伴后循环粥样硬化性狭窄的急性缺血性脑卒中进展的危险因素研究

Risk Factors for Progression of Acute Ischemic Stroke With Posterior Circulation Atherosclerotic Stenosis

目的研究伴后循环粥样硬化性狭窄的急性缺血性脑卒中进展加重的危险因素。方法调取本院2016年1月—2020年2月期间260例经脑血管CTA/MRA及头颅MRI确诊的伴有后循环ICAS的AIS患者资料,采用卒中量表(national institutes of health stroke scale,NIHSS)为评估依据,以患者入院3天内是否出现进展性神经功能障碍(progressive neurological dysfunction,PND)为评判标准,将260例患者分为PND和非PND两组,患者人数比例为180:80,分析两组患者中基础特征的差异来筛查伴颅内动脉粥样硬化(intracranial atherosclerotic stenosis,ICAS)的AIS急性加重的危险因素,同时运用多因素逻辑回归方法,分析影响伴后循环粥样硬化性狭窄的急性缺血性脑卒中显著和主要危险因素。结果具有高龄(60岁以上)、糖尿病、高血压、吸烟、Willis环缺如、椎基底动脉中重度狭窄、单侧椎动脉供血等特征的伴ICAS的AIS患者出现病情恶化的患者人数更多(P<0.05)。结论多因素回归分析结果显示,糖尿病、椎基底动脉中重度狭窄、Willis环缺如可以显著预测患者的进展性神经功能障碍,高血压对患者进展性神经功能障碍的预测呈边缘显著,这表明在这些因素中,糖尿病、椎基底动脉中重度狭窄、Willis环缺如、高血压是是伴后循环ICAS的急性缺血性脑卒中进展加重的主要危险因素。

Objective To investigate the risk factors for progression of acute ischemic stroke with posterior circulation atherosclerotic stenosis.Methods Data of 260 cases of AIS patients with posterior cycling ICAS confirmed by cerebro-vascular CTA/MRA and cranial MRI in our hospital from January 2016 to February 2020 were collected.The national institutes of health stroke scale(NIHSS)was used as the evaluation basis,and whether the patients presented progressive neurological dysfunction(PND)within 3 days of admission was the evaluation criteria.260 patients were divided into PND unit and the PND unit in the two groups,the proportion of patients was 180:80,the different characteristics of the analysis of the two groups of patients to screening with intracranial atherosclerosis(intracranial atherosclerotic stenosis,ICAS)of the risk factors of acute exacerbation of AIS,and at the same time using multiariable logistic regression method,analysis of the impacts on the circulation of atherosclerotic stenosis with acute ischemic stroke and major risk factors.Results The number of patients with AIS with ICAS with advanced age(over 60 years old),diabetes,hypertension,smoking,absence of the circle of Willis,moderate and severe vertebral basilar artery stenosis,and unilateral vertebral artery blood supply was higher(P<0.05).Conclusion Multiple factors regression analysis results show that diabetes,vertebral basilar artery moderately severe stenosis,Willis ring is absent can significantly predict advanced neural dysfunction,in patients with high blood pressure in patients with advanced prediction of neural dysfunction in edge significantly,indicating that in these factors,diabetes,vertebral basilar artery moderately severe stenosis,Willis ring is absent,high blood pressure is associated with posterior circulation of ICAS major risk factor for acute ischemic stroke progress is aggravating.