广州社区前后循环脑梗死发病与“三高”危险因素的关系

The relationship between the onset of cerebral infarction in anterior and posterior circulation and the "three high" risk factors in Guangzhou communities

目的探讨广州社区前、后循环脑梗死发病与"三高"危险因素之间的关系。方法收集2014年1月至2016年1月经查头颅磁共振弥散成像确诊的广州社区本地新发脑梗死患者367例。先将患者分为前、后循环脑梗死两组,以单因素及多因素方法分析"三高"等因素与前、后循环脑梗死发病的关系;再将前循环脑梗死分为腔隙性和非腔隙性梗死2个亚组,以同样方法分析这两个亚组间危险因素的差异。结果后循环脑梗死患者中高血压的发生率(P=0.040)、大动脉粥样硬化性梗死的比率(P=0.012)高于前循环,而血清高密度脂蛋白(HDL)水平低于前循环(P=0.05)。且其发病与患有高血压(OR=1.767,P=0.035)及HDL水平降低更相关(OR=0.380,P=0.021)。前循环中,非腔隙性梗死的收缩压(P=0.011)及舒张压(P=0.000)水平及大动脉粥样硬化性梗死的比率(P=0.000)均高于腔隙性梗死,且其发病与收缩压水平增高关系更密切(OR=1.045,P=0.001)。结论在"三高"因素中,后循环脑梗死的发病与患有高血压及HDL水平降低关系更密切;前循环中,非腔隙性脑梗死发病与舒张压、收缩压,特别与收缩压的水平升高更相关。

Objective To investigate the relationship between the onset of cerebral infarction in anteriorand posterior circulation and the ＂three high＂ risk factors in Guangzhou communities. Methods From Jan. 2014 to Jan. 2016,367 patients from Guangzhou communities were diagnosed with new cerebral infarction by head diffu-sion weighted imaging（DWI）. The data were divided into two groups of anterior and posterior circulation,and uni-variate and multivariate methods were used to analyze the relationship between the ＂three high＂ and other riskfactors and the onset of cerebral infarction in anterior and posterior circulation. The data of anterior circulation cere-bral infarction were further divided into two subgroups of lacunar and non-lacunar infarction,and the same statisti-cal methods were employed to analyze differences of risk factors between the two subgroups. Results The frequen-cies of hypertension（P = 0.040）and large atherosclerotic infarction（P = 0.012）were significantly higher,andthe serum high-density lipoprotein（HDL）level（P = 0.045）was significantly lower in posterior circulation thanthose in anterior circulation,respectively;and the onset of posterior circulation cerebral infarction was more associ-ated with the incidence of hypertension（OR = 1.767,P = 0.035）and the decrease of HDL（OR = 0.380,P =0.021）. In anterior circulation,the levels of systolic blood pressure（SBP）（P = 0.011）and diastolic blood pres-sure（DBP）（P = 0.000）,as well as the frequency of large atherosclerotic infarction（P = 0.000）in non-lacunarinfarction subgroup were significantly higher than those in lacunar infarction subgroup respectively,and the onsetof non-lacunar infarction was more closely related to increased SBP levels（OR = 1.045,P = 0.001）. ConclusionsAmong the ＂three high＂ risk factors,the onset of posterior circulation cerebral infarction is more closely related tothe incidence of hypertension and the decrease of HDL. In anterior circulation,and the onset of non-lacunar infarc-tion is more closely related to the increased levels of DBP and SBP,especially to the elevated levels of SBP.