青年急性腔隙性梗死伴颅内血管狭窄的危险因素和分布特征分析

Analysis on risk factors and distribution characteristics of acute lacunar infarction accompanied with intracranial vascular stenosis in youth

目的探讨急性腔隙性梗死(lacunar infarction,LI)青年患者的血管危险因素及其分布特征,为预防和治疗提供科学依据。方法收集我院神经内科住院的青年急性腔隙性梗死患者40例,年龄18~45岁,均行头颅MRI、MRA、颈部血管彩超、血脂等检查,根据头颅血管磁共振检查结果分为颅内动脉狭窄组和无颅内动脉狭窄组。对观察指标结果进行统计学分析。结果 40例青年腔梗患者中22例存在颅内大动脉狭窄(狭窄组),18例无狭窄(无狭窄组),经分析发现,颅内动脉狭窄组的甘油三酯、低密度脂蛋白胆固醇、颈动脉斑块形成较无颅内动脉狭窄差异有统计学意义(P<0.05)。而吸烟、饮酒、高血压、尿酸、空腹血糖、高胆固醇、高密度脂蛋白胆固醇2组比较差异无统计学意义(P>0.05)。颅内动脉狭窄组中15例为单发血管狭窄,7例为多发狭窄,单发与多发血管狭窄血管危险因素比较差异无统计学意义(P>0.05);单纯前循环狭窄13例,单纯后循环狭窄7例,单纯前、后循环颅内动脉狭窄间血管危险因素比较差异无统计学意义(P>0.05)。结论青年腔梗合并颅内动脉狭窄患者多于无颅内动脉狭窄患者,且颅内动脉狭窄组甘油三酯、低密度脂蛋白胆固醇、颈动脉斑块形成均显著高于无颅内动脉狭窄组。青年腔梗单发与多发颅内血管狭窄之间的危险因素比较无显著差异;颅内动脉狭窄多发生于前循环,且单纯前、后循环颅内动脉狭窄组之间危险因素比较无显著差异(P>0.05)。

Objective This study mainly aimed at exploring risk factors and distribution characteristics of acute lacunar infarction（ALI）accompanied with intracranial vascular stenosis in youth,in order to provide scientific bases for precautions and treatments.Methods All of 40 young ALI cases with the age of 18-45 years old in neurology department who underwent brainMRI,MRA and carotid duplex ultrasound and blood lipid examination were selected and were divided into intracranial arterial stenosis group and non-stenosis group according to brain MRA outcomes.Finally,statistical analysis of the observed indices was performed.Results Of the 40 young ALI cases,there were 22 cases in stenosis group and 18 cases in non-stenosis group.Compared with non-stenosis group,the stenosis group showed statistically significant differences in triglyceride,low-density cholesterol levels and formation of carotid plaques（P〈0.05）,but not in smoking,drinking,high blood pressure,uric acid,fasting blood glucose,high cholesterol and high-density lipoprotein cholesterol（P〉0.05）.The stenosis group presented 15 cases with simple vascular stenosis and 7cases with multiple stenosis,and no statistical difference was found in risk factors between simple and multiple vascular stemosis.In the stenosis group simple anterior circulation stenosis occurred in 13 cases and pure posterior circulation stenosis occurred in 7cases,which showed no statistical differnces in risk factors（P〉0.05）.Conclusion Lacunar infarction complicated with intracranial artery stenosis in youth can be more common than that without artery stemosis.Triglyceride,low-density cholesterol levels and formation of carotid plaques in stenosis group are significantly higher than those in non-stenosis group.Risk factors between simple and multiple vascular stemosis groups cannot be different.Intracranial artery stenosis often occurs in the anterior circulation,and simple anterior and posterior circulations show no differences in vascular risk factors.