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目的:心房纤颤(Atrial fibrillation,AF)是急性脑梗死的一种重要危险因素.急性分水岭区脑梗死(acute border-zone infarcts,ABZI)的发病机制目前尚不明确.我们通过弥散加权成像(diffusion-weighted imaging,DWI)探讨AF患者ABZI的病理生理学从而对其进行分类.方法:我们选择103名ABZI同时合并存在AF的患者进行研究.在患者脑梗死症状出现24 h之内进行DWI检查.根据动脉支配区特点把ABZI患者分为内侧BZI(Interal border-zone infarcts,IBZI)与皮层BZI(Cortical border-zone infarcts,CBZI)两组,并分别比较两组患者的基本信息、危险因素、临床特点和影像学特点.结果:IBZI组有27名患者,CBZI组有76名患者.与IBZI组相比,CBZI组患者年龄较大,女性患者所占比例偏高.IBZI组患者入院时美国国立卫生院神经功能缺损(National Institutes of Health Stroke Scale,NIHSS)评分与出院时改良Rankin量表 (modified Rankin Scale,mRS)评分皆高于对照组.而IBZI组大脑中动脉( middle cerebral artery,MCA)的严重狭窄率或闭塞率比率较高,DWI上其梗死灶通常为串珠样( P＜0.01),CBZI组较多表现为皮层小梗死病变( P＜0.01).结论:IBZI的病因可能主要为脑动脉血流动力学障碍所致,而栓塞机制是CBZI的主要发病机制.我们的研究结果提示房颤患者不同类型ABZI的治疗方案是有差异的.“,”OBJECTIVE: To investigate the pathophysiology of ABZI and to identify its categories.METHODS: 103 atrial fibril-lation ( AF) patients with ABZI were selected.DWI was performed within 24 hours of stroke onset for the patients.These patients were divided into interal border-zone infarcts (IBZI) group (n=27) and cortical border-zone infarcts (CBZI) group (n=76) based on vascular territories.Their demographic characteristics,cerebrovascular risk factors,clinical and neuroradiological data were compared in two groups.RESULTS: Patients with IBZI were associated with higher National Institutes of Health Stroke Scale ( NIH-SS) scores on admission and higher modified Rankin Scale ( mRS) at discharge.Compared with the CBZI patients,IBZI patients had a higher degree of stenosis or occlusion in middle cerebral artery ( MCA) and exhibited a rosary-like pattern of infarction more fre-quently (P＜0.01).In contrast,concomitant small cortical infarcts were observed more frequently in CBZI patients (P＜0.01).CONCLUSIONS: IBZI are caused mainly by hemodynamic compromise and CBZI by embolic pathogenesis.The studies suggest that different therapeutic approaches may be required in AF patients with different types of ABZI.