伴白质疏松的脑梗死患者相关危险因素分析

Analysis of related risk factors in patients of cerebral infarction with leukoaraiosis

目的分析伴白质疏松（LA）脑梗死患者的相关危险因素，探讨其发病机制。方法回顾性分析216例急性脑梗死患者的临床资料，根据头部CT或MRI表现，将其分为伴LA组（43例）和不伴LA组（173例），比较两组患者脑血管病的危险因素、梗死部位和大小、病变血管及侧支循环情况。结果①Logistic回归分析显示，前循环病变（OR=7．165；95％CI：3．072～16．714）、高血压（OR：3．135；95％CI：1．090—9．013）、高龄（OR=1．119；95％CI：1．067—1．174）是伴LA脑梗死患者的独立危险因素。②43例伴LA组患者中，梗死部位在基底核或皮质下白质的有27例（62．8％），腔隙性脑梗死为18例（41．9％）；173例不伴LA组中，以上两种梗死分别为46例（26．6％）和18例（10．4％），两组比较差异均有统计学意义（P=0．000）。③伴LA组前循环病变的有27例，不伴LA组为41例（Х^2=7．890，P〈0.05）。伴LA组有6例（22.2％）发生大脑前动脉病变，血管闭塞12例（44．4％）；不伴LA组无大脑前动脉病变（P=0．003），血管闭塞的有37例（90．2％），两组比较P〈0．01。两组侧支循环开放率差异均无统计学意义。结论脑小血管及前循环病变是伴LA脑梗死患者发病的病理生理学基础。

Objective To analyze the related risk factors in patients of cerebral infarction with leukoaraiosis and to investigate their pathogenesis. Methods The clinical data of 216 patients with acute cerebral infarction were analyzed retrospectively. The patients were divided into a cerebral infarction with leukoaraiosis group （n =43 ） and a cerebral infarction without leukoaraiosis group （n = 173 ） according to brain CT or magnetic resonance imaging （MRI） findings. The risk factors for cerebrovascular diseases, the location and size of cerebral infarction, and the diseased vessels and collateral circulation were compared between the two groups. Results ①Logistic regression analysis showed that anterior circulation lesion （0177. 165; 95% CI3.072 to 16.714）, hypertension （OR 3. 135; 95% CI 1.090 to 9.013） and advanced age （ OR 1.119 ; 95% CI 1. 067 to 1. 174） were the independent risk factors for patients of cerebral infarction with leukoaraiosis. ②Among the 43 patients in the cerebral infarction with leukoaraiosis group, the infarctions of 27 patients （62. 8% ） were in the basal ganglia or subcortical white matter, and 18 patients （41.9%） had lacunar infarction; 173 patients in the cerebral infarction without leukoaraiosis group were 46 （26. 6% ） and 18 （ 10. 4% ）, respectively, and there were significant differences between the 2 groups （P =0. 000）.③Twenty-seven and 41 patients had anterior circulation lesions in both groups （X^2 = 7. 890 ,P 〈0.05）. Six patients （22.2%） developed anterior circulation lesions and 12（44. 4% ） had vascular occlusion in the cerebral infarction with leukoaraiosis group ; there was no anterior circulation lesion （P =0. 003）, and 37 patients had vascular occlusion （90. 2% ） in the cerebral infarction without leukoaraiosis group, there were significant differences between the 2 groups （P 〈0. 01 ）. The pateney rate of collateral circulation had no significant difference between the 2 groups. Condusion Small cerebral-vessel and anterior circulation lesions are the pathophysiological basis of the patients of cerebral infarction with leukoaraiosis.