脑缺血患者血管狭窄分布及其危险因素：回顾性病例系列研究

Distribution of vascular stenosis cerebral ischemia： a retrospective and its risk factors in patients with case series study

目的探讨缺血性脑血管病患者脑动脉狭窄的分布特点及相关危险因素对狭窄分布的影响。方法回顾性分析接受主动脉弓及全脑血管造影的缺血性脑血管病患者的人口统计学资料和血管危险因素，根据病变部位将患者分为颅内病变组、颅外病变组和颅内外联合病变组，对各组问人口统计学资料和血管危险因素进行比较。结果共有1272例患者纳入分析，1028例（80．8％）存在脑动脉狭窄或闭塞，其中342例（33．3％）为颅内病变，330例（32．1％）为颅外病变，356例（34．6％）为颅内外联合病变。颅内病变组平均年龄显著低于另外两组（F=41．995，P=0．000）。各组间性别（X^2=10．602，P=0．005）、高血压（X^2=11．316，P=0．003）和糖尿病（X^2=13．465，P=0．001）的构成比存在显著性差异；不同年龄组颅内外血管狭窄分布存在显著性差异（P=0．000），青年组和中年组以颅内病变为主，老年组以颅内外联合病变多见。多变量logistic回归分析显示，年龄、高血压、糖尿病、短暂性脑缺血发作史与单纯颅内病变及颅内外联合病变有关，单纯颅外病变仅与高龄和高血压有关。1028例存在血管狭窄或闭塞的患者共累及血管2732支，其中前循环血管1759支（64．4％），后循环血管973支（35．6％），前循环轻、中和重度狭窄均以颈内动脉颅外段最多见，而闭塞以大脑中动脉最多见；后循环各种程度病变均以椎动脉颅外段最多见。结论不同部位脑血管病变患者在性别、年龄以及高血压和糖尿病的患病率方面存在显著差异；年龄、高血压、糖尿病和短暂性脑缺血发作史是脑动脉粥样硬化病变分布的独立预测因素。

Objective To investigate the effects of the distribution characteristics of cerebral artery stenosis and the associated risk factors in patients with ischemic cerebrovascular disease. Methods The demographic data and vascular risk factors in patients with ischemic cerebrovascular disease who performed aortic arch and cerebral angiography were analyzed retrospectively. The patients were divided into intraeranial lesion, entracranial lesion and extra- and intracranial lesion groups according to the lesion sites. The demographic data and vascular risk factors in all groups were compared. Results A total of 1 272 patients were enrolled, and 1 028 （80. 8%） had cerebral artery stenosis or occlusion, in which 342 （33.3%） were intracranial lesions, 330 （32. 1% ） were extracranial lesions, and 356 （34. 6% ） were extra- and intracranial lesions. The mean age of the intracranial lesion group was significantly lower than that of the other 2 goups （F = 41. 995, P = 0. 000）. There were significant differences in the constituent ratios of sex （X^2 = 10. 602, P = 0. 005）, hypertension （X^2= 11. 316,P =0. 003）, and diabetes （X^2 = 13. 465, P =0. 001） among all groups. There were significant differences in the distribution of extra- and intracranial artery stenosis among different age groups （P =0. 001）. lntracranlal lesions were mainly in the youth and middle-aged groups, and extra- and intracranial lesions in the old age group were more common. Multivariate logistic regression analysis showed that age, hypertension, diabetes and history of transient ischemic attack were associated with the simple intracranial lesions and extra- and intracranial lesions, and the simple extracranial lesions were only associated with advanced age and hypertension. The 1 028 patients with vascular stenosis or occlusion affected 2 732 vessels, including 1 759 vessels （64.4%） in anterior circulation and 973 （35.6%） in posterior circulation. The mild, moderate and severe stenosis in anterior circulation were most common in extraeranlal internal carotid artery, and the occlusion was most common in middle cerebral artery. The various degrees of lesions in posterior circulation were most common in extracranial internal carotid artery. Conclusions There were significant differences in patients with cerebrovascular lesions at different sites in sex, age, as well as in the incidences of hypertension and diabetes. Age, hypertension, diabetes and the history of transient ischemic attack were the independent predictive factors for the distribution of cerebral atherosclerotic lesions.