大脑中动脉狭窄患者脑血管储备能力与缺血性卒中事件的随访研究

Cerebral vascular reserve and ischemic stroke in patients with middle cerebral artery stenosis

目的观察大脑中动脉(MCA)狭窄患者脑血管储备能力(CVR)与缺血性卒中发生的关系及其危险因素的随访研究。方法连续纳入2014年2月~2016年9月在广州医科大学附属第三医院荔湾医院神经内科门诊或住院就诊行经颅多普勒超声(TCD)检查者中发现MCA狭窄患者的临床资料及脑血管储备能力(CVR),并进行为期1 y的随访,观察患者发生缺血性卒中的情况。结果 (1)共纳入212例患者,其中31例(14.6%)在随访期间发生缺血性卒中(卒中组);(2)卒中组患者CVR为(12.6±4.8)%,明显低于非卒中组(19.3±4.5)%,两者差异有统计学意义(P<0.05);(3)卒中组中MCA轻度、中度、重度狭窄者分别为6例(19.4%)、11例(35.5%)、14例(45.2%),与非卒中组比较差异有统计学意义(P<0.05);(4)经Logistic回归分析显示CVR是缺血性卒中事件的独立危险因素。结论在MCA狭窄的患者中CVR高、狭窄程度低的缺血性卒中事件发生风险低,且CVR是缺血性卒中的独立危险因素。

Objective To observe the relationship between cerebral vascular reserve(CVR)and ischemic stroke and the risk factors of stroke in patients with middle cerebral artery(MCA)stenosis.Methods From February 2014 to September 2016,we recruited consecutive neurology clinic or hospitalization patients who were found with MCA stenosis through transcranial doppler ultrasonography(TCD)in Li Wang hospital,the third affiliated hospital of guangzhou medical university.At the same time,recording their clinic data and CVR,and all patients were followed up for one year to observe the occurrence of ischemic stroke.Results (1)There were 212 patients,31 of all(14.6%)occurred ischemic stroke(stroke group)during follow-up.(2)In stroke group,CVR was(12.6±4.8)%,significantly lower than non-stroke group(19.3±4.5)%,and the difference were statistically significant(P<0.05).(3)In stroke groug,there were six cases(19.4%),eleven cases(35.5%)and fourteen cases(45.2%)in the patients with mild,moderate and severe MCA stenosis,and the difference were statistically significant(P<0.05).(4)Logistic regression analysis showed that CVR was an independent risk factor for ischemic stroke events.Conclusion The occurrence rate of ischemic stroke with higher CVR and lower degree of MCA stenosis is lower than others,and CVR is an independent risk factor for ischemic stroke.