自发性颅外段椎动脉夹层分离患者缺血性卒中的危险因素

Risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection

目的探讨自发性颅外段椎动脉夹层分离患者缺血性卒中的危险因素。方法回顾性纳入2013年11月至2019年12月包头市中心医院神经内科收治的自发性颅外段椎动脉夹层分离患者,根据是否发生缺血性卒中分为缺血性卒中组和非缺血性卒中组。采用二分类logistic回归分析确定自发性颅外段椎动脉夹层分离患者缺血性卒中的独立危险因素。结果共纳入39例患者,男性14例(35.9%),女性25例(64.1%),年龄(51.51±14.98)岁,其中16例(41.0%)患者发生缺血性卒中。缺血性卒中组存在双腔征和闭塞管腔内膜瓣征(37%对4%;P=0.013)以及具有特异性临床首诊症状(56%对9%;P=0.003)的患者比例显著高于非缺血性卒中组。多变量logistic回归分析显示,双腔征和闭塞管腔内膜瓣征(优势比47.951,95%可信区间26.284~87.478;P<0.001)以及特异性临床首诊症状(优势比19.232,95%可信区间10.695~34.587;P<0.001)与自发性颅外段椎动脉夹层分离患者缺血性卒中独立相关。结论双腔征和闭塞管腔内膜瓣征以及特异性临床症状是自发性颅外段椎动脉夹层分离患者缺血性卒中的独立危险因素。

Objective To investigate the risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection.Methods From November 2013 to December 2019,patients with spontaneous extracranial vertebral artery dissection admitted to the Department of Neurology,Baotou Central Hospital were enrolled retrospectively.According to whether they had ischemic stroke or not,they were divided into ischemic stroke group and non-ischemic stroke group.The independent risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection were identified by binary logistic regression analysis.Results A total of 39 patients were enrolled,25 were female(64.1%),14 were males(35.9%),their age was 51.51±14.98 years old,16 of them(41.0%)had ischemic stroke.The proportion of patients with double-lumen sign,intimal flap sign of occluded lumen(37%vs.4%;P=0.013)and specific initial symptoms(56%vs.9%;P=0.003)of the ischemic stroke group were significantly higher than those of the non-ischemic stroke group.Multivariate logistic regression analysis showed that double-lumen sign and intimal flap sign of occluded lumen(odds ratio 47.951,95%confidence interval 26.284-87.478;P<0.001),and specific initial symptoms(odds ratio 19.232,95%confidence interval 10.695-34.587;P<0.001)were independently associated with ischemic stroke in patients with spontaneous extracranial vertebral artery dissection.Conclusions Double-lumen sign,intimal flap sign of occluded lumen and specific clinical symptoms are the independent risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection.