大脑中动脉水平段狭窄与基底节脑出血及脑梗死关系的临床研究

Clinical study on the relationship between middle cerebral artery stenosis,basal ganglia hemorrhage and cerebral infarction

目的探讨大脑中动脉水平段(M1)狭窄与基底节脑出血和脑梗死的关系。方法选择2015年1~12月陆军军医大学第二附属医院神经内科收治的1123例脑血管疾病患者,经筛选最终纳入470例进行回顾性研究,依据头颅计算机断层扫描和颅脑核磁共振检查结果将其分为基底节脑出血组、急性脑梗死组、陈旧性脑梗死组和正常受试者组。依据计算机断层头颈部血管成像检查结果测量大脑中动脉狭窄程度。利用单因素相关分析模型和多因素Logistic回归模型筛选脑出血和脑梗死的危险因素,探讨大脑中动脉水平段(M1)狭窄和基底节脑出血及脑梗死的关系。结果M1狭窄增加了基底节脑出血的风险(P=0.001,OR=5.675),高血压(HP)增加了基底节脑出血的风险(P<0.001,OR=16.117),糖尿病(DM)减少了基底节脑出血的风险(P=0.001,OR=0.144),M1狭窄增加了急性和陈旧性脑梗死的风险,HP减少了急性和陈旧性脑梗死的风险,差异均有统计学意义(P<0.05)。结论M1狭窄会增加基底节脑出血和脑梗死的风险,需积极予以治疗。

Objective To study the relationship between middle cerebral artery stenosis,basal ganglia hemorrhage and cerebral infarction.Methods Totally 1123 patients with cerebrovascular diseases admitted to the neurology department of second hospital affiliated to army medical university from January to December 2015 were selected,and 470 patients were finally included in the retrospective study.According to the results of CT and MRI,these subjects were divided into four groups:basilar hemorrhage group,acute ischemic stroke group,prior ischemic stroke group and normal group(without cerebral diseases).The severity of middle cerebral artery stenosis was evaluated by computed tomography angiography.The risk factors of cerebral hemorrhage and cerebral infarction were analyzed by univariate correlation analysis model and multivariate logistic regression model to explore the potential association between middle cerebral artery stenosis and basal ganglia cerebral hemorrhage and cerebral infarction.Results Multiple logistic regression analysis showed that middle cerebral artery stenosis was associated with the increased risk of basilar hemorrhage(P=0.001,OR=5.675).The other cerebrovascular risk factors,such as history of hypertension also showed the increased risk of basilar hemorrhage(P<0.001,OR=16.117).In contrast,diabetes mellitus showed the decreased risk of basilar hemorrhage(P=0.001,OR=0.144).Middle cerebral artery stenosis was associated with the increased risk of acute and prior ischemic stroke.On the contrary,hypertension reduced the risk of acute and prior ischemic stroke,the differences were significant(P<0.05).Conclusion Middle cerebral artery stenosis is associated with the increased risk of basilar hemorrhage and ischemic stroke,and it should be treated with positive approach in clinical practice.