老年人的无症状脑梗塞

Cerebral silent infarction in the elderly

回顾性研究３７２例老年人无症状性脑梗塞（ＳＩ）的患病率、与脑卒中危险因素的关系及其临床意义，并与非老年人对照结果显示老年人的ＳＩ患病率为２２．０％（８２／３７２），其中无脑卒中史组为２１．７％（３２／１４２），首次卒中组为２２．５％（５０／２３０），各年龄组的ＳＩ患病率类似。有ＳＩ组较无ＳＩ组高血压和糖尿病患病率高，有ＳＩ组的冠状动脉供血不足及脑白质异常、血管周围间隙增宽的检出率较无ＳＩ组高。非老年人ＳＩ的患病率为１１．６％（２２／１９０），较老年组低。２３０例无卒中史老年人有ＳＩ组５０例中３年内５例发生短暂性脑缺血发作或有症状脑梗塞，而１８０例无ＳＩ组只有３例发生类似情况（Ｐ＜０．０１）。结论：老年人无卒中史和首次卒中患者中，ＳＩ的患病率为２２．０％，较非老年组高，ＳＩ与高血压病、糖尿病、冠状动脉供血不足以及脑白质异常和血管周围间隙增宽有关。无卒中史而有ＳＩ者发生短暂性脑缺血发作或症状性脑梗塞的可能性较无ＳＩ者大。

Objective:To study silent infarction(SI,i.e,cerebral infarction on CT or MRI without a related stroke history and neurological symptoms and signs)in elderly people with non stroke patients. Methods:The study was retropspective and included 230 non strok patients and 142 first ever stroke patients and compared with 190 non elderly patients. The correlation of SI with stroke risk factor and follow up stroke prevalence in non stroke patients were studied. Result:The prevalence of SI in patients with non stroke and first ever stroke was simillar at 22.0% in elderly(50 in 230 non stroke patients,21.7%;32 in first ever stroke patients,22.5%; P >0.05),and was significiently hogher than those of non elderly patients(11.6%,22 in 190, P <0.01),prevalence of the elderly group was simillar too(group aged 60 to 64,17.2%;65 to 27.5% ;70 to 74,19.0%;75 to 79, 24.1%;80 and over,21.4%; P >0.05).In elderly people the percentage pf hypertension was higher in non stroke and first-ever stroke patients with SI than those patients without SI( P <0.01),the percentage of diabetes mellitus was higher in non stroke with SI patients than those patients without SI ( P <0.05),the incidence rate of coronary insufficienct,leucoaraiosis and Virchow Robin space dilation was higher in first ever syroke patients with SI than those patients without SI( P <0.01),Other risk factors suck as hyperlipima,atrial fibrillation and myocardiac infarction in non stroke and first ever stroke with or without SI was simillar( P >0.05).In elderly,the TIA or symptomatis cerebral infarction occured in 5 patients among 50 non stroke with SI patients(10.0%), whereas 3 patients among 180 non stroke without S1(1.7%)( P <0.01)in period of 3 years after first CT scan and MRI. Conclusion:This study shows that silents infarctions in elderly patients was associated with hypertension,coronary insuificantly leucoaraiosis and virchow Robim space obilation, The prevalence of S1 was significantly higher in elderly people than that in non stroke people. The possibility of occurrence of TIA and symptomatic infarction in non stroke with SI patients may be increased.