缺血性脑卒中/短暂性脑缺血发作患者脑动脉病变分布相关危险因素分析

Analysis on the corresponding risk factors of distribution for cerebrovascular disturbance in patients with ischemic stroke/transient ischemic attack

目的探讨缺血性脑卒中(ischemic stroke,IS)/短暂性脑缺血发作(transient ischemic attack,TIA)脑动脉病变分布的相关危险因素。方法对169例IS/TIA患者行颈部及颅内脑血管检查,记录血管病变危险因素如年龄、性别、高血压、糖尿病、长期吸烟、长期饮酒等病史,同时记录实验室、心电图、超声心动图、腹部B超、胸X片等检查结果。确定单变量与不同狭窄模式的相关性采用单变量Logistic回归分析,确定不同颅内外大动脉狭窄模式的独立危险因素采用多元逐步和多变量多项分类Logistic回归分析。结果高龄、长期吸烟及高低密度脂蛋白(LDL-C)是颅内外大动脉狭窄的独立危险因素,发生颅内外大动脉狭窄的风险分别增加了1.83、6.918、1.656倍;脑卒中史(OR=4.816)、长期吸烟(OR=121.608)、高LDL-C(OR=3.067)是单纯颅内大动脉狭窄的独立危险因素;高龄(OR=2.486)、长期吸烟(OR=25.072)、高LDL-C(OR=5.160)是颅内外大动脉狭窄并存的独立危险因素;而高纤维蛋白原(OR=4.790)是单纯颅外大动脉狭窄的独立危险因素。结论不同类型颅内外大动脉狭窄病变的独立危险因素不同。

Objective To explore the corresponding risk factors of distribution for cerebrovascular disturbance in patients with ischemic stroke/transient ischemic attack （TIA）. Methods To detect the carotid and intracranial arteries, record the risk factors such as age, gender, high blood pressure, diabetes, the history of long-term smoking and drinking, and the results of laboratory examination, electrocardiogram, echocardiography, abdominal ultrasound and chest x-ray. Adopting the Logistic regression analysis of univariate to confirm the correlation between the univariate and different stenotic models. Adopting multiple stepwise Logistic regression analysis and multivariate multiple Logistic regression analysis classification to confirm the independent risk factors in different intra-/extracranial large-arterial stenotic models. Results With multivariable Logistic regression analysis, older age, long-term smoking and high low density lipoprotein cholesterol level are the independent risk factors for intra-/extracranial large artery disturbance. Among above three risk factors, the risk of occuring intra-/extracranial large-artery stenosis respectively increased 1.83, 6. 918, 1. 656 times. For different narrow models, the stroke history （OR= 4. 816）, long-term smoking （OR= 121. 608）, high low density lipoprotein cholesterol level （OR= 3. 067） are independent risk factors for pure intracranial large-artery stenosis; older age （OR=2. 486）, long-term smoking （OR=25. 072）, high low density lipoprotein cholesterol level （OR 25. 160） are the independent risk factors for stenosis of intracranial and extracranial large artery together; and high fibrinogen （OR = 4. 790） is the independent risk factor for pure extracranial large-artery stenosis. Conclusions The independent risk factors for different model of intra/extracranial large-artery stenosis are different.