孤立性脑桥梗死的危险因素分析

Analysis of Risk Factors for Isolated Pontine Infarction

目的：探讨脑桥旁正中梗死（paramedian pontine infarction, PPI）及脑桥腔隙性梗死（lacunar pontine infarction, LPI）的危险因素、大血管病变及脑小血管病之间的区别。方法将58例急性孤立性脑桥梗死分为PPI组（n=37）及LPI组（n=21），对PPI组、LPI组及对照组（n=121）三组间的传统脑血管病危险因素、大血管病变情况、脑小血管病等比较分析，并回顾分析PPI及LPI的危险因素。结果 PPI组中高血压（91.9% vs 64.5%，χ2=10.330，P=0.001）、高血压控制不佳（56.8% vs 25.6%，χ2=12.442，P＜0.001）、糖尿病（40.5% vs 17.4%，χ2=8.658，P=0.003）、糖化血红蛋白[（6.99±1.66）% vs（6.12±1.38）%，t=2.889，P=0.005]、空腹血糖[（6.74±2.15）mmol/L vs（5.62±1.98） mmol/L，t=2.963，P=0.004]、高密度脂蛋白[（1.13±0.26）mmol/L vs（1.29±0.32）mmol/L，t=-2.850，P=0.005]、同型半胱氨酸[（16.86±4.92）mmol/L vs（15.02±3.48）mmol/L，t=2.122，P=0.039]、基底动脉硬化（67.6% vs 16.5%，χ2=36.237，P＜0.001）及其不规则（62.2% vs 16.5%，χ2=29.788，P＜0.001）及颅内血管粥样硬化（64.9% vs 43.8%，χ2=5.032，P=0.025）显著高于对照组。LPI组高血压（95.2% vs 64.5%，χ2=7.925，P=0.005）、高血压控制不佳（66.7% vs 25.6%，χ2=13.920，P＜0.001）、糖化血红蛋白[（6.97±1.65）% vs（6.12±1.38）%，t=2.213，P=0.036]、空腹血糖[（6.72±3.05）mmol/L vs（5.62±1.98）mmol/L，t=2.133，P=0.035]、甘油三酯[（2.17±1.96）mmol/L vs（1.41±0.91） mmol/L，t=2.886，P=0.005]、同型半胱氨酸[（16.80±4.48）mmol/L vs（15.02±3.48）mmol/L，t=2.067，P=0.041]、基底动脉硬化（52.4% vs 16.5%，χ2=13.478，P＜0.001）、不规则（47.6% vs 16.5%，χ2=10.380，P=0.001）显著高于对照组，其余危险因素在三组间差异无统计学意义。分别进行多变量Logistic回归分析，仅有基底动脉粥样硬化（OR 7.457，95%CI 2.806～19.820，P＜0.001）是PPI形成的独立危险因素。高血压控制不佳（OR 3.847，95%CI 1.166～12.693，P=0.027）和基底动脉粥样硬化（OR 3.647，95%CI 1.064～12.494，P=0.039）是LPI形成的独立危险因素。结论 PPI组和LPI组组间一般脑血管病危险因素、大血管病变及脑小血管病没有明显差异，与基底动脉粥样硬化同时是LPI与PPI的独立危险因素有关，高血压控制不佳仍然是LPI的独立危险因素之一。

Objective To investigate and compare the difference in risk factors, macrovascular disease and small vessel disease （SVD） between paramedian pontine infarction （PPI） and lacunar pontine infarction （LPI）. Methods58 acute isolated pontine infarction patients and 121 control patients were analyzed retrospectively. The isolated pontine infarction patients were divided into PPI group （n=37） and LPI group （n=21） according to infarct location. Traditional risk factors for cerebrovascular disease, vascular pathology classifi cation consisting of macrovascular disease, and SVD were collected and compared in different groups.Results The patients＇constituent ratios of hypertension （91.9% vs 64.5%,χ2=10.330,P=0.001）, uncontrolled hypertension （56.8% vs 25.6%,χ2=12.442,P〈0.001）, diabetes （40.5% vs 17.4%,χ2=8.658,P=0.003）, basilar artery atherosclerosis （67.6% vs 16.5%,χ2=36.237,P〈0.001）, irregular basilar artery （62.2% vs 16.5%,χ2=29.788,P〈0.001）, intracranial atherosclerosis （64.9% vs 43.8%,χ2=5.032,P=0.025）, and glycated hemoglobin （[6.99±1.66]% vs [6.12±1.38]%,t=2.889,P=0.005）, fasting plasma glucose （FPG） （[6.74±2.15]mmol/L vs [5.62±1.98]mmol/L,t=2.963,P=0.004）, high-density lipoprotein （HDL） （[1.13±0.26]mmol/L vs [1.29±0.32]mmol/L,t=-2.850, P=0.005） and homocysteine （Hcy） （[16.86±4.92]mmol/L vs [15.02±3.48]mmol/L,t=2.122,P=0.039） in the PPI group were signifi cantly higher than those in control group. The patients＇constituent ratios of hypertension （95.2% vs 64.5%,χ2=7.925,P=0.005）, uncontrolled hypertension （66.7% vs 25.6%,χ2=13.920,P〈0.001）, basilar artery atherosclerosis （52.4% vs 16.5%,χ2=13.478,P〈0.001）, irregular basilar artery （47.6% vs 16.5%,χ2=10.380,P=0.001）, and glycated hemoglobin （[6.97±1.65]% vs [6.12±1.38]%,t=2.889,P=0.005）, FPG （[6.72±3.05]mmol/L vs [5.62±1.98]mmol/L,t=2.133,P=0.035）, triglycerides （[2.17±1.96]mmol/L vs [1.41±0.91]mmol/L,t=2.886,P=0.005） and Hcy （[16.80±4.48]mmol/L vs [15.02±3.48]mmol/L,t=2.067, P=0.041） in the LPI group were signifi cantly higher than those in control group. Multivariate Logistic regression analysis showed basilar artery atherosclerosis was the independent risk factor for the onset of PPI （OR 7.457, 95%CI 2.806～19.820,P〈0.001）, uncontrolled hypertension （OR 3.847, 95%CI 1.166～12.693,P=0.027） and basilar artery atherosclerosis （OR 3.647, 95%CI1.064～12.494,P=0.039） were the independent risk factor for the onset of LPI.Conclusion Traditional risk factors, macrovascular disease and SVD for cerebrovascular disease and vascular pathology classification were similar between the LPI group and PPI group according to basilar artery atherosclerosis as the independent risk factor for both PPI and LPI. Uncontrolled hypertension was still the independent risk factor for the onset of LPI.