缺血性卒中患者颅内动脉粥样硬化的危险因素——344例回顾性病例系列研究  

Risk factors of intracranial atherosclerosis in patients with ischemic stroke A retrospective case series study of 344 patients

作　　者：卢涛声[1,2] 尤寿江[1] 曹勇军[1] 刘春风[1] 

机构地区：[1]苏州大学附属第二医院神经内科,215004 [2]常熟市第一人民医院神经内科,215500

出　　处：《国际脑血管病杂志》2011年第12期881-886,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的 探讨缺血性卒中患者颅内动脉粥样硬化的危险因素.方法 回顾性分析接受数字减影血管造影术检查的缺血性卒中患者的人口统计学资料和血管危险因素.根据病变部位将中重度颅内动脉狭窄患者分为颈内动脉颅内段、大脑中动脉、椎动脉颅内段和基底动脉,比较各组间人口统计学资料和血管危险因素.结果 共纳入344例缺血性卒中患者,其中147例（42.7％）为中重度颅内动脉狭窄,197例（57.3％）为轻度颅内动脉狭窄.单变量分析显示,中重度颅内动脉狭窄组糖尿病（34.0％对20.8％,x2 =7.541,P=0.006）和高脂血症（78.9％对66.0％,x2=6.900,P=0.009）比例显著高于轻度颅内动脉狭窄组,总胆固醇[ （4.656±0.955） mmol/L对（4.401±0.882） mmol/L,t=-2.543,P=0.011]、低密度脂蛋白胆固醇[（3.015±0.817） mmol/L对（2.741±0.786） mmol/L,t=-3.113,P=0.002]、空腹血糖[（6.184±2.127）mmol/L对（5.568±1.772） mmol/L,t=-2.869,P=0.004]和美国国立卫生研究院卒中量表评分[（5.480±4.980）分对（4.330±4.094）分,t=-2.332,P =0.020]显著较高.多变量logistic回归分析显示,糖尿病（优势比1.907,95％可信区间1.164～3.124；P=0.010）和低密度脂蛋白胆固醇（优势比1.500,95％可信区间1.133 ～1.986;P =0.005）是中重度颅内动脉狭窄的独立危险因素.在不同颅内动脉部位患者中,男性（P =0.017）、冠心病（P=0.002）、吸烟（P =0.026）等危险因素的分布存在显著差异.结论 糖尿病和低密度脂蛋白胆固醇水平增高是颅内动脉中重度狭窄的独立危险因素,颅内动脉粥样硬化危险因素的分布存在部位特异性.Objective To investigate the risk factors for intracranial atherosclerosis in patients with ischemic stroke.Methods The demographic data and vascular risk factors in patients with ischemic stroke who performed digital subtraction angiography were analyzed retrospectively.According to the lesion locations,the patients with moderate to severe intracranial arterial stenosis were divided into intracranial internal carotid artery,middle cerebral artery,intracranial vertebral artery,and basilar artery.The démographic data and vascular risk factors among all groups were compared.Results A total of 344 patients with ischemic stroke were recruited,147 （42.7% ） of them were moderate to severe intracranial arterial stenosis and 197 （57.3% ） were mild intracranial arterial stenosis.Univariate analysis showed that the proportion of diabetes （34.0% vs.20.8%,x2 =7.541,P=0.006） or hyperlipidemia （78.9% vs.66.0%,x2 =6.900,P=0.009） in the moderate to severe intracranial arterial stenosis groups was significantly higher than that in the mild intracranial arterial stenosis group.The levels of total cholesterol （4.656 ±0.955 mmol/L vs.4.401 ±0.882 mmol/L,t =-2.543,P =0.011）,low-density lipoprotein cholesterol （3.015 ± 0.817 mmol/L vs.2.741 ± 0.786 mmol/L,t =-3.113,P =0.002）,fasting blood glucose （FBG） （6.184 ± 2.127 mmol/L vs.5.568 ±1.772 mmol/L,t =-2.869,P =0.004）,and the National Institutes of Health Stroke Scale score （5.48 ± 4.980 vs.4.33 ± 4.094,t =-2.332,P =0.020） were significantly higher.Multivariable logistic regression analysis showed that diabetes （odds ratio [ OR ] 1.907,95%confidence interval [ CI] 1.164-3.124; P =0.010） and low-density lipoprotein cholesterol （OR 1.500,95% CI 1.133-1.986; P =0.005） were the independent risk factors for moderate to severe intracranial arterial stenosis.Among the patients with different locations of intracranial arteries,there were significant differences in the distribution of the risk factors,such as male （P =0.017）,coronary arter

关 键 词：颅内动脉硬化 卒中 脑缺血 危险因素 血管造影术 数字减影 

分 类 号：R743.3[医药卫生—神经病学与精神病学]