椎基底动脉系统多发重度动脉粥样硬化AIS患者的预后分析  

The prognosis of the acute ischemic stroke patients with multiple severe atherosclerosis in vertebral basilar system

作　　者：史晓曼 王斌斌[1] 杨鹏 赵盼娣 李桐 霍颖浩[1] 张彤[1] 李培芳 闫佳佳 郭力[1] 刘晓云[1] Shi Xiaoman;Wang Binbin;Yang Peng;Zhao Pandi;Li Tong;Huo Yinghao;Zhang Tong;Li Peifang;Yan Jiajia;Guo Li;Liu Xiaoyun(Department of Neurology,the Second Hospital,Heibei Medical University,Shijazhuang 050o00,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000 [2]河北大学附属医院神经内科 [3]河北省第八人民医院神经内科 [4]邯郸市中心医院 [5]沧州中西医结合医院

出　　处：《脑与神经疾病杂志》2022年第9期529-534,共6页Journal of Brain and Nervous Diseases

基　　金：河北省重点研发项目(20377701D);河北省自然科学基金(H2021206206)。

摘　　要：目的 研究椎基底动脉系统(VBS)多发重度动脉粥样硬化急性缺血性脑卒中(AIS)患者的预后和死亡率的相关因素。方法 分析了144例被诊断为VBS多发重度动脉粥样硬化AIS患者,通过头颅MRA和(或)CTA发现VBS主干动脉狭窄≥70%且狭窄主干动脉根数≥2支,利用二元Logistic回归分析研究其预后相关因素,并对其3个月的复发率及死亡率进行随访。结果 144例VBS多发重度动脉粥样硬化AIS患者中,男性多于女性(77.1%vs 22.9%),其中高血压患者84%,高脂血症患者69.4%。95.1%的患者同时存在多种危险因素。肢体瘫痪和眩晕是最常见的临床症状。65.3%患者存在多发梗死部位,主要分布在脑桥(52.8%)和小脑(38.9%)。多因素分析显示,高同型半胱氨酸血症(Hhcy)(P=0.012)、肢体瘫痪(P=0.008)及并发症(P=0.005)是此类患者预后不良的独立预测因子。经过约3个月的随访调查,发现Hhcy是此类患者死亡的独立危险因素(OR:3.175 1.083~9.309,P=0.035)。抗血小板+他汀类药物联合丁苯酞软胶囊(NBP)治疗与该类患者的死亡率降低明显相关(OR:0.076 0.027~0.215,P<0.001)。结论对VBS多发重度动脉粥样硬化AIS患者,应该更加关注血Hcy水平,防治并发症,另外,抗血小板+他汀类药物联合丁苯酞软胶囊(NBP)治疗对降低此类患者三个月的死亡率可能起到积极的作用。Objective To investigate the related factors of prognosis and mortality of the acute ischemic stroke(AIS) patients with multiple severe atherosclerosis in vertebral basilar system(VBS).Methods We retrospectively analyzed 144 patients who were diagnosed as AIS with multiple severe atherosclerosis in VBS(70%or more stenosis were founded in two or more major arteries in VBS by cranial MRA and(or) CTA).The clinical manifestation and prognosis were investigated,furthermore,followed-up investigation was performed to identify the recurrence rate and mortality during about 3 months after stroke.We analyzed the prognosis,recurrent,and mortality factors of patients with AIS with multiple severe atherosclerosis in VBS using binary Logistic regression analysis.Results In 144 ischemic stroke patients with multiple severe atherosclerosis in VBS,males were more than females(77.1% versus 22.9%),84% patients had hypertension and 69.4% patients had hyperlipidemia.95.1% patients had multiple risk factors,and this ratio was much higher than the previous posterior circulation studies.Limb paralysis and dizziness were the most common clinical symptoms.65.3% patients had multiple infarct sites,mainly in pons(52.8%)and cerebellum(38.9%).Multivariate analysis showed that hyperhomocysteinemia(P=0.012),limb paralysis(P=0.008)and complications(P=0.005) were independent predictors of poor prognosis of such patients.After about 3 months follow-up investigation,we found that hyperhomocysteinemia(Hhcy) was the only independent risk factor for death(OR:3.175 1.083-9.309,P=0.035).Antiplatelet and statin combined with butylphthalide(NBP) could significantly reduce the mortality of such patients(OR:0.076 0.027-0.215,P<0.001).Conclusions For AIS patients with multiple severe atherosclerosis in VBS,lowering blood homocysteine,preventing and treating complications,combined with NBP therapy may play a positive role in improving the prognosis.

关 键 词：急性缺血性脑卒中 椎基底动脉系统 动脉粥样硬化 高同型半胱氨酸血症 死亡率 预后 丁苯酞 

分 类 号：R743.34[医药卫生—神经病学与精神病学]