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目的:探讨脑白质高信号(white matter hyperintensities, WMHs)与急性孤立性穿支供血区梗死患者卒中病因学分型的相关性。方法:回顾性纳入2017年1月至2020年5月期间徐州医科大学附属医院收治的首发急性孤立性穿支供血区梗死患者。依据中国缺血性卒中亚型分类系统(chinese ischemic stroke subclassification, CISS)分为大动脉粥样硬化(large artery atherosclerosis, LAA)和穿支动脉疾病(penetrating artery disease, PAD)。依据梗死分布情况，分为豆纹动脉(lenticulostriate artery, LSA)和脑桥旁正中动脉(paramedian pontine artery, PPA)供血区梗死。记录患者人口统计学、血管危险因素、基线临床资料、WMHs部位以及Fazekas量表评分。采用多变量n logistic回归分析确定卒中病因学分型的独立影响因素。n 结果:共纳入440例急性孤立性穿支供血区梗死患者，LAA组120例(27.3%)，PAD组320例(72.7%)；LSA供血区梗死213例(48.4%)，PPA供血区梗死227例(51.6%)。PAD组WMHs总Fazekas评分3～6分和脑室周围WMHs(periventricular WMHs, PWMHs)评分2～3分的患者构成比显著高于LAA组(n P均<0.05)。在LSA供血区梗死患者中，PAD亚组高血压、WMHs总Fazekas评分3～6分和PWMHs评分2～3分的患者构成比显著高于LAA亚组，而高脂血症的患者构成比显著低于LAA亚组(n P均<0.05)；在PPA供血区梗死患者中，PAD亚组低密度脂蛋白胆固醇和高半胱氨酸水平显著低于LAA亚组。多变量n logistic回归分析显示，PWMHs评分2～3分为PAD的独立相关因素[优势比(odds ratios, n OR)2.220, 95%置信区间(confidence interval, n CI)1.085～4.541；n P＝0.029]；在LSA供血区梗死患者中，高脂血症与LAA独立相关(n OR 0.432，95% n CI 0.192～0.972；n P＝0.042)，PWMHs评分2～3分与PAD独立相关(n OR 3.846，95% n CI 1.193～12.397；n P＝0.024)；在PPA供血区梗死患者中，高低密度脂蛋白胆固醇(n OR 0.660，95%n CI 0.494～0.883；n P＝0.005)、高半胱氨酸(n OR 0.958，95% n CI 0.930～0.987；n P＝0.005)和C反应蛋白(n OR 0.987，95% n CI 0.977～0.997；n P＝0.008)与LAA独立相关。n 结论:LAA型和PAD型急性孤立性穿支供血区梗死患者普遍存在WMHs，较严重的PWMHs提示病因为PAD可能性大，特别是在LSA供血区梗死患者中。“,”Objective:To investigate the correlation between white matter hyperintensities (WMHs) and stroke etiology classification in patients with acute isolated penetrating artery territory infarction.Methods:Patients with first-ever acute isolated penetrating artery territory infarction admitted to the Department of Neurology, the Affiliated Hospital of Xuzhou Medical University from January 2017 to May 2020 were enrolled retrospectively. According to the Chinese Ischemic Stroke Subclassification (CISS) system, they were divided into large artery atherosclerosis (LAA) and perforating artery disease (PAD). According to the distribution of infarcts, they were divided into lenticulostriate artery (LSA) territory infarction and paramedian pontine artery (PPA) territory infarction. The demographics, vascular risk factors, baseline clinical data, WMHs location, and Fazekas Scale scores were documented. Multivariate n logistic regression analysis was used to identify the independent influencing factors of stroke etiology classification.n Results:A total of 440 patients with acute isolated penetrating artery territory infarction were enrolled, including 120 (27.3%) in the LAA group, and 320 (72.7%) in the PAD group; 213 (48.4%) with LSA territory infarction, and 227 (51.6%) with PPA territory infarction. The proportion of patients with total Fazekas score 3-6 and periventricular WMHs (PWMHs) score 2-3 in the PAD group was significantly higher than those in the LAA group (all n P<0.05). In patients with LSA territory infarction, the proportion of the patients with hypertension, WMHs total Fazekas score 3-6 and PWMHs score 2-3 in PAD subgroup was significantly higher than those in the LAA subgroup, while the proportion of the patients with hyperlipidemia was significantly lower than that in LAA subgroup (alln P<0.05). In patients with PPA territory infarction, the levels of low-density lipoprotein cholesterol and homocysteine in the PAD subgroup were significantly lower than those in the LAA subgroup. Multivariaten logistic regression analysis showed that PWMHs score 2-3 was an independent correlation factor of PAD (odds ratio [n OR] 2.220, 95% confidence interval [n CI] 1.085-4.541; n P=0.029). In patients with LSA territory infarction, hyperlipidemia was independently correlated with LAA (n OR 0.432, 95% n CI 0.192-0.972; n P=0.042), and PWMHs score 2-3 was independently correlated with PAD (n OR 3.846, 95% n CI 1.193-12.397; n P=0.024). In patients with PPA territory infarction, higher low-density lipoprotein cholesterol (n OR 0.660, 95% n CI 0.494-0.883; n P=0.005), homocysteine (n OR 0.958, 95% n CI 0.930-0.987; n P=0.005) and C-reactive protein (n OR 0.987, 95% n CI 0.977-0.997; n P=0.008) were independently correlated with LAA.n Conclusions:WMHs are common in patients with acute isolated perforating territory infarction caused by LAA and PAD, and more severe PWMHs suggest that PAD is more likely to be the cause of the acute isolated perforating territory infarction, especially in patients with LSA territory infarction.