椎基底动脉延长扩张症与急性缺血性脑卒中患者预后的相关性  

Relationship between vertebrobasilar artery dolichoectasia and outcome in acute ischemic stroke patients

作　　者：刘宁 张高才 徐建可 张洪阳 韩新生 Liu Ning;Zhang Gaocai;Xu Jianke;Zhang Hongyang;Han Xinsheng(Department of Neurology,Kaifen Central Hospital,Kaifen 475000,Henan Province,China)

机构地区：[1]开封市中心医院神经内科,475000

出　　处：《中华老年心脑血管病杂志》2020年第8期793-796,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河南省科技发展计划项目(182102310445);开封市科技发展计划项目(1503073)。

摘　　要：目的探讨椎基底动脉延长扩张症(vertebrobasilar dolichoectasia,VBD)与急性缺血性脑卒中患者预后的关系。方法选择2015年12月~2019年6月开封市中心医院神经内科住院的急性缺血性脑卒中患者467例,依据影像标准分为VBD组37例,非VBD组430例。采用美国国立卫生研究院卒中量表(national institutes of health stroke,NIHSS)评分,综合评估患者患病的严重程度,其次行头颅CT、MRI、CT血管造影和数字减影血管造影等影像学检查,进一步评估颅内血管形态、结构等情况。根据发病后90 d改良的Rankin量表(modified Rankin scale,mRS)评分分为预后良好组386例(mRS评分≤3分预后良好)及预后不良组81例(mRS评分>3分预后不良)。采用SPSS 16.0统计软件分析患者流行病学特征、TOAST分型、血管危险因素、血管变异的情况和实验室检查结果,评估可能影响患者临床预后的相关因素。结果VBD组发病90 d转归良好28例,转归不良9例;非VBD组发病90 d转归良好358例,转归不良72例。随访期间VBD组死亡2例,再次非致死性脑梗死7例;非VBD组死亡11例,再次非致死性脑梗死61例。VBD组基线NIHSS评分和Hcy水平明显高于非VBD组,差异有统计学意义(P<0.01)。预后不良组基线NIHSS评分、高血压、高脂血症、脑梗死、Hcy和心房颤动比例明显高于预后良好组,差异有统计学意义(P<0.05,P<0.01)。多元logistic回归分析显示,Hcy是发生VBD的独立危险因素(OR=1.04,95%CI:1.01~1.08,P=0.005);VBD和基线NIHSS评分是急性缺血性脑卒中预后不良的独立危险因素(OR=2.75,95%CI:1.04~7.29,P=0.042;OR=1.54,95%CI:1.40~1.69,P=0.005)。结论VBD合并急性缺血性脑卒中患者早期预后差,VBD和基线NIHSS评分是急性缺血性脑卒中患者早期预后的独立预测因素;Hcy是VBD的独立预测因素。Objective To study the relationship between vertebrobasilar artery dolichoectasia(VBD)and outcome in acute ischemic stroke(AIS)patients.Methods Four hundred and sixty-seven AIS patients admitted to our hospital from December 2015 to June 2019 were divided into VBD group(n=37)and VBD-free group(n=430)according to the findings on their images.The severity of AIS patients was assessed according to their NIHSS score.The patients who underwent brain CT,MRI and CTA for further assessment of their vascular morphology and structure were divided into good outcome group or mRS score≤3 group(n=386)and poor outcome group or mRS score>3 group(n=81)on day 90 after onset of AIS.Their epidemiological characteristics,TOAST classification,vascular risk factors,vascular variation and laboratory testing parameters were analyzed using SPSS16.0 software and the relevant factors influencing their clinical outcome were assessed.Results The outcome was good in 28 patients of VBD group and poor in 9 patients of VBD-free group while the outcome was good in 358 patients of VBD group and poor in 72 patients of VBD-free group on day 90 after onset of AIS.Two patients died of VBD and 7 patients died of secondary non-fetal cerebral infarction in VBD group while 11 patients died of VBD and 61 patients died of secondary non-fetal cerebral infarction in VBD-free group during the follow-up period.The baseline NIHSS score and serum Hcy level were significantly higher in VBD group than in VBD-free group(P<0.01).The baseline NIHSS score and incidence of hypertension,hyperlipidemia,cerebral infarction were significantly higher while the incidence of AF was significantly lower in poor outcome group than in good outcome group(P<0.05,<0.01).Multivariate logistic regression analysis showed that serum Hcy level was the independent risk factor for VBD(OR=1.04,95%CI:1.01-1.08,P=0.005)while VBD and baseline NIHSS score were the risk factors for poor outcome in AIS patients(OR=2.75,95%CI:1.04-7.29,P=0.042;OR=1.54,95%CI:1.40-1.69,P=0.005).Conclusion The outcom

关 键 词：椎底动脉供血不足 卒中 血管造影术 数字减影 高血压 高脂血症 脑梗死 

分 类 号：R743.3[医药卫生—神经病学与精神病学]