Analysis Of Risk Factors For Progressive Motor Function Defect In Isolated Infarction With Deep Penetrating Branch Of Middle Cerebral Artery

Objective:Progressive motor function defects(PMD)are common in deep cerebral infarction of the middle cerebral artery,often leading to poor prognosis.The purpose ofthis study was to investigate the association between clinical features,biochemical parameters,and imaging features of progressive middle cerebral artery in patients with isolated infarction.Methods:A total of 185 patients with deep cerebral artery stenosis and isolated cerebral infarction were included in the study.According to the diagnostic criteria of PMD,the National Institute of Health Stroke Score NIHSS within 5 days after the onset of ischemic stroke.The scores of the sports items in the score increased by ? 2 points and lasted for at least 24 hours and were divided into the progression group and the non-progress group.General clinical data of the two groups of patients,such as risk factors for stroke,NIHSS score at admission,blood pressure at admission,relevant laboratory biochemical indicators and imaging findings,such as lesion characteristics on the DWI sequence of the brain magnetic resonance,intracranial and extracranial arteries Univariate analysis of factors such as atherosclerotic changes,stenosis or occlusion,white matter lesions,and statistically significant factors(p<0.05)were used as independent variables to carry out the two-class logisitic regression equation with PMD as the dependent variable.Multivariate analysis to determine independent predictors of PMD occurrence.Results:Progressive motor function defects occurred in 53 of 185 patients(28.6%).Univariate analysis revealed gender,previous infarction/TIA history,time from onset to admission,length of hospital stay,NIHSS score at discharge,total cholesterol in plasma,LDL-C,fibrinogen,infarct volume,infarct location,atherosclerosis Factors such as sclerosis,vertebral-basal artery stenosis,and white matter lesions were associated with PMD,and the difference was statistically significant.Logistic regression analysis of the above factors revealed a history of previous TIA/cerebral infarction(OR=3.298,95% CI= 1.125-9.667),time from onset to admission(OR=0.976,95% CI=0.957-0.995),posterior infarction(OR=5.449,95% CI=1.321-22.474),infarct volume(OR=1.003,95%)CI=1.001-1.005),atherosclerosis(OR=3.904,95% CI=1.504-10.132)and vertebral-basal artery stenosis(OR=42.384,95% CI=3.852-466.3)were independent predictors of PMD development(p<0.05).Conclusion:1.Deep cerebral infarction of the middle cerebral artery is prone to progressive motor function defects,which is still the focus and difficulty of treatment in clinical work.2.This study found that posterior infarction and infarct volume were significantly associated with the occurrence of PMD,which was an independent predictor of PMD development,which may be related to the location and involvement of the corticospinal tract.3.The time from onset to admission and atherosclerosis are also independent predictors of PMD development,which is consistent with previous studies.4.The history of previous TIA/cerebral infarction is an independent risk factor for PMD,but the mechanism of action is still unclear.Previous studies have been controversial.5.Sex,time to onset,length of hospital stay,NIHSS score at discharge,white matter lesions and plasma total cholesterol,LDL-C,fibrinogen and other indicators also had predictive value for PMD,but did not reach statistical significance.