责任动脉闭塞与夹层相关缺血性卒中复发的相关性分析  

Association of Artery Occlusion and Recurrent Ischemic Stroke Related with Cerebral Artery Dissection

作　　者：张一歌 张婉 张璐阳 王鑫[1] 丁澜 王玉莹 裴璐璐 方慧[1] 许予明[1] 宋波[1] ZHANG Yige;ZHANG Wan;ZHANG Luyang;WANG Xin;DING Lan;WANG Yuying;PEI Lulu;FANG Hui;XU Yuming;SONG Bo(Department of Neurology,The First Affiliated Hospital of Zhengzhou University,NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases,Henan Key Laboratory of Cerebrovascular Diseases,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经内科,国家卫生健康委脑血管病防治重点实验室(共建),河南省脑血管病重点实验室(郑州大学),郑州450052

出　　处：《中国卒中杂志》2022年第9期932-936,共5页Chinese Journal of Stroke

基　　金：河南省中青年卫生健康科技创新领军人才培养项目(YXKC2020019)。

摘　　要：目的寻找脑动脉夹层相关卒中复发的高风险影像学特征,探讨责任动脉闭塞与其复发的关系。方法前瞻性连续性纳入2018年1月-2022年2月在郑州大学第一附属医院住院的首发脑动脉夹层相关卒中患者,通过MRI、MRA、CTA、HR-MRI及DSA等影像学方法评估血管闭塞、长节段夹层等影像学特征,长期随访其复发情况。通过单因素、多因素COX回归分析其复发的影响因素,构建Kaplan-Meier生存曲线评估血管闭塞与脑动脉夹层相关卒中复发的关系。结果共纳入107例脑动脉夹层相关卒中患者,有10例(9.3%)患者复发。单因素及多因素COX回归分析提示,责任动脉闭塞是脑动脉夹层相关卒中复发患者预后不良的独立预测因子(HR 6.150,95%CI 1.227~30.810,P=0.027),出血转化也与脑动脉夹层相关卒中复发显著相关(HR 12.605,95%CI 2.373~66.949,P=0.003)。Kapl an-Meier生存曲线提示,闭塞组与非闭塞组卒中复发率差异具有统计学意义(Log-rank P=0.001)。结论责任动脉闭塞是脑动脉夹层相关卒中复发的危险因素,需要大样本研究进一步验证本研究结果,为二级预防提供更精准的帮助。Objective To investigate the relationship between culprit cerebral artery occlusion and cerebral artery dissection(CAD)-related stroke recurrence.Methods The patients with first CAD-related ischemic stroke who were admitted in the First Affiliated Hospital of Zhengzhou University from January 2018 to February 2022 were prospectively included in this study.CTA,MRA,HR-MRI,DSA and other imaging methods were used to evaluate the imaging characteristics of culprit cerebral artery occlusion and long-segment dissection;and the long-term imaging follow-up was performed to evaluate stroke recurrence.COX regression analysis was used to evaluate the risk factors of stroke recurrence,and Kaplan-Meier survival curve was constructed to evaluate the relationship between cerebral artery occlusion and CAD-related stroke recurrence.Results A total of 107 cases were included in the analysis,with stroke recurrence in 10 patients(9.7%).Cox regression analysis showed that culprit artery occlusion(HR 6.150,95%CI 1.227-30.810,P=0.027)and hemorrhagic transformation(HR 12.605,95%CI 2.373-66.949,P=0.003)were independent risk factors of CAD-related stroke recurrence.The Kaplan-Meier survival curve showed that there was statistical difference in stroke recurrence between artery occlusion and nonocclusion groups(Log-rank P=0.001).Conclusions Artery occlusion is a risk factor of CAD-related stroke recurrence.

关 键 词：脑动脉夹层 缺血性卒中 复发 危险因素 血管闭塞 

分 类 号：R743.3[医药卫生—神经病学与精神病学]