腔隙性脑卒中患者的脑血管反应性研究  

Cerebrovascular reactivity in patients with lacunar stroke

作　　者：陈方方[1] 胡霞[1] 张敏[2] 孔祥锋[1] 

机构地区：[1]新疆医科大学第五附属医院神经内科,新疆乌鲁木齐830011 [2]南京医科大学附属常州市第二人民医院神经内科,江苏常州213000

出　　处：《中华全科医学》2016年第8期1286-1288,1372,共4页Chinese Journal of General Practice

基　　金：2013年度新疆医科大学科研创新基金项目(XJC-2013183)

摘　　要：目的探讨腔隙性脑卒中患者的脑血管反应性及影响因素。方法连续选取自2014年1月—2015年1月新疆医科大学第五附属医院神经内科入院的急性腔隙性脑卒中患者75例,性别、年龄相匹配的健康对照60例患者,详细记录腔隙性脑卒中患者的一般临床资料及影像学特点,Fazekas量表对脑白质病变进行分级;并利用脑多普勒(transcranial doppler,TCD)屏气试验,计算腔隙性脑卒中患者及对照组患者基础脑血流速度(MFV)及屏气指数(BHI),进一步多因素分析影响腔隙性脑卒中患者BHI的相关临床因素。结果腔隙性脑卒中患者基础MFV[(56.5±8.9)cm/s]及BHI(1.09±0.18)分均低于对照组[MFV:(59.9±6.6)cm/s;BHI:(1.39±0.14)分],差异有统计学意义(P<0.05);在腔隙性脑卒中患者中,白质疏松等级与BHI评分呈负相关(r=-0.869,P<0.01),白质疏松等级越高,BHI评分越低;进一步多因素线性回归方程分析,将BHI为应变量,将吸烟、糖尿病、高血压、及白质疏松等级纳入方程,年龄(OR=-0.333,P<0.01)、白质疏松等级(OR=-0.583,P<0.01)是影响腔隙性脑卒中患者BHI的相关危险因素。结论腔隙性脑卒中患者脑血管反应性发生了严重的破坏,脑血流调节功能严重受损,白质病变越严重,损伤越重,年龄及白质疏松等级是影响腔隙性脑卒中脑血管反应性的相关危险因素。Objective To investigate the cerebral vasoreactivity in patients with lacunar stroke and influencing factors.Methods Total 75 cases of acute lacunar stroke were consecutive selected in our hospital between January,2014 and January,2015. Sixty healthy cases with matched age and sex were selected as control. Detailed clinical data and imaging features were recorded in patients with lacunar stroke. The degrees of leukoaraiosis were measured by Fazekas scale classification. The Mean flow velocity（ MFV） and breath holding index（ BHI） were calculated by the transcranial Doppler（ TCD） breath-holding test in patients with lacunar stroke and the control group. Further analysis of the influence of clinical related factors to BHI was performed in lacunar stroke patients. Results The based MFV[（ 56. 5 ± 8. 9） cm / s] and BHI（ 1. 09 ± 0. 18） were lower in lacunar stroke patients than those in the control group[MFV：（ 59. 9 ± 6. 6） cm / s;BHI： 1. 39 ± 0. 14 ],the difference was statistically significant（ P〈0. 05）; The degrees of leukoaraiosis was negatively correlated with BHI in lacunar stroke patients（ r =- 0. 869,P〈0. 01）. The lower the BHI score was correlated with the higher grades of Leukoaraiosis. The multivariate linear regression analysis showed that age（ OR =- 0. 333,P〈0. 01） and degree of leukoaraiosis（ OR =- 0. 583,P〈0. 01） were the risk factors for BHI in lacunar stroke patients. Conclusion The vascular reactivity in lacunar stroke patients is commonly severe destroyed,and cerebral blood flow regulation function is severely impaired; The more severe white matter damage,the more severe vasoreactivity injure. Age and grade of leukoaraiosis are risk factors for the cerebral vasoreactivity in patients with lacunar stroke.

关 键 词：腔隙性脑卒中 血管反应性 平均血流速度 屏气指数 

分 类 号：R743.3[医药卫生—神经病学与精神病学]