大动脉粥样硬化性脑梗死不同发病机制的危险因素分析  

Risk factors for different pathogenic mechanisms of ischemic stroke due to large artery atheromatous sclerosis

作　　者：杜真真[1] 张灿飞[1] 汤媛媛[1] 马弯弯 贾小飞[1] 黄丽娜[1] 

机构地区：[1]河南科技大学第一附属医院神经内科,洛阳471003

出　　处：《中华老年心脑血管病杂志》2016年第4期394-397,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河南省科技攻关计划项目(132102310167)

摘　　要：目的探讨大动脉粥样硬化性脑梗死4种发病机制的危险因素。方法采用改良Org 10 172急性脑卒中治疗试验分型筛选大动脉粥样硬化性脑梗死患者176例,进一步确定其发病机制,记录患者的危险因素。分析各发病机制危险因素分布差异。结果176例患者中,载体动脉阻塞穿支动脉76例(43.2%)、动脉-动脉栓塞15例(8.5%)、低灌注/栓子清除下降47例(26.7%)和混合机制38例(21.6%),男性分别为(67.1%、53.3%、42.6%和47.4%)、高血压(59.2%、73.3%、74.5%和84.2%)、TIA或脑卒中史(35.5%、46.7%、66.0%和36.8%)、高脂血症(9.2%、40.0%、31.9%和15.8%)和入院时NIHSS评分(5.5分、10分、6分和12分)有显著差异(P<0.05)。载体动脉阻塞穿支动脉以轻度狭窄多见(P=0.000),低灌注/栓子清除下降以重度狭窄多见(P=0.004),混合机制以血管闭塞多见(P=0.001)。结论大动脉粥样硬化性脑梗死不同发病机制危险因素不尽相同,血管狭窄程度存在差异,在临床防治工作中应加以考虑。Objective To study the risk factors for 4pathogenic mechanisms of ischemic stroke due to large artery atheromatous sclerosis.Methods One hundred and seventy-six patients with ischemic stroke due to large artery atheromatous sclerosis were included in this study.The pathogenic mechanisms of ischemic stroke due to large artery atheromatous sclerosis were further observed with their risk factors recorded and analyzed.Results Of the 176 patients,76（43.2%）were diagnosed with parent artery occluding penetrating artery,15（8.5%）were diagnosed with artery-artery embolism,47（26.7%）were diagnosed with hypoperfusion and/or impaired emboli clearance,and 38（21.6%）were diagnosed with multiple pathogenic mechanisms.Males accounted for 67.1%,53.3%,42.6% and 47.4%,hypertension accounted for 59.2%,73.3%,74.5% and84.2%,TIA or ischemic stroke accounted for 35.5%,46.7%,66.0% and 36.8%,hyperlipidemia accounted for 9.2%,40.0%,31.9%and 15.8%,NIHSS score on admission was 5.5,10,6and 12（P〈0.05）.Mild stenosis was common in parent artery occluding penetrating artery（P=0.000）,severe stenosis was common in hypoperfusion and/or impaired emboli clearance（P=0.004）,vascular occlusion was common in multiple pathogenic mechanisms（P=0.001）.Conclusion Ischemic stroke due to large artery atheromatous sclerosis and vascular stenosis should be considered in their prevention and treatment because the risk factors for their pathogenic mechanisms are different.

关 键 词：动脉粥样硬化 脑梗死 高血压 高脂血症 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]