颈部动脉迂曲与脑动脉狭窄及脑缺血事件的相关性分析

Correlation of cervical arteries tortuosity with cerebral artery stenosis and cerebral ischemic events

目的探讨颈部动脉迂曲与脑动脉狭窄及脑缺血事件的相关性。方法回顾性分析2018年1～6月在我科完成全脑血管造影(DSA)检查的177例住院患者临床资料。根据缺血事件性质分为急性缺血性卒中组(AIS组,n=73)、短暂性脑缺血发作组(TIA组,n=62)和对照组(n=42);根据脑动脉狭窄程度分为重度狭窄组(n=42)、轻中度狭窄组(n=64)和无狭窄组(n=71)。分别测量颈内动脉(ICA) C1段和椎动脉(VA) V1段的迂曲指数(TI)。分别将每例患者双侧ICA C1段和VA V1段的TI最大值分别指定为ICA-TI和VA-TI,MAX-TI指定为ICA-TI和VA-TI的最大值。使用单因素和多因素分析探讨血管迂曲与脑动脉狭窄和脑缺血事件的相关性。结果单因素分析显示高血压的差异具有统计学意义,而ICA-TI、VA-TI和MAX-TI的差异均无统计学意义,有序多分类Logistic回归多因素分析显示ICA-TI[OR=1. 044,95%CI(0. 919～1. 186),P=0. 504]、VA-TI[OR=1. 008,95%CI(0. 959～1. 059),P=0. 767]和MAX-TI[OR=0. 969,95%CI(0. 844～1. 114),P=0. 662]均不是脑缺血事件的独立危险因素。单因素分析显示年龄、高血压病、高脂血症和糖尿病的差异具有统计学意义,而ICA-TI、VA-TI和MAX-TI的差异均无统计学意义。多因素分析显示ICA-TI[OR=1. 023,95%CI(0. 893～1. 172),P=0. 744]、VA-TI[OR=1. 006,95%CI(0. 953～1. 06),P=0. 84]和MAX-TI[OR=0. 972,95%CI(0. 838～1. 128),P=0. 712]均不是脑动脉狭窄的独立危险因素。结论颈部动脉迂曲与脑动脉狭窄及脑缺血事件无明显相关性,但迂曲是否通过其他途径影响或干预动脉粥样硬化和缺血梗死的进程还需深入研究。

Objective To investigate the correlation of cervical arteries tortuosity with cerebral artery stenosis and cerebral ischemic events.Methods The clinical data of 177 inpatients who underwent digital subtraction angiography(DSA)in cerebral vessels of our department from January to June 2018 was retrospectively analyzed.According to the characteristic of ischemic events,the patients were divided into acute ischemic stroke(AIS)group(n=73),transient ischemic attack(TIA)group(n=62)and control group(n=42).According to the degree of cerebral artery stenosis,the patients were divided into severe stenosis group(n=42),mild or moderate stenosis group(n=64)and none stenosis group(n=71).The tortuosity index(TI)of C1 segment of internal carotid artery(ICA)and V1 segment of vertebral artery(VA)were measured respectively.The maximum of bilateral ICA C1 segment and VA V1 segment were designated as ICA-TI and VA-TI respectively,and the maximum of ICA-TI and VA-TI were designated as MAX-TI.Univariate and multivariate analysis were used to explore the correlation between vascular tortuosity and cerebral artery stenosis and cerebral ischemic events.Results Univariate analysis showed that the difference of hypertension was statistically significant,but the differences in ICA-TI,VA-TI and MAX-TI were not statistically significant.Multivariable ordinal logistic regression analysis showed that ICA-TI[OR=1.044,95%CI(0.919~1.186);P=0.504],VA-TI[OR=1.008,95%CI(0.959~1.059),P=0.767]and MAX-TI[OR=0.969,95%CI(0.844~1.114),P=0.662]were not independent risk factors for cerebral ischemic events.There were significant differences in age,hypertension,hyperlipidemia and diabetes mellitus by univariate analysis.However,the differences in ICA-TI,VA-TI and MAX-TI were not statistically significant as well.Multivariable analysis showed that ICA-TI[OR=1.023,95%CI(0.893~1.172),P=0.744],VA-TI[OR=1.006,95%CI(0.953~1.06),P=0.84]and MAX-TI[OR=0.972,95%CI(0.838~1.128),P=0.712]were not independent risk factors for cerebral artery stenosis.Conclusion There was no significant correlation between cervical arteries tortuosity and cerebral artery stenosis and cerebral ischemic events.But whether the tortuosity has affected the progress of atherosis and ischemic infarction by other ways or not needs further research.