合并颅内外血管病变的缺血性卒中患者相关危险因素的回顾性研究  

Retrospective study of the relevant risk factors in the ischemic stroke patients with intra/extra-cranial artherosclerosis

作　　者：赵鸿琛[1] 王亮[1] 张扬[1] 周磊[1] 吴征瑜[1] 董强[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海200040

出　　处：《中风与神经疾病杂志》2010年第6期539-543,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的研究卒中危险因素在缺血性卒中合并/不合并颅内/外大血管病变患者中的分布。方法根据头部血管影像学(B超、CTA、MRA及DSA)对304例急性缺血性卒中患者是否合并有责任的大血管狭窄进行分组,回顾性分析在不同分组间各个危险因素的差异及相对危险度。结果对比腔隙性缺血性卒中(lacunar stroke,Lac-s),年龄>65岁的患者发生大动脉粥样硬化性缺血性卒中(large artery artherosclerosis stroke,LAA-s)的风险增高2倍;在吸烟人群中,这种风险增高2.3倍,血糖稳定机制异常患者发生LAA-s的风险比Lac-s高近2.8倍,而糖尿病人群中这种风险增高2.3倍,其他卒中危险因素在两组间的分布未见统计学差异(P>0.05)。在缺血性卒中合并责任和非责任大血管病变间,各种危险因素分布无差别。在缺血性卒中合并颅外责任血管病变(Stroke with extracranial artery artheroscloerosis,ECAA-s)组和合并颅内责任血管病变(Stroke with intracranial artery artheroscloerosis,ICAA-s)组间,男性与ECAA-s组相关性更加密切(P=0.001,OR=0.15),男性发生ECAA-s的风险是发生ICAA-s的6.7倍;血糖增高的患者显示出ICAA-s的高风险(P=0.012,OR=2.61)。结论年龄>65岁、吸烟和糖尿病患者更容易发生大动脉粥样硬化性缺血性卒中;血糖的异常增高带来缺血性卒中合并颅内大血管风险的增高,男性卒中患者更加容易发生颅外大血管责任性病变。Objective To evaluate the distribution of the risk factors of stroke among the stroke patients with or without large artery artherosclerosis intracerebral/extracerebral.Method According to the angiographic images,304 cases of ischemia stroke patients were classified into subtypes as lacunar stroke （Lac-s）,large artery artherosclerosis stroke （LAA-s）,stroke with none-criminal artery artherosclerosis （None-CAA-s）,stroke with criminal artery artherosclerosis （CAA-s）,stroke with intracranial criminal artery artherosclerosis （ICAA-s） and stroke with extracranial criminal artery artherosclerosis （ECAA-s）.Risk factor differences among subtypes were examined with the χ2 test or CMH χ2 test for significance. The multiple logistic regression analysis was also employed to evaluate the interrelationship among subtypes and risk factors.Results There were 95 Lac-s patients and 209 LAA-s patients.The latter was composed of 47 None-CAA-s patients and 162 CAA-s patients which can be further divided between ICAA-s patients（55.56%） and ECAA-s（44.44%） ones. Compared with Lac-s,risk for LAA-s was increased with the age（65y）（P=0.018,OR=2.07）,smoking（P=0.013,OR=2.33） and hyperglycemia（P=0.005,OR=1.57）.There were no significant differences in the way risk factors affected None-CAA-s and CAA-s（P0.05）. Between ECAA-s and ICAA-s,decreased risk for ICAA-s was associated with male（P=0.001,OR=0.15）,and increased risk for ICAA-s with hyperglycemia（P=0.012,OR=2.61）,none the less,diabetes didn＇t raise the risk for either subtype（P0.05）.Conclusion Risk factors like age （above 65）,smoking and hyperglycemia would increase the danger for large artery artherosclerosis stroke.Other stroke risk factors,such as sex,obesity,history of coronary artery disease and stroke,hypertension,serum lipid sequence abnormal,did not make much difference between lacunar stroke and large artery artherosclerosis stroke.There was no significant diversity between strokes with and without criminal arter

关 键 词：缺血性卒中 危险因素 动脉粥样硬化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]