目的：探讨皮层分水岭脑梗死（ CWSI ）与内分水岭脑梗死（ IWSI ）的临床特征及发病机制。方法2012年10月～2014年5月连续收集入住航天中心医院（北京大学航天临床医学院）神经内科的分水岭脑梗死（ WSI ）患者，根据动脉支配特点分为CWSI组和IWSI组，比较两组患者的临床资料及影像学特点。结果本研究共纳入43例CWSI及31例IWSI患者。与IWSI组相比，CWSI组患者心房纤颤发生比例更高（P＝0．033），伴随皮质小梗死更为多见（P＝0．028）。而在IWSI组中，患者大脑中动脉狭窄程度≥50％或闭塞的比例更高，且梗死灶多呈串珠状或条索状（ P＝0．022、0．003）；IWSI组患者出院时NIHSS评分更高、住院时间更长（ P＝0．027、0．031）。两组Willis环血流代偿无明显差异（ P＞0．05）。结论 CWSI的主要发病机制是栓塞机制，而血流动力学障碍可能是IWSI的主要发病机制；IWSI患者的短期临床预后较CWSI患者更差。%Objective To investigate the etiology and clinical features for cortical watershed infarction ( CWSI ) and internal watershed infarction (IWSI).Methods Patients with cerebral watershed infarction (WSI) were recruited from October 2012 to May 2014 in the department of neurology of Aerospace Center Hospital ( Aerospace Clinical Medical Col-lege Affiliated to Peking University), who were divided into CWSI group (n=43) and IWSI group (n=31) based on vas-cular teritories.Clinical and demographic features and neuroradiological features were compared between two groups .Re-sults Compared with the IWSI group , CWSI group had a higher incidence of atrial fibrillation and more frequently con-comitant small cortical infarcts (P=0.033 and P=0.028, respectively).In contrast, IWSI group had a higher degree of stenosis or occlusion in the middle cerebral artery (P=0.022) and exhibited a rosary-like pattern of infarction more fre-quently (P=0.003).Patients in IWSI group had higher NIHSS scores before discharge and longer hospital stay than CWSI group (P=0.027 and P=0.031, respectively).No significance was found between two groups in the colleteral ability of Willis circle (P>0.05).Conclusions CWSI are caused mainly by embolic pathogenesis , whereas hemodynamic com-promise appears to contribute greatly to the genesis of IWSI .Patients with IWSI show poor early clinical courses .
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