复发性脑梗死的危险因素及病因学分析

Risk factors for recurrent cerebral infarction and its etiology

目的通过对复发性脑梗死(recurrent cerebral infarction,RCI)与初发性脑梗死(first cerebral infarction,FCI)的危险因素、TOAST分型及病变血管特征进行分析,探讨RCI患者的病因特点。方法提取南京脑卒中注册系统中RCI患者110例为RCI组,同时提取同期FCI患者317例为FCI组;记录患者的一般临床资料,按TOAST分型标准进行分类;通过数字减影血管造影、CT血管造影、磁共振血管造影判断脑血管情况。结果 RCI组和FCI组高血压最为常见(68.2%vs 60.9%),RCI组高脂血症、短暂性脑缺血发作史明显高于FCI组(P<0.01)。RCI组和FCI组均以大动脉粥样硬化性脑梗死最常见(46.4%vs 54.9%)。RCI组不明原因脑梗死比例明显高于FCI组(10.0%vs 3.2%,P<0.01)。2组脑血管病变情况差异有统计学意义(P<0.01);进一步进行两两比较,RCI组脑血管无病变比例明显低于FCI组(9.8%vs 20.4%,P<0.05),狭窄比例明显高于FCI组(75.5%vs59.5%,P<0.01)。结论 RCI与FCI在TOAST分型各亚型的构成存在一定的差异,不明原因脑梗死在RCI中比例上升;血管影像学检查RCI发生血管病变的比例升高。

Objective To study the risk factors for recurrent cerebral infarction（RCI）and first cerebral infarction（FCI） and analyze the TOAST subtypes and the features of vascular lesions. Methods One hundred and ten RCI patients from Nanjing Cerebral Stroke Registry System served as a RCI group and 317 FCI patients served as a control group. Their general clinical data were recorded. The patients were classified following the TOAST criteria. Their cerebrovascular lesions were assessed by digital subtraction angiography, CT angiography, and magnetic resonance angiography, respectively. Results The incidence of hypertension was significantly higher in RCI group than in FCI group（68.2% vs 60.9%）. The incidence of hyperlipidemia and transient isehemic attack was also significantly higher in RCI group than in FCI group（P〈0.05）. The proportion of cerebral stroke due to large atherosclerosis and unknown reasons was significantly higher in RCI group than in FCI group（46. 4% vs 54. 9%,10. 0% vs 3. 2%,P〈0.01）. A significant difference was found in cerebrovascular lesions between the two groups（P〈0.01）. The proportion of lesion-free blood vessels was significantly lower whereas that of artery stenosis was significantly higher in RCI group than in FCI group（9.8% vs 20.4%,75.5% vs 59.5%,P〈0.05,P〈 0.01）. Conclusion TOAST subtypes of RCI and FCI are different. The proportion of RCI due to unknown reasons increases. Angiography can show a higher proportion of vascular lesions in RCI patients.