伴有前后循环颅内动脉粥样硬化的缺血性卒中患者1年死亡和卒中复发的差异  

Difference of one year death and stroke recurrence in ischemic stroke patients with anterior and posterior circulation intracranial atherosclerosis

作　　者：濮月华[1] 邹昕颖[1] 王伊龙[1] 潘岳松[1] 向祥龙 苏霭欣[3] 梁慧康 赵性泉[1] 王春雪[2] 黄家星[3] 王拥军[1] 刘丽萍[1] Pu Yuehua;Zou Xinying;Wang Yilong;Pan Yuesong;Xiang Xianglong;Yannie Oi-yan Soo;Thomas Wai-hong Leung;Zhao Xingquan;Wang Chunxue;Lawrence Ka-sing Wong;Wang Yongjun;Liu Liping(Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050. China)

机构地区：[1]首都医科大学附属北京天坛医院神经内科,北京100050 [2]首都医科大学附属北京天坛医院神经精神医学与临床心理科,北京100050 [3]香港中文大学内科与药物治疗学系

出　　处：《中华医学杂志》2018年第7期502-507,共6页National Medical Journal of China

基　　金：北京市科技新星计划（Z161100004916104）

摘　　要：目的探讨伴有前循环和后循环颅内动脉粥样硬化狭窄或闭塞的缺血性卒中患者1年的死亡和卒中复发风险是否存在差异。方法在中国颅内动脉粥样硬化研究（2007年10月至2009年6月）的数据库中，剔除颅外动脉狭窄或闭塞的病例、头核磁弥散加权成像未见急性梗死灶的病例和颅内前后循环联合病变的病例，将患者分为无明显颅内动脉病变组（n=964）、前循环动脉病变组（n=440）、后循环动脉病变组（n=233）。预后评估指标为发病后1年内任何原因所致的死亡、卒中复发。结果在纳入分析的1637例患者中，1年随访结果显示，任何原因所致死亡30例，卒中复发58例。与无明显颅内动脉病变组相比，前循环动脉病变组和后循环动脉病变组校正后的死亡风险比（95％可信区间）分别为1．349（0．311～5．851）、4．542（1．227～16．813）；卒中复发分别为1．663（0．620～4．460）、2．464（0．935—6．493）。结论伴有后循环颅内动脉粥样硬化的缺血性卒中患者1年死亡风险高于前循环者，而前后循环动脉病变卒中复发风险差异有待进一步评估。Objective To explore the differences of one year death and stroke recurrence between ischemic stroke patients with intracranial atherosclerotic stenosis or occlusion of anterior circulation and those of posterior circulation. Methods All the patients were from the Chinese Intracranial Atherosclerosis Study （CICAS） , between October 2007 and June 2009; patients with extracranial stenosis or occlusion, patients without acute infarction by diffusion weighted image, and patients with intraeranial atherosclerosis of both anterior and posterior circulation were excluded. All the enrolled patients were divided into three groups：no significant intraeranial atherosclerosis group （n = 964） , anterior circulation intraeranial atherosclerosis group （ n = 440 ） , posterior circulation intraeranial atherosclerosis group （ n = 233 ） . One year outcome was evaluated by any cause of death and stroke recurrence. Results Of the 1 637 patients, 30 cases were died and 58 cases had stroke recurrence within one year. Compared with ：no significant intracranial atherosclerosis group, adjusted hazard ratio （95% confidence interval） of one-year death for anterior and posterior circulation intracranial atherosclerosis group were 1. 349 （0. 311 - 5. 851 ）, 4. 542 （ 1. 227 - 16. 813 ）, respectively. Adjusted hazard ratio （ 95% confidence interval ） of one year stroke recurrence were 1. 663 （0. 620 - 4. 460） and 2. 464 （0. 935 - 6. 493 ）, respectively. Conclusions Ischemic stroke patients with intracranial atherosclerosis of posterior circulation has higher risk of one year death. One year stroke recurrence risk for patients with intracranial atherosclerosis of anterior and posterior circulation needs to be further evaluated.

关 键 词：缺血性卒中 颅内动脉粥样硬化 预后 卒中复发 

分 类 号：R743.3[医药卫生—神经病学与精神病学]