自发性颈部动脉夹层与缺血性卒中的关系

Associated risk factors of ischemic events for spontaneous cervical artery dissection

目的 探讨自发性颈部动脉夹层与缺血性卒中发生的关系.方法 选择2007年1月至2012年6月在第三军医大学大坪医院野战外科研究所神经内科住院经脑血管造影确诊的自发性颈部动脉夹层患者161例,按照入院时是否发生缺血性卒中进行分组,对两组的基线特征、血管危险因素及影像学特征进行比较,并对患者进行随访,观察不良终点事件发生情况.结果 161例入组患者中,卒中组77例,非卒中组84例,卒中组高血压、糖尿病比例显著高于非卒中组（62.3％比41.7％,14.3％比6.2％,P＜0.05）,影像学表现上,卒中组血管重度狭窄比例显著高于非卒中组（61.0％比23.8％,P＜0.001）,而瘤样扩张、双腔征显著低于非卒中组（19.5％比44.0％,P＜0.001;22.1％比38.1％,P＜0.05）.多因素分析提示糖尿病、重度狭窄与自发性颈部动脉夹层的卒中发生呈正相关（OR=3.095,95％CI1.273 ～7.524,P =0.013;OR=4.335,95％CI2.123 ～8.854,P＜0.001）,瘤样扩张呈负相关（OR =0.429,95％CI0.198～0.930,P=0.032）.对患者进行平均16.0个月随访显示,不良终点事件发生率9.3％,以缺血性卒中起病、动脉闭塞、超重（或肥胖）与不良终点事件发生有关.结论 本研究证实糖尿病、重度狭窄病变与自发性颈部动脉夹层的卒中发生相关,以缺血性卒中起病、动脉闭塞病变、超重（或肥胖）是自发性颈部动脉夹层发生不良终点事件的相关因素.

Objective This study sought to identify risk factors of ischemic events and predictors of outcome for spontaneous cervical artery dissection （sCAD）.Methods One hundred and sixty one patients diagnosed as sCAD were classified as patients with （n =77） and without （n =84） cerebral ischemia.Demographics,vascular risk factors and imaging features were compared between the two groups.Multivariate Cox regression analysis was performed to identify predictors of primary end-point events （all cause stroke and death） at follow-up.Results Patients with cerebral ischemia had a higher prevelence of hypertension and diabetes mellitus （62.3% vs 41.7%,14.3% vs 6.2%,P 〈 0.05）.Patients with cerebral ischemia were more likely to present with stenosis （61.0% vs 23.8%,P 〈0.001） and less likely to present with aneurysmal dilatation （19.5% vs 44.0%,P 〈 0.001） and double lumen （22.1% vs 38.1%,P 〈 0.05）.There was significant positive association of diabetes mellitus （odds ratio 3.095;95 % confidence interval,1.273 to 7.524,P =0.013） and stenosis （odds ratio 4.335,95% confidence interval,2.123 to 8.854,P 〈 0.001）,and an inverse association of aneurysmal dilatation （odds ratio 0.429,95% confidence interval,0.198 to 0.930,P =0.032） with occurrence of ischemic events in patients with sCAD.At a mean follow-up of 16.0 months,overall incidence of primary end-point was 9.3% （n =15）.Cox regression analysis showed cerebral ischemia at onset,arterial occlusion,obesity or overweightness were significant predictors of the primary endpoint.Conclusions This study confirms that diabetes mellitus and arterial stenosis are risk factors of ischemic events for sCAD patients.Cerebral ischemia at onset,arterial occlusion,obesity or overweightness are predictors of primary endpoint at follow-up.