缺血性卒中住院患者脑颈动脉狭窄地域分布差异性的多中心研究  

Correlation between the distribution of cerebral artery stenosis and geographic variation in hospitalized patients with ischemic stroke: a multicenter registry study in China

作　　者：唐煜 华扬[1] 贾凌云[1] 邢英琦[2] 惠品晶[3] 孟璇[4] 于德林[5] 潘晓芳[6] 房亚兰[7] 宋彬彬[8] 吴春霞[9] 张春梅[10] 隋秀芳[11] 金友贺[12] 张京芬[13] 李建卫[14] 王凌[15] 穆玉明[16] 钟经馨[17] 朱榆红[18] 张恒 蔡晓宇[20] Tang Yu;Hua Yang;Jia Lingyun;Xing Yingqi;Hui Pinjing;Meng Xuan;Yu Delin;Pan Xiaofang;Fang Yalan;Song Binbin;Wu Chunxia;Zhang Chunmei;Sui Xiufang;Jin Youhe;Zhang Jingfen;Li Jianwei;Wang Ling;Mu Yuming;Zhong Jingxin;Zhu Yuhong;Zhang Heng;Cai Xiaoyu(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;不详)

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053 [2]吉林大学第一医院神经内科和神经科学中心 [3]苏州大学附属第一医院神经外科-颈脑血管超声科 [4]兰州大学第二医院神经血管功能检查科 [5]天津市环湖医院超声科 [6]大连市中心医院超声科 [7]山西医科大学第一医院超声科 [8]洛阳市中心医院神经内科 [9]山东省聊城市人民医院脑科医院超声科 [10]哈尔滨医科大学附属第一医院超声科 [11]安徽省立医院超声科 [12]中国医科大学附属第一医院超声科 [13]包头市中心医院神经内科 [14]福建省立医院超声科 [15]四川省绵阳市中心医院超声科 [16]新疆医科大学第一附属医院超声科 [17]广东省中医院超声科 [18]昆明医科大学第二附属医院神经内科 [19]珠海市人民医院超声科 [20]湖南省脑科医院超声科

出　　处：《中国脑血管病杂志》2020年第6期308-314,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：国家卫生健康委员会脑卒中筛查与防治工程委员会[血管超声对短暂性脑缺血发作(TIA)与缺血性脑卒中住院患者颅内外动脉病变的多中心检查登记研究].

摘　　要：目的探讨中国南北方地区缺血性卒中患者脑、颈动脉狭窄闭塞性病变分布及危险因素的差异。方法回顾性连续纳入2015年6月至2016年5月全国20家国家卫健委脑卒中防治基地医院住院的缺血性卒中患者共9346例。联合应用颈动脉超声和经颅彩色多普勒超声/经颅多普勒超声评估颅内、外动脉狭窄程度,并经CT血管成像或MR血管成像验证。根据我国地理位置标准,将患者分为南方地区组和北方地区组,比较两组间脑、颈动脉病变分布特征及危险因素的差异性;根据患者是否存在脑、颈部动脉病变(≥50%狭窄,含闭塞)分为动脉病变组和无动脉病变组,对两组患者的基线资料及南北分布差异进行单因素及多因素Logistic回归分析,分析南北分布差异在脑、颈部动脉病变中的作用。结果9346例患者中,南方地区组2561例,北方地区组6785例。北方地区脑、颈部动脉中度及以上狭窄(≥50%狭窄,含闭塞)检出率显著高于南方地区[33.1%(2243/6785)比25.0%(639/2561),χ2=57.295,P<0.01]。除颈总动脉外,颈内动脉颅外段、椎动脉颅外段、锁骨下动脉、大脑中动脉、颈内动脉终末段、椎动脉颅内段、基底动脉中度及以上狭窄发生率北方地区均明显高于南方地区(均P<0.05)。南、北方地区组间动脉病变在颅内、颅外分布差异无统计学意义(χ2=2.790,P=0.248),均以单纯颅内动脉病变多见。南、北方地区患者动脉病变在前、后循环分布上差异有统计学意义(χ2=13.433,P=0.001),南方地区患者单纯前循环动脉病变占比明显高于北方地区患者[58.5%(374/639)比50.3%(1129/2243)],而北方地区患者单纯后循环动脉病变[27.2%(609/2243)比23.0%(147/639)]及前、后循环动脉联合病变占比[22.5%(505/2243)比18.5%(118/639)]均显著高于南方地区。9346例患者中,动脉病变组2882例,无动脉病变组6464例。多因素Logistic回归分析结果显示,高龄、男性、高血压病、糖�Objective To investigate the geographic variation in the distribution and risk factors of cerebral artery diseases in Chinese patients with ischemic stroke.Methods All 9346 continuously hospitalized patients with ischemic stroke in 20 hospitals from June 2015 to May 2016 were enrolled in this multicenter study,using carotid ultrasonography and transcranial color-coded sonography/transcranial doppler to evaluate the degree of extra-and intra-cranial arteries stenosis and verifying by CT angiography or magnetic resonance angiography.All patients were divided into the southern group and the northern group by the definition of the Huai River-Qinling Mountains line to compare the differences of the distribution and risk factors of cerebrovascular diseases.Meanwhile,all patients were divided into the lesion group(defined as the degree of stenosis more than 50%)and the non-lesion group according to the degree of stenosis to compare the differences of baseline data and geographic distribution of cerebrovascular diseases.Results The 2561 northern patients and 6785 northern patients were enrolled in the study.The proportion of patients with more than 50%degree of extra-and intra-cranial arteries stenosis was significantly higher in northern China than that in southern China(33.1%[2243/6785]vs.25.0%[639/2561],χ2=57.295,P<0.01).The proportions of northern patients with more than 50%degree of stenosis located in the extracranial segment of internal carotid artery,vertebral artery,subclavian artery,middle cerebral artery,the terminal segment of internal carotid artery,intracranial segment of the vertebral artery,and basilar artery were higher than those of southern patients(all P<0.05).The proportion of patients with intracranial artery stenosis was higher than that with extracranial arteries stenosis in both southern and northern patients(χ2=2.790,P=0.248).The distribution of arterial lesions in the anterior and posterior circulations was significantly different in southern and northern patients(χ2=13.433,P=0.001).The prop

关 键 词：超声检查 缺血性卒中 动脉狭窄 地域分布 

分 类 号：R743.3[医药卫生—神经病学与精神病学]