急性脑梗死患者脑侧支循环形成的相关因素分析  

Analysis of related factors of cerebral collateral circulation in patients with acute cerebral infarction

作　　者：张娜 张广波 殷小芳 于凯 冀瑞俊[2] Zhang Na;Zhang Guangbo;Yin Xiaofang;Yu Kai;Ji Ruijun(Department of Neurology,Renqiu Kangji Xintu Hospital,Renqiu 062550,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]任丘康济新图医院神经内科,任丘062550 [2]首都医科大学附属北京天坛医院神经内科,北京100070

出　　处：《中国医师进修杂志》2023年第12期1067-1071,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨急性脑梗死(ACI)患者脑侧支循环形成的相关因素。方法采用回顾性研究的方法将2014年1月至2018年11月任丘康济新图医院收治的4483例ACI住院患者作为研究对象,依据经颅多普勒超声(TCD)和CT血管造影(CTA)检查结果,以是否存在脑侧支循环开放分为有侧支循环组(154例)和无侧支循环组(4329例),对两组患者中影响脑侧支循环形成的相关因素进行统计分析。根据改良Rankin量表(mRS)评分标准,将患者出院时mRS评分0~1分为出院结局良好,mRS≥3分为出院结局不良,分析侧支循环开放与出院结局不良的关系。结果与无侧支循环组比较,年龄[67.00(61.00,73.00)岁比65.00(57.00,72.00)岁]、卒中史[52.59%(81/154)比32.08%(1389/4329)]、颈动脉狭窄[85.71%(132/154)比20.23%(876/4329)]、同型半胱氨酸(Hcy)[16.85(13.00,28.03)μmol/L比15.00(11.00,21.00)μmol/L],明显促进脑侧支循环形成,差异有统计学意义(P<0.05)。在校正混杂因素后,显示年龄(OR=0.97,95%CI 0.95~0.99)、卒中史(OR=1.60,95%CI 1.11~2.32)、颈动脉狭窄(OR=23.63,95%CI 14.64~38.11)和Hcy(OR=1.01,95%CI 1.00~1.02)是促进ACI患者脑侧支循环形成的独立因素(P<0.05),其中颈动脉狭窄为显著促进因素,OR值为23.63。受试者工作特征曲线分析发现建立的模型预测脑侧支循环开放的曲线下面积为0.869。4483例ACI患者中,出院结局不良798例(17.80%),其中有脑侧支循环形成18例(11.68%),无脑侧支循环形成780例(18.01%),提示有脑侧支循环组出院结局不良的发生率低(P<0.05),OR值为0.60,95%CI 0.36~0.99,说明脑侧支循环形成是ACI患者良好预后的促进因素。结论年龄、卒中史、颈动脉狭窄以及Hcy与ACI患者脑侧支循环形成相关,现有的模型可以有效预测ACI患者侧支循环的形成,并且脑侧支循环形成与ACI患者出院结局密切相关。Objective To investigate the related factors of cerebral collateral circulation in patients with acute cerebral infarction(ACI).Methods A retrospective study was conducted on 4483 inpatients with ACI admitted to the Renqiu Kangji Xintu Hospital from January 2014 to November 2018 were selected as the research subjects.According to transcranial Doppler(TCD)and CT angiography(CTA)examination results,they were divided into the group with collateral circulation(154 cases)and the group without collateral circulation(4329 cases)according to the presence of collateral circulation.The related factors affecting the formation of cerebral collateral circulation in the two groups were statistically analyzed.According to the Modified Rankin Scale(mRS)score,0-1 score was defined as good discharge outcome,and mRS≥3 scores was defined as bad discharge outcome.The relationship between collateral circulation opening and poor discharge outcome was analyzed.Results Compared with the group without collateral circulation,age:67.00(61.00,73.00)years vs.65.00(57.00,72.00)years,history of stroke:52.59%(81/154)vs.32.08%(1389/4329),carotid artery stenosis:85.71%(132/154)vs.20.23%(876/4329),homocysteine(Hcy):16.85(13.00,28.03)μmol/L vs.15.00(11.00,21.00)μmol/L,significantly promoted the formation of collateral circulation,and the differences were statistically significant(P<0.05).After adjusting for confounding factors,age(OR=0.97,95%CI 0.95-0.99),stroke history(OR=1.60,95%CI 1.11-2.32),carotid artery stenosis(OR=23.63,95%CI 14.64-38.11)and Hcy(OR=1.01,95%CI 1.00-1.02)were independent factors promoting the formation of cerebral collateral circulation in ACI patients(P<0.05),carotid artery stenosis was a significant promoting factor,OR value was 23.63.Receiver operating characteristic(ROC)curve analysis showed that the model predicted the area under the curve value of cerebral collateral circulation opening reached 0.869.Among 4483 ACI patients,798 cases(17.80%)had poor discharge outcome,including 18 cases(11.68%)with collateral circulati

关 键 词：脑梗死 侧支循环 颈动脉狭窄 同型半胱氨酸 

分 类 号：R743.33[医药卫生—神经病学与精神病学]