轻型缺血性脑卒中患者脑动脉狭窄及其相关因素

Cerebral artery stenosis in patients with minor ischemic stroke and its related factors

目的探讨轻型缺血性脑卒中(MIS)患者脑动脉狭窄(CAS)及其相关因素.方法选取2015年1月至2018年7月安徽医科大学第一附属医院神经内科住院的402例急性MIS患者(NIHSS评分≤5分)作为研究对象,急性期即行国立卫生研究院卒中量表(NIHSS)、卒中预测工具Ⅱ(SPI-Ⅱ)评分,调查血管危险因素,并通过头颈计算机断层扫描动脉造影(CTA)检测CAS情况,按动脉狭窄部位和程度将其分为颅内和/或颅外动脉狭窄,轻度、中度、重度狭窄或闭塞,按照年龄分为青年组(≤44岁)、中年组(45~59岁)、老年组(>59岁),对MIS伴CAS的血管危险因素进行统计学分析,并对SPI-Ⅱ评分与CAS程度进行相关分析.结果402例MIS中331例存在CAS(82.34%).颅内狭窄141例(42.60%),颅外狭窄77例(2326%),颅-内外狭窄113例(34.14%);轻度狭窄111例(33.53%),中度狭窄63例(19.03%),重度狭窄或闭塞157例(47.43%).青年组CAS25例(7.55%),中年组CAS107例(32.33%),老年组CAS199例(60.12%);中老年组颅内CAS233例,青年组颅内CAS21例.有无CAS两组血管危险因素的单因素Logistic回归分析发现,CAS组年龄、糖尿病史、高脂血症史、高同型半胱氨酸血症、收缩压、D)-二聚体显著升高,高密度脂蛋白胆固醇显著降低,差异有统计学意义(P<0.05).多因素Logistic同归分析发现,CAS组年龄、糖尿病史、高脂血症史、高同型半胱氨酸血症、D-二聚体显著升高,高密度脂蛋白胆固醇显著降低,差异有统计学意义[OR=1.053,95%CI(1.027-1.079),P<0.001;OR=2.418,95%CI(1.107-5.284),P=0.027;OR=2289,95%CI(1.204-4.353),P=0.012;OR=2.071,95%CI(1.129-3.796),P=0.O19;OR=3.446,95%CI(1.243-9.554),P=0.017;OR=0.358,95%CI(0.136-0.942),P=0037].中老年组颅内动脉狭窄所占比例显著高于青年组,差异有统计学意义(Х^2=4.261,P=0.039).SPI-Ⅱ评分与CAS程度有显著正相关(r=0.108,P=0.031).结论80%以上MIS患者存在CAS,以颅内血管狭窄为主;各年龄组CAS分布不同,以中老年组颅内动脉狭窄为主.MIS患者CAS危险因素除了年龄、血压、血糖、血脂外,同型半胱氨酸和D-二聚体亦值得关注.SPI-Ⅱ评分可能对预测MIS患者CAS有重要价值.

Objective To investigate cerebral artery stenosis(CAS)in patients with minor ischemic stroke(MIS)and its related factors.Methods A total of 402 patients with acute MIS(National Institutes of Health Stroke Scale[NIHSS]W5)who were hospitalized in the Department of Neurology,The First Affiliated Hospital of Anhui Medical University,from January 2015 to July 2018 were selected as study subjects.NIHSS and Stroke Prognosis InstrumentⅡ(SPI-Ⅱ)scores were evaluated for the patients in acute phase to investigate vascular risk factors,and the CAS condition was evaluated by head and neck computed tomography angiography.The patients were divided into intracranial and/or extracranial artery stenosis groups as well as mild,moderate,and severe stenosis or occlusion groups,according to the location and degree of arterial stenosis,and were divided into young(W44 years),middle-aged(45-59 years),and elderly(>59 years)groups according to the age.A statistical analysis was performed on vascular risk factors for pa tients with MIS and CAS,and a correlation analysis was performed on the association between SPI-Ⅱscore and CAS degree.Results CAS was found in 331(82.34%)out of 402 cases of MIS.Intracranial,extracranial,and intra-and extracranial stenosis were present in 141 cases(42.60%),77 cases(23.26%),and 113 cases(34.14%),respectively;mild,moderate,and severe stenosis or occlusion was present in 111 cases(33.53%),63 cases(19.03%),and 157 cases(47.43%),respectively.The young,middleaged,and elderly groups had 25 cases(7.55%),107 cases(32.33%),and 199 cases(60.12%)of CAS,respectively;the middleaged and elderly groups together had 233 cases of intracranial CAS,and the young group had 21 cases of intracranial CAS.A univariate logistic regression analysis based on presence or absence of vascular risk factors for CAS in either group revealed significantly increased age,proportion of patients with a history of diabetes,hyperlipidemia,or hyperhomocysteinemia,systolic blood pressure,and D-dimer level,but significantly reduced high-density lipoprotein cholesterol(HDL-C)level in the CAS group(P<0.05).A multivariate logistic regression analysis showed significantly increased age,proportion of patients with a history of diabetes,hyperlipidemia,or hyperhomocysteinemia,and D-dimer level,but significantly reduced HDL-C level in the CAS group(odds ratio[OR]=1.053,95%confidence interval[CI:1.027-1.079,P<0.001;OR=2.418,95%CI:1.107-5.284,0.027;OR=2.289,95%CI:1.204-4.353,P=0.012;OR=2.071,95%CI:1.129-3.796,P=0.019;OR=3.446,95%CI:1.243-9.554,P=0.017;OR=0.358,95%CI:0.136-0.942,P=0.037).The proportion of patients with intracranial artery stenosis was significantly higher in the middle-aged and elderly groups than in the young group(Х^2=4.261,P=0.039).There was a significantly positive correlation between SPI-II score and CAS degree(rs=0.108,P=0.031).Conclusions More than 80%of patients with MIS have CAS(mainly intracranial stenosis);the CAS distribution varies between different age groups,with intracranial artery stenosis as the dominant type identified in the middle-aged and elderly groups.In addition to indices such as age,blood pressure,blood glucose,and blood lipids,homocysteine and D-dimer are also noteworthy risk factors for CAS in patients with MIS.SPI-Ⅱscore may be of great value in predicting CAS in patients with MIS.