脑梗死患者动脉粥样硬化性肾动脉狭窄与脑供血动脉狭窄的关系  

Relationship between atherosclerotic renal artery stenosis and cerebral blood supply artery stenosis in patients with cerebral infarction

作　　者：叶强[1] 杨学志[1] 叶祖森[1] 殷为勇[1] 程建华[1] 范良好[2] 伍晓扬[2] 

机构地区：[1]温州医科大学附属第一医院神经内科,325000 [2]温州医科大学附属第一医院介入科,325000

出　　处：《中国医师进修杂志》2016年第3期254-257,共4页Chinese Journal of Postgraduates of Medicine

基　　金：温州市科技局公益性科技计划项目（Y20140537）

摘　　要：目的探讨脑梗死患者动脉粥样硬化性肾动脉狭窄（ARAS）的发生率、ARAS与动脉粥样硬化性脑供血动脉狭窄的关系以及ARAS的危险因素。方法选取脑梗死患者1650例，均行脑血管及肾动脉数字减影血管造影（DSA），统计ARAS发生率，观察脑供血动脉狭窄程度和数量，分析其与ARAS的关系；记录人口学特征及常见动脉粥样硬化危险因素，进行ARAS危险因素分析。结果ARAS发生率为12．8％（211／1650）；1423例存在动脉粥样硬化性脑供血动脉狭窄，其中轻度狭窄192例，中度狭窄421例，重度狭窄及闭塞810例；1支血管狭窄452例，2支血管狭窄662例，≥3支血管狭窄309例。脑供血动脉中度血管狭窄患者、重度血管狭窄及闭塞患者ARAS发生率明显高于无血管狭窄患者和轻度血管狭窄患者[8．6％（36／421）、19．8％（160／810）比3．1％（7／227）、4.2％（8／192）]，而重度血管狭窄及闭塞患者ARAS发生率明显高于中度血管狭窄患者，差异有统计学意义（P〈0．05）；轻度血管狭窄患者与无血管狭窄患者ARAS发生率比较差异无统计学意义（P〉0．05）。2支血管狭窄患者、≥3支血管狭窄患者ARAS发生率明显高于无狭窄患者和1支血管狭窄患者[15．3％（101／662）、21．7％（67／309）比3．1％（7／227）、8．0％（36／452）]，≥3支血管狭窄患者ARAS发生率明显高于2支血管狭窄患者，1支血管狭窄患者ARAS发生率明显高于无血管狭窄患者，差异有统计学意义（P〈0．05）。ARAS患者年龄、高血压、嗜烟率、脑供血动脉≥中度血管狭窄和≥2支血管狭窄率均明显高于无ARAS患者[（67．5±12．5）岁比（63．1±11．1）岁、67．3％（142／211）比58．9％（847／1439）、53．1％（112／211）比45．1％（649／1439）、92．9％（196／211）比71．9％（1035／1439）、79．6％（168／211）比55．8％（803／1439）]，差异有统计�Objective To investigate the incidence of atheroselerotic renal artery stenosis （ARAS）, the relationship between ARAS and cerebral artery stenosis, and the risk of ARAS in patients with brain infarction. Methods The clinical data of 1 650 brain infarction patients were analyzed, which were carried out digital subtraction angiography（DSA） of cerebral and renal artery.The incidence of ARAS was counted out, and the relationship was analyzed between the different degree and number of cerebralartery stenosis and the rate of RAS. The demographic characteristics and the common risk factors of atherosclerosis were recorded, and the risk factors of ARAS were analyzed. Results The rate of ARAS in moderate stenosis group and severe stenosis and occlusion group of cerebral artery were all significantly higher than that in mild stenosis group and no stenosis group （all P 〈 0.01）. The rates of ARAS in severe stenosis and occlusion group were significantly significantly higher than those in moderate stenosis group （P 〈 0.01）. The rates of ARAS in 2 branch stenosis group and ≥3 branch stenosis group were both significantly higher than those in no stenosis group and 1 branch stenosis group （P 〈 0.01）. The rates of ARAS of ≥3 branch stenosis group were significantly higher than those in 2 branch stenosis group （P 〈 0.05）. The rate of ARAS of 1 branch stenosis group were significantly higher than those in no stenosis group （P 〈 0.05）. Age, hypertension, moderate or more artery stenosis or occlusion, and≥2 branch stenosis was independent risk factor of ARAS. Conclusions The incidence of ARAS increasesd with the increase of the degree of cerebral artery stenosis and the number of branch involved.Older age, hypertension, moderate or more artery stenosis or occlusion, and/〉 2 branch stenosis is risk factor for ARAS.

关 键 词：脑梗塞 动脉粥样硬化性 肾动脉梗阻 回顾性研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]