炎症对颅内外动脉重度狭窄或闭塞影响的临床研究

Clinical study on the effect of inflammation on severe stenosis or occlusion of intracranial and extracranial arteries

目的筛查颅内外动脉重度狭窄或闭塞的危险因素,探讨炎症对颅内外动脉狭窄或闭塞部位的影响。方法纳入2018年9月至2019年4月诊断与治疗的100例大动脉粥样硬化型急性缺血性卒中病例,测定血清超敏C-反应蛋白(hs-CRP)水平,参照北美症状性颈动脉内膜切除术试验标准判断颅内外动脉狭窄程度并分为重度狭窄/闭塞组或对照组以及不同亚组;单因素和多因素后退法Logistic回归分析筛查颅内外动脉重度狭窄或闭塞的危险因素。结果Logistic回归分析显示,糖尿病(OR=11.092,95%CI:2.288~53.774;P=0.003)和血清hs-CRP(OR=1.553,95%CI:1.184~2.036;P=0.001)是急性缺血性卒中患者颅内外动脉重度狭窄或闭塞的危险因素。亚组分析显示,颅内动脉病变(49例)、颅外动脉病变(11例)与颅内合并颅外动脉病变(12例;H=0.652,P=0.722),前循环病变(37例)、后循环病变(18例)与前循环合并后循环病变(17例;H=0.283,P=0.868),单支血管病变(41例)与多支血管病变(31例;Z=-0.530,P=0.596)各亚组患者血清hs-CRP水平差异均无统计学意义,不同责任血管病变亚组(大脑中动脉、大脑前动脉、大脑后动脉、基底动脉、椎动脉颅内段、颈内动脉颅内段、颈动脉颅外段、椎动脉颅外段、锁骨下动脉)患者血清hs-CRP水平升高比例差异亦无统计学意义(χ2=2.628,P=0.917)。结论血清hs-CRP可以作为颅内外动脉重度狭窄或闭塞的炎性预测因子。但炎症对颅内外动脉狭窄或闭塞部位和病变数目无明显影响,对不同血管的作用机制可能相似。

Objective To screen the risk factors for severe stenosis or occlusion of intracranial and extracranial arteries,and to explore the influence of inflammation on the location of intracranial and extracranial arteries stenosis or occlusion.Methods A total of 100 patients with acute ischemic stroke of large artery atherosclerosis(LAA)type from September 2018 to April 2019 were enrolled.Serum high sensitive C-reactive protein(hs-CRP)was measured by grains strengthen immunoturbidimetry.According to the standard of North American Symptomatic Carotid Endarterectomy Trial(NASCET),the patients were divided into severe stenosis/occlusion group and control group and then further divided into different subgroups.Univariate and multivariate backward Logistic regression analysis was used to screen the risk factors for intracranial and extracranial arteries stenosis or occlusion.Results Logistic regression analysis showed that diabetes mellitus(OR=11.092,95%CI:2.288-53.774;P=0.003)and serum hs-CRP(OR=1.553,95%CI:1.184-2.036;P=0.001)were risk factors for severe stenosis or occlusion of intracranial and extracranial arteries in patients with acute ischemic stroke.Subgroup analysis showed that there was no significant difference in serum hs-CRP in patients of intracranial artery subgroup(n=49),extracranial artery subgroup(n=11)and intracranial combined with extracranial artery subgroup(n=12;H=0.652,P=0.722);anterior circulation subgroup(n=37),posterior circulation subgroup(n=18)and anterior circulation combined with posterior circulation subgroup(n=17;H=0.283,P=0.868);single vessel subgroup(n=41)and multi-vessel subgroup(n=31;Z=-0.530,P=0.596).There was no significant difference in serum hsCRP in patients with different responsibility vascular stenosis/occlusion[middle cerebral artery(MCA),anterior cerebral artery(ACA),posterior cerebral artery(PCA),basilar artery(BA),intracranial segment of vertebral artery(VA),intracranial segment of internal carotid artery(ICA),extracranial segment of carotid artery,extracranial segment of VA and subclavian artery(SA);χ~2=2.628,P=0.917].Conclusions hsCRP may be an inflammatory predictor of cerebral artery stenosis or occlusion.But inflammation has no selective effect on the distribution and numbers of the cerebral vascular stenosis and may have similar effects on different cerebral arteries.