：回顾性分析了112例急性缺血性脑梗死患者，分为ICA病变组、大脑中动脉（middle cerebral artery，MCA）病变组及对照组(control group，CG、轻度狭窄组)。根据梗死灶形态分为单发和多发，前者按部位分为：穿动脉梗死灶（perforating arteryinfarct，PAI)、皮质支梗死灶(pial infarct，PI)、分水岭梗死灶(border-zone infarct，BZ)。借助DWI研究其梗死模式，运用DSA分析其初级和次级代偿情况；3个月后应用Barthel指数和改良Rankin量表评估预后。
结果：三组患者的梗死灶形态存在差异(P=0.001)，两病变组中多发梗死病灶多见；与CG组相比，ICA病变组易出现的梗死灶形态是PAI+PI（P=0.005)、MCA组易出现PAI+BZ（P=0.006)；血管狭窄的程度与梗死灶模式存在一定关联，ICA狭窄越严重，PAI+PI发生率越高(P=0.003)，MCA狭窄越严重，PAI+BZ发生率越高(P=0.043)；侧支代偿总发生率为89.66%（52/58），其中初级Willis环合并次级代偿发生率为60.34%（35/58），Willis环前交通开放率为27.59%（16/58），后交通开放率为32.76%（19/58），次级代偿眼动脉代偿发生率为37.93%（22/58），软脑膜支代偿发生率为39.66%（23/58）。ICA闭塞组的眼动脉开放率较ICA重度狭窄组高（P=0.005）。与CG组相比，ICA病变组三个月后的功能恢复差（P=0.002）。
结论：ICA病变组：ICA重度狭窄/闭塞性患者中PAI+PI模式多见，以初级合并次级混合代偿为主，闭塞组眼动脉代偿较重度狭窄组常见，血管狭窄越重，侧支代偿越少，预后越差；MCA病变组：MCA重度狭窄/闭塞性患者中PAI+BZ模式多见。
Objectives: To analyze the infarct patterns and collateral compensation to cerebralinfarction patients with the unilateral internal carotid artery（ICA）severe stenosis orocclusion.
Methods: Retrospective studying of one hundred and twelve acute ischemic strokepatients. All patients were divided into ICA disease, middle cerebral artery（MCA）disease,or control group (CG, slightly stenosis group). According to the infarct lesion wereclassified as single and multiple, the former was divided into perforating artery infarct(PAI), pial infarct(PI) and border-zone infarct(BZ). We studied the infarct patternsaccording to the DWI performed and analyzed the information about the primary andsecondary collateral compensation on the basis of DSA. Application of Barthel index andmodified Rankin scale, we evaluated the prognosis three months later.
Results: Distribution of lesion patterns in three groups might be different(P=0.001).The DWI multi-infarct pattern was more seen in the two morbid groups; Compared withnegative group, pial infarct with perforating artery infarct appeared more often in the ICAlesion group（P=0.005), concomitant perforator with border-zone infarcts were more seenin the MCA lesion group（P=0.006); The extent of the blood vessel stenosis was connectedto the infarct patterns, the more serious of ICA stenosis, concomitant perforator and pialinfarcts were more common in patients with ICA disease(P=0.003), and the more heavierof MCA stenosis, concomitant perforator with border-zone infarcts were more often inpatients with MCA disease(P=0.043); The incidence of collateral circulation was89.66%(52/58), and the incidence of the circle of Willis mixed with the second collateralcirculation was60.34%(35/58), anterior communicating artery,27.59%(16/58), posteriorcommunicating artery,32.76%(19/58), ophthalmic artery,37.93%(22/58), leptomeningeal artery,39.66%(23/58); The incidence of ophthalmic artery was higher in ICA occlusivedisease (P=0.005); The function recovery was poorer in ICA disease three months later (P=0.002).
Conclusions：Pial infarct with perforating artery infarct were more seen in acutecerebral infarction patients with ICA stenosis severe or occlusion, and the maincompensatory approach for those patients was the circle of Willis mixed with the secondcollateral circulation; The incidence rate of ophthalmic artery was more in ICA occlusivegroup than ICA severe stenotic group; Blood vessels stenosis more heavier, less collateralcompensation, the prognosis was worse; Concomitant perforator with border-zone infarctswere more often in MCA severe stenotic or occlusive patients.
方法：回顾性分析了112例急性缺血性脑梗死患者，分为ICA病变组、大脑中动脉（middle cerebral artery，MCA）病变组及对照组(control group，CG、轻度狭窄组)。根据梗死灶形态分为单发和多发，前者按部位分为：穿动脉梗死灶（perforating arteryinfarct，PAI)、皮质支梗死灶(pial infarct，PI)、分水岭梗死灶(border-zone infarct，BZ)。借助DWI研究其梗死模式，运用DSA分析其初级和次级代偿情况；3个月后应用Barthel指数和改良Rankin量表评估预后。
结果：三组患者的梗死灶形态存在差异(P=0.001)，两病变组中多发梗死病灶多见；与CG组相比，ICA病变组易出现的梗死灶形态是PAI+PI（P=0.005)、MCA组易出现PAI+BZ（P=0.006)；血管狭窄的程度与梗死灶模式存在一定关联，ICA狭窄越严重，PAI+PI发生率越高(P=0.003)，MCA狭窄越严重，PAI+BZ发生率越高(P=0.043)；侧支代偿总发生率为89.66%（52/58），其中初级Willis环合并次级代偿发生率为60.34%（35/58），Willis环前交通开放率为27.59%（16/58），后交通开放率为32.76%（19/58），次级代偿眼动脉代偿发生率为37.93%（22/58），软脑膜支代偿发生率为39.66%（23/58）。ICA闭塞组的眼动脉开放率较ICA重度狭窄组高（P=0.005）。与CG组相比，ICA病变组三个月后的功能恢复差（P=0.002）。
结论：ICA病变组：ICA重度狭窄/闭塞性患者中PAI+PI模式多见，以初级合并次级混合代偿为主，闭塞组眼动脉代偿较重度狭窄组常见，血管狭窄越重，侧支代偿越少，预后越差；MCA病变组：MCA重度狭窄/闭塞性患者中PAI+BZ模式多见。
Objectives: To analyze the infarct patterns and collateral compensation to cerebralinfarction patients with the unilateral internal carotid artery（ICA）severe stenosis orocclusion.
Methods: Retrospective studying of one hundred and twelve acute ischemic strokepatients. All patients were divided into ICA disease, middle cerebral artery（MCA）disease,or control group (CG, slightly stenosis group). According to the infarct lesion wereclassified as single and multiple, the former was divided into perforating artery infarct(PAI), pial infarct(PI) and border-zone infarct(BZ). We studied the infarct patternsaccording to the DWI performed and analyzed the information about the primary andsecondary collateral compensation on the basis of DSA. Application of Barthel index andmodified Rankin scale, we evaluated the prognosis three months later.
Results: Distribution of lesion patterns in three groups might be different(P=0.001).The DWI multi-infarct pattern was more seen in the two morbid groups; Compared withnegative group, pial infarct with perforating artery infarct appeared more often in the ICAlesion group（P=0.005), concomitant perforator with border-zone infarcts were more seenin the MCA lesion group（P=0.006); The extent of the blood vessel stenosis was connectedto the infarct patterns, the more serious of ICA stenosis, concomitant perforator and pialinfarcts were more common in patients with ICA disease(P=0.003), and the more heavierof MCA stenosis, concomitant perforator with border-zone infarcts were more often inpatients with MCA disease(P=0.043); The incidence of collateral circulation was89.66%(52/58), and the incidence of the circle of Willis mixed with the second collateralcirculation was60.34%(35/58), anterior communicating artery,27.59%(16/58), posteriorcommunicating artery,32.76%(19/58), ophthalmic artery,37.93%(22/58), leptomeningeal artery,39.66%(23/58); The incidence of ophthalmic artery was higher in ICA occlusivedisease (P=0.005); The function recovery was poorer in ICA disease three months later (P=0.002).
Conclusions：Pial infarct with perforating artery infarct were more seen in acutecerebral infarction patients with ICA stenosis severe or occlusion, and the maincompensatory approach for those patients was the circle of Willis mixed with the secondcollateral circulation; The incidence rate of ophthalmic artery was more in ICA occlusivegroup than ICA severe stenotic group; Blood vessels stenosis more heavier, less collateralcompensation, the prognosis was worse; Concomitant perforator with border-zone infarctswere more often in MCA severe stenotic or occlusive patients.
引文
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2. Wong KS, Huang YN, Yang HB, et al. A door-to-door survey of intracranialatherosclerosis in Liangbei Country, China. Neurology,2007,68:2031-2034.
3.李东波,田彦龙,宋冬雷,等.120例颅内外脑供血动脉严重狭窄或闭塞患者全脑血管造影分析.国际脑血管病杂志,2009,17:98-103.
4. Wong KS, Gao S, Chan YL, et al. Mechanisms of acute cerebral infarctions in patientswith middle cerebral artery stenosis: a diffusion-weighted imaging and microembolimonitoring study. Ann Neurol,2002,52:74-81.
5. Albem GW, Lansberg MG, Norbash AM, et al. Yield of diffusion-weighted MRI fordetection of potentially relevant findings in stroke patients, Neurology,2000,54:1562—1567.
6.王新,黄家星,范玉华,等.急性缺血性卒中病因与早期弥散加权成像表现的关系.中华神经科杂志,2005,38:301-304.
7. Tam L, Moulin T, Bogousslavsky J, et al. Arterial territories of the human brain:cerebral hemispheres. Neurology,1998,50:1699-1708.
8. Lee DK, Kim JS, Kwon SU, et al. Lesion patterns and stroke mechanism inatherosclerotic middle cerebral artery disease: early diffusion-weighted imaging study.Stroke,2005, Dec;36(12):2583-8.
9. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficialeffect of carotid endarterectomy in symptomatic patients with high-grade carotidstenosis. N Engl J Med,1991,325:445-453.
10. Berg M, Zhang Z, Ikonen A, et al. Multi-detector row CT angiography in theassessment of carotid artery disease in symptomatic patients: comparison withrotational angiography and digital subtraction angiography. AJNR Am J Neuroradol,2005,26:1022-1034.
11. Josephson SA, Bryant SO, M ak HK, et al. Evaluation of carotid stenosis using CTangiography in the initial evaluation of stroke and TIA. Neurology,2004,63:457-460.
12. Bash S, Villablanca JP, Jahan R, et al. Intracranial vascular stenosis and occlusivedisease: evaluation with CT angiography, MR angiography, and digital subtractionangiography. AJNR Am J Neuroradol,2005,26:1012-1021.
13. Westwood ME, Kelly S, Berry E, et al. Use of magnetic resonance angiography toselect candidates with recently symptomatic carotid stenosis for surgery: systematicreview. BMJ,2002,324:198.
14. Schreiber S, Serdaroglu M, Schreiber F, et al. Simultaneous occurrence and interactionof hypoperfusion and embolism in a patient with severe middle cerebral arterystenosis. Stroke,2009,40: e478-e480.
15. Kang DW, Chu K, Ko SB, et al. Lesion patterns and mechanism of ischemia ininternal carotid artery disease: a diffusion-weighted imaging study. Arch Neurol,2002,59:1577-1582.
16. Caplan LR, Wong KS, Gao S, et al. Is hypoperfusion an important cause of strokes? Ifso, how? Cerebrovasc Dis,2006,21：145-153.
17. Szabo K, Kern R, Gass A, et al. Acute stroke patterns in patients with internal carotidartery disease: a diffusion-weighted magnetic resonance imaging study. Stroke,2001,32:1323-1329.
18. Bisschops RH, Klijn CJ, Kappelle LJ, et al. Collateral flow and ischemic brain lesionsin patients with unilateral carotid artery occlusion. Neurology,2003,13;60(9):1435-
41.
19. Caplan LR. Large artery occlusion disease of the anterior circulation. In: Caplan’sStroke: A Clinical Approach.4th Ed. Philadelphia PA: Saunders,2009,221-257.
20. Mantese VA, Timaran CH, Chiu D, et al. The Carotid Revascularization Endarterec tomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotiddisease. Stroke,2010, S31-4.
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