超高龄人群颅内外动脉狭窄的发生特点及危险因素分析

Analysis on characteristics and risk factors of the cerebral artery atherosclerotic stenosis in patients aged 90 years and older

目的探讨90岁以上超高龄人群颅内外动脉狭窄的发生特点及危险因素。方法选择2009年7月至2014年7月在本院住院的年龄超过90岁,已行头颈部CTA检查的患者92例,对其颅内外动脉狭窄的CTA影像形态特点进行分析,并记录其病史及住院期间体重指数(BMI)、血压、血糖、血脂、尿酸、胱抑素等检查结果,分析以上因素与颅内外动脉狭窄发生的关系。结果发现患者中单纯型颅内动脉狭窄发生率为34.8%,颅外动脉狭窄发生率为8.7%,颅内外混合型狭窄发生率为19.6%。其中颅内动脉狭窄发生率(86.2%)高于颅外动脉(44.8%),颅内动脉狭窄最常见受累部位为大脑中动脉(43.1%)与大脑后动脉(43.1%);颅外动脉狭窄最常见受累部位为椎动脉颅外段(32.8%)。单因素分析中发现脑动脉狭窄组患者年龄、BMI、收缩压、舒张压、空腹血糖均高于非狭窄组(P<0.05),且多因素Logistic回归分析显示BMI是颅内外动脉狭窄发生的独立危险因素(β=1.326,OR=3.765,P<0.05)。结论 90岁以上超高龄人群颅内外动脉狭窄发生率较高,BMI是其独立危险因素,积极控制体质量可能预防和减少颅内外动脉狭窄以及缺血性脑卒中的发生。

Objective To investigate the characteristics and risk factors of the cerebral artery atherosclerotic stenosis in patients aged 90 years and older. Methods A total of 92 patients,aged 90 years or older,admitted to our hospital from July 2009 to July 2014 were respectively enrolled in this study. All participants underwent CTA to assess the presence and severity of atherosclerotic stenosis with intracranial and extracranial cerebral artery. The association between atherosclerotic stenosis and related risk factors were analyzed. Results The prevalence of cerebral artery atherosclerotic stenosis was high in the cohort. The frequency of stenosis with intracranial artery was higher than the frequency with extracranial artery（86. 2% vs 44. 8%）. The most common positions of cerebral artery atherosclerotic stenosis were the middle cerebral artery（43. 1%）,the posterior cerebral artery（43. 1%）,and extracranial vertebral artery（32. 8%）. The mean age,body mass index,systolic and diastolic blood pressure,and fasting blood glucose of stenosis group are significantly different from the non- stenosis group in single factor analysis（ P〈0. 05）. Multivariate Logistic regression analysis showed body mass index was the independent risk factor of cerebral artery atherosclerotic stenosis（ β = 1. 326,OR = 3. 765,P〈0. 05）. Conclusion The prevalence of cerebral artery atherosclerotic stenosis was high in the patients aged 90 years and older. Body mass index was the independent risk factor. The weight control should be pay attention to prevent cerebral artery atherosclerotic stenosis and stroke.