机构地区:[1]南京大学医学院临床学院南京军区南京总医院神经内科,210002 [2]南京大学医学院临床学院南京军区南京总医院医学影像科,210002
出 处:《中国脑血管病杂志》2014年第4期173-177,共5页Chinese Journal of Cerebrovascular Diseases
基 金:国家自然科学基金资助项目(81220108008;81070922);江苏省自然科学基金重点研究专项(BK2011021)
摘 要:目的探讨颈动脉钙化与缺血性卒中患者预后的关系。方法纳入南京卒中注册系统2009年12月—2012年10月登记的首发非心源性缺血性卒中患者522例。所有患者均接受头颈部CT血管成像(CTA)检查。CT平扫原始数据传入西门子工作站,采用相同的重建条件,应用Agat—stonCMciumScore系统进行钙化积分的测量。根据积分将患者分为无钙化(0分)、轻度钙化(0分〈积分〈100分)和重度钙化组(≥100分)。记录患者的临床基线资料,随访卒中后2年内主要终点事件(缺血性卒中、心肌梗死、血管性死亡)的发生情况。采用COX回归分析评价颈动脉钙化积分对主要终点事件的影响,应用Kaplan—Meier生存曲线分析不同钙化程度患者的预后情况。结果522例患者颈动脉钙化积分中位数为11.9分(四分位数:0,107.9分),其中无钙化组183例(35.1%),轻度钙化组200例(38.3%),重度钙化组139例(26.6%)。随访至2年时,共52例患者发生主要终点事件。多变量COX回归分析显示,年龄(HR=1.034,95%CI:1.006~1.062,P=0.017)、颈动脉钙化积分(HR=1.001,95%CI:1.000~1.001,P=0.037)是影响缺血性卒中预后的独立危险因素。Kaplan—Meier分析显示,无钙化组2年累积主要终点事件发生率为5.5%(10例),轻度组为9.7%(16例),重度组为15.0%(26例)。重度钙化组终点事件发生率明显高于无钙化组(HR=1.612,95%CI:1.106—2.350,P:0.013)。结论颈动脉钙化可能是缺血性卒中患者预后的重要影响因素。Objective To investigate the relationship between the carotid calcification and the prognosis in patients with ischemic stroke. Methods A total of 522 patients with non-cardiac ischemic stroke registered in the Nanjing Stroke Registry Program (NSRP) from December 2009 to October 2012 were enrolled. All patients underwent head and neck CT angiography (CTA). The original data of CT scan were transmitted into the Siemens workstation. Calcium score measurement was performed using the same reconstruction conditions and Agatston calcium score to measure calcification score. The patients were divided into no (0) ,mild (0 〈 score 〈 100) and severe calcification ( ≥ 100) groups according to their scores. The baseline clinical data of the patients were recorded. The occurrence of primary endpoint events within 2 years after stroke was followed up (ischemic stroke, myocardial infarction, and cardiovascular death). Multivariate COX regression analysis was used to evaluate the effect of carotid calcification score on the primary endpoint events. Kaplan-Meier survival curve was used to analyze the prognosis of patients with different degrees of calcification. Results The median carotid calcification score in 522 patients was 11.9 (quartiles:0,107.9) ,in which 183 (35.1%) were in the no calcification group,200 (38.3%) were in themild calcification group ,and 139 (26.6%) were in the severe calcification group. A total of 52 patients had a primary endpoint event at follow-up to 2 years. Multivariate COX regression analysis showed that age (HR, 1. 034,95% CI 1. 006 -1. 062;P = 0.017) and carotid artery calcification (HR, 1. 001,95% CI 1. 000 - 1. 001 ;P = 0. 037 ) were the independent risk factors for the prognosis of isehemie stroke. Kaplan-Meier analysis showed that the 2-year cumulative incidences of the primary endpoint events were 5.5% ( n = 10) ,9.7% (n = 16) , and 15. 0% ( n = 26 ) , respectively in the no, mild and severe calcification groups. The incidenc
分 类 号:R743.3[医药卫生—神经病学与精神病学]
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