颅内动脉粥样硬化评分的建立及可行性研究  

Establishment and Feasibility Study of an Intracranial Atherosclerosis Scoring System

作　　者：常嫣格 宋焱[1,2] 于雪 黄娟 焦晟[1] 吴曙[1] 胡佳圆[1,2] 黄天琪 孙宇鹏 季福绥 Chang Yange;Song Yan;Yu Xue;Huang Juan;Jiao Sheng;Wu Shu;Hu Jiayuan;Huang Tianqi;Sun Yupeng;Ji Fusui(Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Graduate School of Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Peking University Fifth School of Clinical Medicine,Beijing 100730,China)

机构地区：[1]北京医院放射科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]中国医学科学院北京协和医学院研究生院,北京100730 [3]北京医院心血管内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [4]北京大学第五临床医学院,北京100730

出　　处：《中华老年医学杂志》2025年第4期477-483,共7页Chinese Journal of Geriatrics

基　　金：北京医院临床研究"领航"专项(BJ-2022-113);北京医院临床研究"助航"专项(BJ-2022-131)。

摘　　要：目的初步建立一种用于全面反映颅内动脉粥样硬化病变严重程度的评分体系,并探讨该评分与动脉粥样硬化危险因素以及脑梗死事件之间的相关性。方法回顾性分析2021年1月至2024年8月,在北京医院接受头颈计算机断层扫描血管成像(computer tomography angiography,CTA)检查,并在CTA检查前后1个月内进行了头部磁共振成像(magnetic resonance imaging,MRI)检查的患者。根据颅内血管狭窄的程度及数量构建颅内动脉粥样硬化评分(Intra Cranial Atherosclerosis Disease Score,ICADS)系统。根据ICADS的四分位数分组,探讨ICADS与动脉粥样硬化危险因素之间的关系。将入组患者分为急性脑梗死组、无急性脑梗死组,比较两组患者ICADS、脑血管病危险因素之间的差异,并探讨脑梗死事件与ICADS之间的相关性。结果不同ICADS组之间,高血压、糖尿病患者的比例具有统计学差异,多元线性回归分析显示高血压(B=1.17,95%CI:0.20~2.14,P<0.05)、糖尿病(B=2.75,95%CI:1.85~3.64,P<0.001)是ICADS较高的危险因素。急性脑梗死组的ICADS高于无急性脑梗死组(9分比6分,P<0.001),较高的ICADS是脑梗死的危险因素(OR=1.10,95%CI:1.07~1.14,P<0.001)。结论ICADS可以较为全面地反映颅内动脉粥样硬化病变严重程度,与脑梗死事件具有相关性,可以用于临床对脑梗死高危患者的筛查。Objective This study aims to initially establish a scoring system for comprehensively reflecting the severity of intracranial atherosclerotic lesions and to explore the correlation between this score and atherosclerotic risk factors as well as stroke events.Methods This study retrospectively analyzed patients who underwent head and neck computer tomography angiography(CTA)examinations and had head MRI examinations within one month before or after the CTA examination from January 2021 to August 2024 in Beijing Hospital.An intracranial atherosclerosis disease score(ICADS)system was constructed based on the degree and number of vascular stenosis.The relationship between ICADS and atherosclerotic risk factors was explored by grouping patients according to the quartile of ICADS.Patients were divided into acute stroke group and non-acute stroke group to compare differences in ICADS and cerebrovascular disease risk factors between the two groups,and to investigate the correlation between stroke events and ICADS.Results There were statistically significant differences in the proportions of patients with hypertension and diabetes among different ICADS groups.Multiple linear regression analysis showed that hypertension(B=1.17,95%CI:0.20-2.14,P<0.05)and diabetes(B=2.75,95%CI:1.85-3.64,P<0.001)were risk factors for higher ICADS.The ICADS was higher in the acute stroke group than in the non-acute stroke group(9 vs.6,P<0.001),and a higher ICADS was identified as a risk factor for stroke(OR=1.10,95%CI:1.07-1.14,P<0.001).Conclusions ICADS can comprehensively reflect the severity of intracranial atherosclerotic lesions and is correlated with stroke events,making it useful for clinical screening of high-risk patients for stroke.

关 键 词：颅内动脉硬化 脑梗死 脑血管造影术 

分 类 号：R743[医药卫生—神经病学与精神病学]