老年急性轻型脑卒中患者中陈旧性腔隙性脑梗死研究

The value of old lacunar infarction in elderly patients with acute mild stroke

目的探讨老年急性轻型缺血性脑卒中患者中陈旧性腔隙性脑梗死(LI)的影响因素。方法选自延安大学附属医院于2015年3月至2018年3月期间收治的老年急性缺血性脑卒中患者800例作为研究对象,观察合并陈旧性LI发生情况。采用单因素和多因素分析合并陈旧性LI危险因素,收集患者临床资料,包括性别、陈旧性脑卒中史、LI数目、合并糖尿病、合并高血压、阿司匹林使用、脑白质改变严重程度、脑内微出血情况。结果老年急性缺血性脑卒中患者800例中,合并陈旧性LI 169例,发生率为21.13%。经单因素分析表明,A组患者的≥2级脑内微出血的发生比例明显高于B组,且A组患者≥2级的脑白质改变严重程度的发生比例显著高于B组,差异均有统计学意义(P<0.05);A组患者中重度抑郁发生比例明显高于B组,且认知障碍显著高于B组,差异均有统计学意义(P<0.05)。Logistics多因素回归分析显示,脑白质改变严重程度和脑内微出血为影响陈旧性LI独立危险因素(P<0.05)。结论老年急性轻型缺血性脑卒中合并陈旧性LI患者的脑白质改变严重程度和脑内微出血、抑郁程度及认知障碍更严重,观察其陈旧性LI情况对判断患者预后具有重要临床价值。

Objective To investigate the influencing factors of old lacunar infarction(LI)in elderly patients with acute mild ischemic stroke.Methods 800 elderly patients with acute ischemic stroke from March 2015 to March 2018 were selected as the subjects,and the occurrence of old LI was observed.The risk factors of old LI were combined with single factor and multi factor analysis,and the clinical data of patients were collected,including sex,old LI history,the number of LI,diabetes,hypertension,aspirin use,the severity of white matter change,and intracerebral hemorrhage.Results Among the 800 elderly patients with acute ischemic stroke,169 cases had old LI,the incidence was 21.13%.Univariate analysis showed that the incidence of grade≥2 intracerebral microhemorrhage in group A was significantly higher than that in group B,and the incidence of severity of grade≥2 intracerebral microhemorrhage in group A was significantly higher than that in group B,with statistically significant differences(P<0.05).The incidence of major depression in group A was significantly higher than that in group B,and the incidence of cognitive impairment was significantly higher than that in group B,with statistically significant differences(P<0.05).Logistics multivariate regression analysis showed that the severity of white matter change and intracerebral microhemorrhage were independent risk factors for the influence of old LI(P<0.05).Conclusion Elderly patients with acute mild ischemic stroke complicated with old LI,the severity of white matter change,intracerebral hemorrhage,depression and cognitive impairment are more serious.Observation of the status of old cerebral infarction is of great clinical value in judging the prognosis of patients.