缺血性脑血管病患者颅内外大动脉狭窄的危险因素对比

Risk factors of extracranial and intracerebral artery stenosis in ischemic cerebrovascular disease

目的观察影响缺血性脑血管病（ischemiacerebrovaseulardisease，ICVD）患者颅内外动脉狭窄的危险因素。方法对458例ICVD患者行数字减影全脑血管造影（digitalsubtractionangiography，DSA）检查，根据有无颅内外大动脉狭窄将患者分为无狭窄组、颅内动脉狭窄组、颅外动脉狭窄组和颅内外动脉狭窄组；根据狭窄程度又分轻、中、重度狭窄。对其危险因素进行统计分析。结果无狭窄组94例、颅内动脉狭窄组132例（狭窄支数173，平均1．30±0．54）、颅外动脉狭窄组135例（狭窄支数237，平均1．76±0．88）、颅内外动脉狭窄组97例（狭窄支数282，平均2．91±0．97），颅内外动脉狭窄组狭窄支数〉颅外动脉支数〉颅内动脉支数，差异有统计学意义（P〈0．01）。轻、中和重度狭窄各定为1、2、3分，颅内、颅外和颅内外动脉狭窄组的狭窄分数为2．55±0．69、2．61±0．68和2．85±0．41，三组比较差异无统计学意义（P〉0．05）。多元逐步回归分析显示：与颅内动脉狭窄有关的危险因素为糖尿病（OR3．218，95％CI1．583～6．545）；与颅外动脉狭窄有关的危险因素为糖尿病（OR2．499，95％CI1．174～5．318）、年龄（OR1．030，95％CI1．006—1．053）；与颅内外动脉狭窄有关的危险因素为糖尿病（OR3．024，95％CI1．327～6．889）、年龄（OR1．049，95％CI1．015～1．083）和收缩压（OR1．017，95％CI1．003～1．031）。结论颅内外动脉狭窄组狭窄支数〉颅外动脉〉颅内动脉。糖尿病是颅内动脉狭窄的独立危险因素；糖尿病、年龄是颅外动脉狭窄的独立危险因素；糖尿病、年龄、收缩压是颅内外动脉狭窄的独立危险因素。危险因素越多，狭窄支数越多。

Objective To analyze the risk factors of extracranial and intracerebral artery stenosis in ischemie cerebrovascular disease （ICVD）. Methods By the digital subtraction angiography （DSA）, the 458 patients with ICVD were divided into the non - stenosis group, extracranial artery stenosis group, intracerebral artery stenosis group, extracranial - intracerebral artery stenosis group, and were divided into the slight, moderate and severe stenosis according to the degree of stenosis. The four groups＇ risk factors were contrasted. Results The non stenosis group were 94 cases, the intracerebral artery stenosis group were 132 cases[ stenosis branches 1＂73 ,mean （ 1.30 ±0.54） ] , the extracranial artery stenosis group were 135 cases [ stenosis branches 237, mean （ 1.76 ± 0.88 ） ] , the extracranial - intracerebral artery stenosis group were 97 cases [ stenosis branches 282, mean （ 2.91 ± 0. 97 ） ]. The extracranial - intracerebral artery stenosis group ＇s branches were 〉 the extracranial artery stenosis groups＇ branches 〉 the intracerebral artery stenosis group ＇s branches （ P 〈 0.01 ）. When the slight, moderate and severe stenosis were marked 1, 2 and 3, the scores of intracerebral artery stenosis group, extracranial artery stenosis group, and extracranial - intracerebral artery stenosis group were 2. 55 ± 0. 69, 2.61 ± 0.68, and 2.85 ± 0.41 respectively, there were no significant differences among three groups （P 〉 0.05 ）. Logistic regression analysis revealed that diabetes was significant predictors for intracerebral artery stenosis with a odds ratio （OR） of 3. 218 （95% CI 1. 583 - 6. 545 ）. Diabetes and age were significant predictors for extracranial artery stenosis with a OR of 2. 499 （95% CI 1. 17-5. 318 ） and 1. 030 （95 % CI 1. 006 - 1. 053 ） respectively. Diabetes, age and systolic blood pressure （SBP） were significant predictors for extracranial- intracerebral artery stenosis artery with a OR of 3. 024（95% CI 1. 327 - 6.889）, OR of 1. 049（95% CI 1. 015 - 1. 083） ,OR of 1. 017 （95% CI, 1. 003 - 1. 031） respectively. Conchtsion The extracranial - intracerebral artery stenosis group ＂s branches are 〉 the extracranial artery stenosis groupg branches 〉 the intracerebral artery stenosis groupg branches. Diabetes is significant predictors for intracerebral artery stenosis. Diabetes and age are significant predictors for extracranial artery stenosis. Diabetes, age and SBP are significant predictors for extracranial - intracerebral artery stenosis. The more risk factors are, the more stenosis branches are.