缺血性卒中住院患者脑颈动脉狭窄地域分布差异性的多中心研究

Correlation between the distribution of cerebral artery stenosis and geographic variation in hospitalized patients with ischemic stroke: a multicenter registry study in China

目的探讨中国南北方地区缺血性卒中患者脑、颈动脉狭窄闭塞性病变分布及危险因素的差异。方法回顾性连续纳入2015年6月至2016年5月全国20家国家卫健委脑卒中防治基地医院住院的缺血性卒中患者共9346例。联合应用颈动脉超声和经颅彩色多普勒超声/经颅多普勒超声评估颅内、外动脉狭窄程度,并经CT血管成像或MR血管成像验证。根据我国地理位置标准,将患者分为南方地区组和北方地区组,比较两组间脑、颈动脉病变分布特征及危险因素的差异性;根据患者是否存在脑、颈部动脉病变(≥50%狭窄,含闭塞)分为动脉病变组和无动脉病变组,对两组患者的基线资料及南北分布差异进行单因素及多因素Logistic回归分析,分析南北分布差异在脑、颈部动脉病变中的作用。结果9346例患者中,南方地区组2561例,北方地区组6785例。北方地区脑、颈部动脉中度及以上狭窄(≥50%狭窄,含闭塞)检出率显著高于南方地区[33.1%(2243/6785)比25.0%(639/2561),χ2=57.295,P<0.01]。除颈总动脉外,颈内动脉颅外段、椎动脉颅外段、锁骨下动脉、大脑中动脉、颈内动脉终末段、椎动脉颅内段、基底动脉中度及以上狭窄发生率北方地区均明显高于南方地区(均P<0.05)。南、北方地区组间动脉病变在颅内、颅外分布差异无统计学意义(χ2=2.790,P=0.248),均以单纯颅内动脉病变多见。南、北方地区患者动脉病变在前、后循环分布上差异有统计学意义(χ2=13.433,P=0.001),南方地区患者单纯前循环动脉病变占比明显高于北方地区患者[58.5%(374/639)比50.3%(1129/2243)],而北方地区患者单纯后循环动脉病变[27.2%(609/2243)比23.0%(147/639)]及前、后循环动脉联合病变占比[22.5%(505/2243)比18.5%(118/639)]均显著高于南方地区。9346例患者中,动脉病变组2882例,无动脉病变组6464例。多因素Logistic回归分析结果显示,高龄、男性、高血压病、糖尿病、卒中家族史、吸烟史、肥胖是缺血性卒中患者脑、颈部动脉狭窄闭塞性病变的独立危险因素(OR值分别为1.006、1.670、1.202、1.176、1.546、1.414及1.230,均P<0.05)。校正上述因素后,生活在北方地区仍为动脉病变的独立危险因素(OR=1.385,95%CI:1.237~1.550,P<0.01)。结论中国南北地区缺血性卒中患者脑、颈部动脉狭窄闭塞性病变的分布及其危险因素存在明显差异。

Objective To investigate the geographic variation in the distribution and risk factors of cerebral artery diseases in Chinese patients with ischemic stroke.Methods All 9346 continuously hospitalized patients with ischemic stroke in 20 hospitals from June 2015 to May 2016 were enrolled in this multicenter study,using carotid ultrasonography and transcranial color-coded sonography/transcranial doppler to evaluate the degree of extra-and intra-cranial arteries stenosis and verifying by CT angiography or magnetic resonance angiography.All patients were divided into the southern group and the northern group by the definition of the Huai River-Qinling Mountains line to compare the differences of the distribution and risk factors of cerebrovascular diseases.Meanwhile,all patients were divided into the lesion group(defined as the degree of stenosis more than 50%)and the non-lesion group according to the degree of stenosis to compare the differences of baseline data and geographic distribution of cerebrovascular diseases.Results The 2561 northern patients and 6785 northern patients were enrolled in the study.The proportion of patients with more than 50%degree of extra-and intra-cranial arteries stenosis was significantly higher in northern China than that in southern China(33.1%[2243/6785]vs.25.0%[639/2561],χ2=57.295,P<0.01).The proportions of northern patients with more than 50%degree of stenosis located in the extracranial segment of internal carotid artery,vertebral artery,subclavian artery,middle cerebral artery,the terminal segment of internal carotid artery,intracranial segment of the vertebral artery,and basilar artery were higher than those of southern patients(all P<0.05).The proportion of patients with intracranial artery stenosis was higher than that with extracranial arteries stenosis in both southern and northern patients(χ2=2.790,P=0.248).The distribution of arterial lesions in the anterior and posterior circulations was significantly different in southern and northern patients(χ2=13.433,P=0.001).The proportion of anterior circulation arteries stenosis was higher in southern patients than that in northern patients(58.5%[374/639]vs.50.3%[1129/2243]).While the posterior circulation artery stenosis(27.2%[609/2243]vs.23.0%[147/639])and combined anterior with posterior circulation artery stenosis(22.5%[505/2243]vs.18.5%[118/639])were more common in northern patients compared to southern patients.Multivariate logistic regression analysis showed that age,male gender,hypertension,diabetes mellitus,family history of stroke,smoking,and obesity were independent risk factors of cerebral artery stenosis(OR values were 1.006,1.670,1.202,1.176,1.546,1.414 and 1.230,all P<0.05).While living in northern China was an independent risk factor for cerebral arterial stenosis after modifying the aforementioned parameters(OR=1.385,95%CI:1.237-1.550,P<0.01).Conclusion The distribution and risk factors of cerebrovascular stenosis in patients with ischemic stroke were significantly different in the north and south of China.