代谢综合征与皮质下缺血性血管病患者脑动脉狭窄的相关性  

Correlation between metabolic syndrome and cerebral artery stenosis in patients with subcortical ischemic vascular disease

作　　者：刘寒 夏禹 孙中武 Liu Han;Xia Yu;Sun Zhongwu(Department of Neurology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Neurology,the Forth Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]安徵医科大学第一附属医院神经内科,合肥230022 [2]安徽医科大学第四附属医院神经内科,合肥230000

出　　处：《国际脑血管病杂志》2019年第11期814-818,共5页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81771154);国家科技部国家重点研发计划(2016YFC1305900)。

摘　　要：目的探讨代谢综合征(metabolic syndrome,MetS)及各组分对皮质下缺血性血管病(subcortical ischemic vascular disease,SIVD)患者脑动脉狭窄的影响。方法回顾性纳入2017年6月至2019年5月期间安徽医科大学第一和第四附属医院神经内科收治的SIVD患者。应用NCEP-ATPⅢ标准诊断MetS,应用北美有症状颈动脉内膜切除术试验标准评价脑动脉狭窄程度。采用多变量logistic回归分析确定MetS与脑动脉狭窄的独立相关性。结果共纳入SIVD患者460例,男性289例(62.8%),女性171例(37.2%),年龄(72.7±4.787)岁;MetS组278例(60.4%),非MetS组182例(39.6%);脑动脉狭窄组279例(60.7%),非狭窄组181例(39.3%)。MetS组存在脑动脉狭窄的患者比例显著高于非MetS组(84.2%对24.7%;χ2=162.876,P<0.001)。其中,MetS组存在大脑中动脉、颈内动脉、椎动脉、基底动脉以及多组脑动脉狭窄的患者比例均显著高于非MetS组(P均<0.05),而且中度和重度脑动脉狭窄患者的构成比亦显著高于非MetS组(P均<0.05)。多变量logistic回归分析显示,校正既往卒中或短暂性脑缺血发作史、饮酒和低密度脂蛋白胆固醇水平等混杂因素后,MetS组分数量仍与脑动脉狭窄显著独立相关;随着MetS组分数量的增多,尤其是3个及3个以上,脑动脉狭窄的风险大增[2个组分:优势比(odds ratio,OR)4.573,95%可信区间(confidence interval,CI)1.388~15.068;3个组分:OR 452.450,95%CI 115.505~1772.310;4个组分:OR 452.503,95%CI 117.664~1740.191;5个组分:OR 411.356,95%CI 96.975~1744.911]。结论MetS是SIVD患者存在脑动脉狭窄的独立危险因素,而且两者的相关性随着MetS组分数量的增多而增强。Objective To investigate the effects of metabolic syndrome(MetS)and each component on cerebral artery stenosis in patients with subcortical ischemic vascular disease(SIVD).Methods From June 2017 to May 2019,patients with SIVD admitted to the Departments of Neurology,the First and Forth Affiliated Hospitals of Anhui Medical University were enrolled retrospectively.MetS was diagnosied using NCEP-ATP III criteria.The North American Symptomatic Carotid Endarterectomy Trial criteria were used to evaluate the degree of cerebral artery stenosis.Multivariate logistic regression analysis was used to determine the independent correlation between MetS and cerebral artery stenosis.Results A total of 460 patients with SIVD were enrolled,including 289 males(62.8%),171 females(37.2%),and age 72.7±4.787 years;278(60.4%)in the MetS group,182(39.6%)in the non-MetS group;and 279(60.7%)in the cerebral artery stenosis group,181(39.3%)in the non-stenotic group.The proportion of patients with cerebral artery stenosis in the MetS group was significantly higher than that in the non-MetS group(84.2%vs.24.7%;χ2=162.876,P<0.001).Among them,the proportions of patients with middle cerebral artery,internal carotid artery,vertebral artery,basal artery,and multiple cerebral artery stenosis in the MetS group were significantly higher than those in the non-MetS group(all P<0.05),and the proportion of patients with moderate and severe cerebral arterial stenosis was also significantly higher than that in the non-MetS group(all P<0.05).Multivariate logistic regression analysis showed that after adjusting for confounding factors such as previous stroke or transient ischemic attack history,alcohol consumption,and low-density lipoprotein cholesterol levels,there was still a significant independent correlation between the number of MetS components and cerebral arterial stenosis;with the number of MetS components increaseing,especially 3 or more,the risk of cerebral artery stenosis increased(2 components:odds ratio[OR]4.573,95%confidence interval[CI]1.3

关 键 词：卒中 腔隙 脑白质疏松 脑缺血 代谢综合征 颅内动脉硬化 颈动脉狭窄 脑血管造影术 体层摄影术 X线计算机 危险因素 

分 类 号：R74[医药卫生—神经病学与精神病学]