急性脑梗死合并冠心病患者的危险因素分析

Analysis of Risk Factors of Acute Cerebral Infarction with Coronary Artery Disease

目的探讨急性脑梗死(acute cerebral infarction,ACI)合并冠心病(coronary artery disease,CAD)患者的危险因素。方法回顾性分析245例因怀疑冠心病接受冠状动脉CTA检查的急性脑梗死患者。根据冠状动脉CTA结果分为两组,冠状动脉CTA提示其中任何一支主要冠状动脉狭窄程度≥50%为脑梗死合并冠心病组(ACI合并CAD组),狭窄均<50%为脑梗死组(ACI组)。分析两组患者的临床特点、实验室检查及颅内外动脉狭窄位置及数量的差异,并分析颅内外动脉狭窄与冠状动脉狭窄的相关性。结果单因素分析显示ACI合并CAD组的男性、糖尿病比例、中性细胞计数、糖化血红蛋白、甘油三酯、肌酐水平、颅内外动脉狭窄数量显著高于ACI组,差异有统计学意义(P均<0.05)。单因素分析显示ACI合并CAD组患者的颅内外动脉狭窄的数量更多,狭窄位置更可能在颈内动脉颅外段、椎动脉颅外段、椎动脉颅内段、基底动脉、大脑中动脉、大脑后动脉(P均<0.05)。Logistics逐步回归分析显示糖尿病(OR=3.931,95%CI:1.476~10.467)、肌酐水平(OR=1.037,95%CI:1.005~1.069)、颅内外动脉多支病变(OR=6.227,95%CI:1.774~21.858)是ACI合并CAD的独立危险因素。颅内外动脉狭窄数量与冠状动脉狭窄程度(r=0.371,P<0.05)、冠状动脉狭窄数量(r=0.429,P<0.05)呈正相关。结论糖尿病、肌酐水平、颅内外动脉多支病变是脑梗死合并冠心病的独立危险因素。

Objective To explore the risk factors of acute cerebral infarction(ACI)patients with coronary artery disease(CAD).Methods This study used a retrospective study to enroll 245 patients with ACI.All patients underwent coronary CTA due to suspected coronary artery disease.According to the results of CTA,the patients were divided into two groups,CTA showed that the degree of stenosis of any main coronary artery≥50%was cerebral infarction with coronary artery disease group(ACI with CAD group),and<50%in the group of cerebral infarction(ACI group).Differences in clinical characteristics,laboratory examination,location and quantity of intracranial and extracranial artery were compared between the two groups.The correlation between intracranial and extracranial artery stenosis and coronary atherosclerotic stenosis was also analyzed.Results Univariate analysis showed that the male proportion,diabetes proportion,neutrophil count,glycosylated hemoglobin,triglyceride,creatinine level and the number of intracranial and extracranial artery stenosis in ACI group with CAD were significantly higher than those in ACI group(P<0.05).Univariate analysis showed that the number of intracranial and extracranial artery stenosis was more in ACI with CAD group,and the location of stenosis was more likely to be in the extracranial segment of internal carotid artery,extracranial segment of vertebral artery,intracranial segment of vertebral artery,basilar artery,middle cerebral artery and posterior cerebral artery(P<0.05).Logistic regression analysis showed that diabetes mellitus(OR=3.931,95%CI:1.476-10.467),creatinine level(OR=1.037,95%CI:1.005-1.069),and intracranial and extracranial artery multivessel disease(OR=6.227,95%CI:1.774-21.858)were independent risk factors of ACI with CAD.The number of intracranial and extracranial artery stenosis was positively correlated with the degree of coronary artery stenosis(r=0.371,P<0.05)and the number of coronary artery stenosis(r=0.429,P<0.05).Conclusion Diabetes mellitus,creatinine level and multiple branches of intracranial and extracranial arteries are independent risk factors of ACI with CAD group.