颈内动脉系统脑梗死患者早期代偿途径形成的影响因素  

Influencing factors of early compensation pathway formation in patients with cerebral infarction of internal carotid artery system

作　　者：贺兴友 黄朝阳[2] 王玉平[2] He Xingyou;Huang Zhaoyang;Wang Yuping(Department of Neurology,the First People's Hospital of Bijie,Bijie,Guizhou 551700,China)

机构地区：[1]贵州省毕节市第一人民医院神经内科,551700 [2]首都医科大学宣武医院神经内科

出　　处：《中国脑血管病杂志》2019年第4期187-191,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨颈内动脉系统脑梗死患者早期代偿途径形成的影响因素。方法回顾性连续纳入2016年2月至2018年3月贵州省毕节市第一人民医院神经内科收治的颈内动脉系统脑梗死患者88例,按侧支循环开放情况将其分为低度开放组(26例)和高度开放组(62例)。比较两组患者性别、年龄、吸烟史、饮酒史、高血压病、糖尿病、高脂血症、脑梗死家族史、颈内动脉狭窄程度、脑梗死体积、美国国立卫生研究院卒中量表(NIHSS)评分等的差异,并通过多因素Logistic回归分析筛选侧支循环高度开放的影响因素。两组患者出院3个月行门诊随访,比较其日常生活活动能力(ADL)量表评分。结果 (1)侧支循环低度开放组患者合并高血压病、糖尿病、高脂血症的比例高于高度开放组,组间差异均有统计学意义[80. 8%(21/26)比58. 1%(36/62),57. 7%(15/26)比14. 5%(9/62),96. 2%(25/26)比53. 2%(33/62);均P <0. 05];男性、年龄≥60岁及脑梗死家族史、吸烟史、饮酒史比例的组间差异均无统计学意义(均P> 0. 05)。(2)侧支循环低度开放组NIHSS评分、梗死灶体积均高于高度开放组,颈内动脉重度狭窄的比例低于高度开放组,组间差异均有统计学意义[(18±5)分比(10±3)分,89(46,145) mm^3比35(12,70) mm^3,42. 3%(11/26)比66. 1%(41/62);均P <0. 05]。发病至CTA时间的组间差异无统计学意义(P> 0. 05)。(3)以侧支循环高度开放为因变量,经变量筛选,将高血压病、糖尿病、颈内动脉重度狭窄进行多因素Logistic回归分析,结果显示,糖尿病是侧支循环高度开放的危险因素(OR=1. 361,95%CI 1. 277～2. 475,P=0. 032),颈内动脉重度狭窄是侧支循环高度开放的保护因素(OR=0. 614,95%CI 0. 513～0. 724,P=0. 027),高血压病与侧支循环开放程度无关(P> 0. 05)。(4)侧支循环低度开放组ADL量表评分低于高度开放组,组间差异有统计学意义[(51±15)分比(67±18)分,t=3. 746,P <0. 01]。结论颈内动脉系�Objective To investigate the influencing factors of early compensation pathway formation in patients with cerebral infarction of internal carotid artery system.Methods Eighty-eight consecutive patients with cerebral infarction in the internal carotid artery system admitted to the Department of Neurology,the First People's Hospital of Bijie,Guizhou Province from February 2016 to March 2018 were enrolled retrospectively.They were divided into low-open group ( n =26) and high-open group ( n =62) according to the degree of collateral circulation opening.The differences of sex,age,smoking history,drinking history,hypertension, diabetes,hyperlipidemia,family history of cerebral infarction,degree of internal carotid artery stenosis,volume of cerebral infarction,National Institutes of Health Stroke Scale (NIHSS) score in patients of the two groups were compared.Multivariate logistic regression analysis was used to screen the influencing factors of highly open collateral circulation.Outpatient follow-up was performed in the two groups of patients at 3 months after discharge.Their activities of daily living (ADL) scale scores were compared. Results (1) The proportion of hypertension,diabetes mellitus,and hyperlipidemia in the patients of the collateral circulation low- open group was higher than that in those of the collateral circulation high-open group,and the differences between groups were statistically significant (80.8%[21/26] vs .58.1%[36/62],57.7%[15/26] vs .14.5%[9/62],96.2%[25/26] vs .53.2%[33/62],all P <0.05).There was no significant difference in the proportion of male,age ≥60,family history of cerebral infarction,smoking history,and drinking history between the groups (all P >0.05).(2) The NIHSS score and infarct volume of the collateral circulation low-open group were higher than those of the high-open group,and the proportion of severe stenosis of internal carotid artery was lower than that of the high-open group ([18±5] vs .[10±3],89 [46 ,145]mm^3 vs .35 [12,70]mm^3,42.3%(11/26) vs .66.1%(41/62);all P <

关 键 词：侧支循环 颈内动脉 颈动脉狭窄 大脑梗塞 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]