高海拔地区进展性脑梗死发生率、病因分型及相关因素分析

The research about ncidence,etiology,classification and related factors of progressive cerebral infarction in high altitude area

目的探讨高海拔地区进展性脑梗死的发生率、病因分型及相关危险因素。方法采用前瞻性研究方法,连续收集2014年5月-2017年5月青海省人民医院神经内科急性脑梗死病例共1200例,采用美国国立卫生研究院卒中量表(NIHSS)评分与Glasgow昏迷评定量表(GCS)评分,分析进展性脑梗死发生率,同时进行病因分型,分析各亚型所占比例,并明确相关危险因素。结果 (1)进展性脑梗死的发生率为19%(228/1200),其中大动脉粥样硬化性卒中(LAA)占31.6%(72/228),心源性栓塞(CE)占28.9%(66/228),小动脉闭塞性卒中(SAO)占18.9%(43/228),其他原因(OE)占15.8%(36/228),原因不明型(UE)占4.8%(11/228)。(2)对两组各因素行χ2检验或t检验,发现房颤病史、高血压病史、糖尿病史、脑卒中病史、大动脉病变、血清同型半胱氨酸浓度(Hcy)、血红蛋白浓度;冬季、感染、吸烟、年龄等两组间比较差异有统计学意义(P<0.05,P<0.01)。进一步做多因素Logistic回归分析显示,高血压病史、糖尿病史、大动脉病变、房颤病史、血清同型半胱氨酸浓度(Hcy)、血红蛋白浓度等6个因素与脑梗死进展有显著相关。结论高海拔地区进展性脑梗死发生率较高,大动脉粥样硬化性脑梗死最易发生进展,相关危险因素为高血压病史、糖尿病史、大动脉病变、房颤病史、血清同型半胱氨酸浓度(Hcy)、血红蛋白浓度。

Objective To explore the incidence,TOAST classification and risk factors of progressive cerebral infarction in high altitude area.Methods A total of 1200 consecutive patients with acute ischemic stroke were recruited with a method of prospective study.All of patients was evaluated NIHSS and GCS.Analyzing the incidence of progressive cerebral infarction.The group of progressive cerebral infarction was performed by the etiological classification,Make clear the proportion of each subtypes and identify the risk factors.Results（1） The incidence of progressive cerebral infarction was 19%（228/1200）.Among them,Large artery atherosclerosis（LAA） was 31.6%（72/228）.Cardiogenic stroke（CE） was 28.9%（66/228）.Small artery occlusion（SAO） was 18.9%（43/228）.Other etiology（OE） was 15.8%（36/228）.Undetermined etiology（UE） was 4.8%（11/228）.（2） There were statistically significant differences in,infection,smoking and age between the two groups（P〈0.05 or P〈0.01）.Multiple factor regression analysis showed the history of atrial fibrillation,hypertension,diabetes,macro artery disease,serum homocysteine（HCY） and concentration of hemoglobin were positively related with progression of cerebral infarction.Conclusion The incidence of progressive cerebral infarction in high altitude area is high,LAA is easiest to make progress.Risk factors of patients with progressive cerebral infarction include history of atrial fibrillation,hypertension,diabetes,macro artery disease,serum homocysteine（HCY） and concentration of hemoglobin.