脑梗死伴颅内动脉粥样硬化性狭窄的影响因素分析  

Influencing factors of intracranial artery atherosclerotic stenosis in patients with cerebral infarction

作　　者：朱振国[1] 黄艳君[2] 陈艳艳[1] 殷为勇[1] 叶祖森[1] 林源绍[1] 邵蓓[1] 

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妇产科,325000

出　　处：《浙江医学》2016年第13期1066-1068,1085,共4页Zhejiang Medical Journal

基　　金：国家自然科学基金资助项目(81301014);温州市科技计划项目(Y20140292)

摘　　要：目的探讨脑梗死伴颅内动脉粥样硬化性狭窄的影响因素。方法选取脑梗死住院患者464例,根据头颅MRA和颈部CEMRA结果分为单纯颅内动脉狭窄(ICAS)组199例、单纯颅外动脉狭窄(ECAS)组47例、颅内合并颅外动脉狭窄(IECAS)组113例和无颅内颅外动脉狭窄(NCAS)组105例;其中ICAS组颅内动脉狭窄率≥50%135例、<50%64例。测定与比较以上4组患者间血清TG、TC、LDL-C、HDL-C、载脂蛋白B(apo B)、载脂蛋白A1(apo A1)、尿酸(UA)和同型半胱氨酸(Hcy)等指标的差异,采用单因素分析和多因素logistic回归分析脑梗死伴颅内动脉粥样硬化性狭窄的影响因素。结果以上4组患者平均年龄,高血压、糖尿病患病情况,TC、LDL-C水平,apo A1、apo B、apo B/apo A方面比较,差异均有统计学意义(均P<0.05)。颅内外动脉狭窄分布显示,颅外血管病变以颈内动脉颅外段和椎动脉颅外段为主,颅内动脉病变以大脑中动脉和颈内动脉颅内段为主。多支颅内动脉狭窄患者的a p o B水平明显高于单支颅内动脉狭窄患者(P<0.05)。a p o B(OR=8.821)、a p o B/a p o A1(OR=10.149)和吸烟(OR=2.093)是脑梗死伴颅内动脉粥样硬化性狭窄的影响因素。结论 apo B、apo B/apo A1是颅内动脉粥样硬化性狭窄的独立危险因素,可能成为今后临床上筛查与治疗高危人群的靶点。Objective To investigate the influencing factors of intracranial artery atherosclerotic stenosis in patients with cerebral infarction.Methods Total 464 hospitalized patients with cerebral infarction were enrolled.All patients were examined by brain MRA and cervical CEMRA,and according the results patients were divided into four groups,intracranial arterial stenosis（ICAS） group（n=199）,extracranial arterial stenosis（ECAS） group（n=47）,intracranial and extracranial arterial stenosis（IECAS）group（n=113） and non- cranial arterial stenosis（NCAS） group（n =105）.The ICAS group was subdivide into two groups,moderate to severe intracranial arterial stenosis（grade≥50%,at least one vessel）（n=135） and mild intracranial arterial stenosis（grade50%）（n= 64）.Serum biochemicalmarkers,including TG,TC,LDL- C,HDL- C,apoB,apoAl,UA and Hcy were detected and compared,then influencing factors of intracranial artery atherosclerotic stenosis in patients with cerebral infarction were studied by univariate analysis and multiple logistic regression analysis.Results There were statistically significant differences among the four groups in the mean age,prevalence ofhypertension and diabetes mellitus,levelofTC,LDL- C,apoAl,apoB and apoB/apoA1 ratio（P〈0.05）.The extracranial stenosis was mainly located in extracranial internal carotid artery and extracranial vertebra artery,and the intracranial vascular lesions were mainly located in middle cerebral artery and internal carotid artery.Level of apoB in patients with multiple intracranial artery stenosis was much higher than that in patients with single intracranial artery stenosis（P〈0.05）.Multivariate regression showed that apoB（OR=8.821）,apoB/apoAl（OR=10.149） and smoking（OR=2.093） were influencing factors of intracanial artery atherosclerotic stenosis in patients with cerebral infarction.Conclusion The results suggest that apoB and apoB/apoA1 ratio are independent risk factors for intracranial arterial atherosclerotic stenosis,wh

关 键 词：脑梗死 颅内动脉粥样硬化性狭窄 载脂蛋白B 载脂蛋白A1 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]