DSA检查对重度椎动脉起始端狭窄患者卒中复发评估的临床研究

Clinical study of DSA in the assessment of stroke recurrence in patients with severe vertebral artery stenosis

目的探讨数字减影血管造影(DSA)检查对重度椎动脉起始端狭窄患者卒中复发评估的临床价值。方法选择2014年1月至2015年8月收治的104例缺血性脑卒中患者作为研究对象。均行DSA检查,观察患者椎动脉起始端狭窄程度。随访90 d后,观察患者卒中复发情况,根据有无复发分为复发组和非复发组,比较两组患者一般资料,并通过COX回归分析法分析患者卒中复发相关因素。结果 104例患者中椎动脉起始端无狭窄18例(17.31%),轻度狭窄26例(25.00%),中度狭窄34例(32.69%),重度狭窄22例(21.15%),完全闭塞4例(2.88%);随访90 d后复发9例(8.65%);重度狭窄、完全闭塞患者复发率分别为27.27%和50.00%,均高于无狭窄、轻度狭窄和中度狭窄患者(P<0.05);复发组患者高血压比率、短暂性脑缺血发作史、重度狭窄+完全闭塞比率显著高于非复发组(P<0.05);重度狭窄及完全闭塞(HR=0.549)、短暂性脑缺血发作(HR=0.517)、高血压(HR=0.506)是缺血性脑卒中患者卒中复发的独立危险因素(P<0.05)。结论重度椎动脉起始端狭窄与缺血性脑卒中患者卒中复发密切相关,DSA检查对重度椎动脉起始端狭窄及完全闭塞的缺血性脑卒中患者短期卒中复发具有重要预测价值。

Objective To investigate the clinical value of digital subtraction angiography（ DSA） in the assessment of stroke recurrence in patients with severe vertebral artery stenosis. Methods 104 cases of ischemic stroke patients admitted to our hospital from January 2014 to August2015 were selected as research subjects,all patients were examined by DSA. The degree of stenosis of vertebral artery origin was observed in the patients. All patients were followed up for 90 d,according to the recurrence of the patients,they were divided into recurrent group and non recurrent group. The general data of two groups were compared,and through COX regression analysis to analyze the factors related to the recurrence of stroke. Results In 104 patients,18 patients（ 17. 31%） had no stenosis at the beginning of the vertebral artery,mild stenosis was 26 cases（ 25%）,moderate stenosis was 34 cases（ 32. 69%）,severe stenosis was 22 cases（ 21. 15%）,total occlusion was 4 cases（ 2. 88%）. The recurrence occurred rate was 8. 65%（ 9 /104）. The recurrence rates were 27. 27% and 50% in patients with severe stenosis,which were higher than those with no stenosis,mild stenosis and moderate stenosis（ P〈0.05）. The proportion of hypertensive patients with transient ischemic attack,the proportion of total occlusion of severe stenosis was significantly higher than that of non recurrence group（ P〈0.05）. Severe stenosis and complete occlusion（ HR=0. 549）,transient ischemic attack（ HR=0. 517）,hypertension（ HR=0. 506） were independent risk factors for stroke recurrence in patients with ischemic stroke（ P〈0.05）. Conclusion Severe vertebral artery stenosis and ischemic stroke in patients with stroke recurrence is closely related,digital subtraction angiography（ DSA） has great value in predicting short stroke recurrence.