粥样硬化性大脑中动脉狭窄合并内分水岭梗死的相关因素分析

Predictors of internal borderzone infarcts in atherosclerotic middle cerebral artery stenosis

目的：研究粥样硬化性大脑中动脉狭窄（ MCAS）合并内分水岭梗死（ IBZ）的独立预测因素。方法选取2008年1月至2014年3月福建医科大学附属协和医院和福建省立临床学院的粥样硬化性MCAS患者167例，收集人口学、粥样硬化危险因素、MCA狭窄程度、前向血流评分和侧支循环评分等临床和影像资料，并将患者分为“IBZ组”（55例）和“无IBZ组”（112例）；单变量分析比较两组的临床资料，将P＜0．1变量纳入多变量分析，分别建立包含前向血流评分或MCAS狭窄程度的两个Logistic回归模型。结果 MCAS患者共167例（ IBZ组55例，无IBZ组112例），平均年龄（54±12）岁。单变量分析显示血压偏低（P＝0．006）、MCA狭窄程度（P＝0．012）和前向血流评分（P＝0．003）差异有统计学意义，其他P＜0．1的变量有高血压病史（P＝0．055）和侧支循环评分（P＝0．067）。 Logistic回归模型Ⅰ包含前向血流评分（ OR 4．310，95％CI 1．698～10．869），高血压病史（OR 0．458，95％CI 0．224～0．936）和血压偏低（ OR 3．848，95％CI 1．345～7．983）；模型Ⅱ包含MCA狭窄程度（P＝0．006；重度比中度狭窄： OR 4．796，95％CI 1．676～13．729；闭塞比中度狭窄： OR 5．537，95％CI 1．846～16．603），高血压病史（ OR 0．444，95％CI 0．215～0．914）和血压偏低（OR 5．747，95％CI 1．500～9．425）。结论 MCA重度狭窄或闭塞、前向血流受损以及血压偏低是MCAS发生IBZ的独立危险因素，MCAS患者有高血压病史则为IBZ的保护性因素。

Objective To explore the independent predictors of internal borderzone （ IBZ） infarcts in patients with atherosclerotic middle cerebral artery stenosis/occlusion （ MCAS） .Methods A total of 167 hospitalized patients with atherosclerotic MCAS during January 2008 and March 2014 were retrospectively analyzed.They were divided into“with IBZ group” （n=55） and“without IBZ group” （n=112） according to the findings of magnetic resonance images （ MRI ） . Their clinical data were collected including demographics, traditional vascular risk factors, stenotic degree of MCA and other cerebral supply arteries, TICI grading for antegrade blood flow, ASITN/SIR grading for collateral circulation and other variables.The intra-group data were compared by univariate analysis. Variables with P 〈0.1 were included into multivariate Logistic regression model for obtaining the independent predictors of IBZ.Two models were established including either TICI-grading or stenotic degree of MCAS due to close correlations between two variables.Results There were 45 females and 122 males with a mean age of 54 ±12 years.Variables with a P value 〈0.1 in univariate analysis included relatively low blood pressure （P=0.006）, stenotic degree of MCAS （P=0.012）, TICI-grading （P=0.003）, history of hypertension （P =0.055） and ASITN-grading （P=0.067）.In multivariate model Ⅰ, independent predictors of IBZ included TICI-grading （OR 4.310, 95%CI 1.698-10.869, P=0.002）, history of hypertension （OR 0.458, 95%CI 0.224-0.936, P=0.032）, relatively low blood pressure （OR 3.848; 95%CI 1.345 -7.983, P =0.039）.In multivariate modelⅡ, independent predictors of IBZ included stenotic degree of MCAS （P=0.006;severe vs moderate：OR 4.796, 95%CI 1.676-13.729, P=0.003;occlusion vs moderate：OR 5.537, 95%CI 1.846-16.603, P=0.002）.The two models had a similar area under the curve （AUC） of receiver operating curve （ROC） of 0.702 （95%CI 0.618 -0.787, P〈0.001） and 0.709 （95%CI 0.626 -0.792, P〈0.001）.Conclusion Severe stenosis or total occlusion of MCA, impairment of antegrade blood flow and relatively low blood pressure are the independent risk factors of IBZ.And history of hypertension is a protective fact or of IBZ in patients with MCAS.