有症状颅内动脉粥样硬化性狭窄的危险因素:前循环与后循环比较

Risk factors for symptomatic intracranial atherosclerotic stenosis:a comparison of anterior circulation and posterior circulation

目的探讨前循环和后循环有症状颅内动脉粥样硬化性狭窄(symptomatic intracranial atherosclerosis stenosis,sICAS)的危险因素。方法回顾性纳入河北省人民医院2019年5月至2020年5月期间因缺血性卒中或短暂性脑缺血发作(transient ischemic attack,TIA)行数字减影血管造影并确诊sICAS患者的临床资料。按狭窄部位分为前循环组和后循环组,分析sICAS的分布及其危险因素。结果共纳入134例sICAS患者,男性82例(61.2%),女性52例(38.8%);年龄(60.28±11.46)岁;缺血性卒中115例(85.8%),TIA 19例(14.2%);前循环组92例(68.7%),后循环组42例(31.3%)。后循环组体重指数、收缩压和舒张压水平以及高血压、糖尿病、吸烟和饮酒的患者构成比显著高于前循环组(P均<0.05)。多变量logistic回归分析显示,体重指数较高[优势比(odds ratio,OR)1.191,95%置信区间(confidence interval,CI)1.029~1.379;P=0.019]、高血压(OR 4.073,95%CI 1.135~14.616;P=0.031)和糖尿病(OR 2.783,95%CI 1.149~6.738;P=0.023)与后循环sICAS独立相关。结论相对于前循环,高体重指数、高血压和糖尿病是后循环sICAS的独立危险因素。

Objective To investigate the risk factors for anterior circulation and posterior circulation symptomatic intracranial atherosclerotic stenosis(sICAS).Methods The clinical data of patients admitted to Hebei General Hospital for ischemic stroke or transient ischemic attack(TIA)and diagnosed with sICAS by digital subtraction angiography from May 2019 to May 2020 were retrospectively included.The patients were divided into anterior circulation group and posterior circulation group according to the stenosis sites,and the distribution of sICAS and its risk factors were analyzed.Results A total of 134 patients with sICAS were enrolled,including 82 males(61.2%)and 52 females(38.8%).Their age was 60.28±11.46 years;115(85.8%)had ischemic stroke and 19(14.2%)had TIA.There were 92 patients(68.7%)in the anterior circulation group and 42(31.3%)in the posterior circulation group.Body mass index(BMI),systolic and diastolic blood pressure levels,as well as the proportion of patients with hypertension,diabetes,smoking and drinking in the posterior circulation group were significantly higher than those in the anterior circulation group(all P<0.05).Multivariate logistic regression analysis showed that higher BMI(odds ratio[OR]1.191,95%confidence interval[CI]1.029-1.379;P=0.019),hypertension(OR 4.073,95%CI 1.135-14.616;P=0.031)and diabetes(OR 2.783,95%CI 1.149-6.738;P=0.023)were independently correlated with the posterior circulation sICAS.Conclusions Compared with anterior circulation,high BMI,hypertension and diabetes are the independent risk factors for posterior circulation sICAS.