颅内动脉粥样硬化性狭窄支架置入术后再发症状性脑梗死的危险因素分析  

Analysis of Risk Factors in Patients with Recurrent Symptomatic Cerebral Infarction after Stenting for Intracranial Atherosclerotic Stenosis

作　　者：汪洋 吴磊[2] 尹博文[1] 庞燕[1] WANG Yang;WU Lei;YIN Bowen;PANG Yan(Department of Neurology,Qinhuangdao First Hospital,Qinhuangdao 066000,China;Department of Neurosurgery,Qinhuangdao First Hospital,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院神经内科,河北秦皇岛066000 [2]秦皇岛市第一医院神经外科,河北秦皇岛066000

出　　处：《医学综述》2020年第18期3712-3716,共5页Medical Recapitulate

基　　金：秦皇岛市科学技术局项目(201602A136)。

摘　　要：目的分析颅内动脉粥样硬化性狭窄(ICAS)支架置入术后再发症状性脑梗死的危险因素。方法回顾性分析2014年1月至2017年1月秦皇岛市第一医院收治的108例ICAS患者的临床资料,所有患者均行支架置入术,按照术后是否再发症状性脑梗死分为两组,其中将术后18个月内再发症状性脑梗死患者作为观察组(n=32),将未发症状性脑梗死患者作为对照组(n=76)。比较两组患者的一般资料及血脂成分,包括三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白(Apo)A、ApoB和脂蛋白a[Lp(a)],采用多因素Logistic回归分析ICAS支架置入术后再发症状性脑梗死的危险因素。结果观察组患者吸烟、高血压、糖尿病、术前狭窄程度>70%及遗留有术后残余狭窄的比例高于对照组(P<0.05)。观察组的TG、LDL-C及Lp(a)水平显著高于对照组[(2.13±0.15)mmol/L比(1.52±0.15)mmol/L,(4.02±1.09)mmol/L比(2.78±0.77)mmol/L,(358±96)mmol/L比(235±87)mmol/L],HDL-C水平显著低于对照组[(1.17±0.30)mmol/L比(1.52±0.29)mmol/L](P<0.01)。经多因素Logistic回归分析结果显示,高血压、糖尿病、TG、HDL-C、LDL-C及Lp(a)是ICAS支架置入术后再发症状性脑梗死的危险因素(P<0.01)。结论TG、LDL-C及Lp(a)水平升高,HDL-C水平降低会增加ICAS支架置入术后再发症状性脑梗死的风险。Objective To analyze the risk factors of patients with symptomatic cerebral infarction after intracranial atherosclerotic stenosis(ICAS)stenting.Methods Retrospective analysis of 108 ICAS patients admitted to Qinhuangdao First Hospital from Jan.2014 to Jan.2017 was done,all the patients were treated with stent implantation,according to whether there was recurrence of symptomatic cerebral infarction they were divided into two groups,patients with recurrent symptomatic cerebral infarction within 18 months after operation as an observation group(n=32)and patients without symptomatic cerebral infarction as a control group(n=76).The general data,and the levels of serum lipids,including triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein(Apo)A,ApoB,and lipoprotein(a)[Lp(a)]of the two groups were compared.Risk factors for complicated cerebral infarction after ICAS stenting was analyzed by multivariate Logistic regression analysis.Results The proportions of smoking,hypertension,diabetes,preoperative stenosis>70%and the proportion of residual stenosis in the observation group were higher than those in the control group(P<0.05).The TG,LDL-C and Lp(a)levels in the observation group were significantly higher than those in the control group[(2.13±0.15)mmol/L vs(1.52±0.15)mmol/L,(4.02±1.09)mmol/L vs(2.78±0.77)mmol/L,(358±96)mmol/L vs(235±87)mmol/L],and the HDL-C level was significantly lower than that in the control group[(1.17±0.30)mmol/L vs(1.52±0.29)mmol/L](P<0.01).Multivariate Logistic regression analysis showed that hypertension,diabetes,TG,HDL-C,LDL-C and Lp(a)were risk factors for recurrent symptomatic cerebral infarction after ICAS stenting(P<0.01).Conclusion Elevated TG,LDL-C and LP(a)levels and reduced HDL-C levels increase the risk of syptomatic cerebral infarction after ICAS stenting.

关 键 词：颅内动脉粥样硬化性狭窄 再发症状性脑梗死 血清脂蛋白A 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]