大动脉炎合并脑梗死的影像特征及危险因素分析

Imaging features and risk factors for cerebral infarction in Takayasu arteritis

目的:分析大动脉炎(TA)患者脑梗死的特征,并探讨TA患者发生脑梗死的危险因素。方法 :回顾性分析2015年6月至2021年10月,北京安贞医院128例确诊TA的住院患者的临床及影像资料,根据有无脑梗死分为脑梗死组(32例)和无脑梗死组(96例)。比较两组患者的临床及影像资料。分析TA患者发生脑梗死的危险因素。结果 :32例患者(25%)存在脑梗死,其中21例为急性或慢性脑梗死,11例为无症状腔隙性脑梗死。TA脑梗死组临床活动度评分(ITAS 2010及ITAS-A)较非脑梗死组高(9 vs.8,10 vs.5, P=0.003,P=0.013)。脑梗死组患者合并高血压(50%vs.25%P=0.009)及高脂血症(56%vs.28%,P=0.004)的比例较无脑梗死组患者高。脑梗死组患者颅内动脉受累的比例较无脑梗死组患者高(62.5%vs.26%,P <0.001),且最常受累的血管是颈内动脉颅内段及大脑中动脉,以重度狭窄或闭死为主,差异有统计学意义。脑梗死最常见的部位为额顶叶及基底节区。多元Logistic回归分析表明,高脂血症(OR=3.286,95%CI:1.435~7.521, P=0.005)、颅内动脉受累(OR=3.831, 95%CI:1.585~9.262, P=0.003)、大脑中动脉受累(OR=7.517, 95%CI:1.302-43.393, P=0.024)与TA患者脑梗死显著相关。结论 :TA患者脑梗死并不少见,少数为无症状性腔隙性脑梗死,最常发生的部位是额、顶叶及基底节区。高脂血症、颅内动脉受累及大脑中动脉受累是TA患者脑梗死的危险因素。

Objective: To analyze the characteristics of cerebral infarction in patients with Takayasu ′ s arteritis(TA) and to determine the risk factors for cerebral infarction in TA patients. Methods: Retrospectively analyzed the clinical and imaging data of 128 hospitalized TA patients in Beijing Anzhen Hospital from June 2015 to October 2021.Patients were divided into cerebral infarction group(n =32) and non-cerebral infarction group(n =96) according to the presence or absence of cerebral infarction. Compared the clinical and imaging data between 2 groups. Analyze the risk factors for cerebral infarction in TA patients.Results:Cerebral infarction was present in 32 TA patients(25%), 21 patients with ischemic stroke,including acute cerebral infarction and chronic cerebral infarction, and 11 patients with asymptomatic lacunar cerebral infarction. The Indian Takayasu Clinical Activity Score(ITAS 2010 and ITAS-A) in 2010 of infarction group was higher than non-infarction group(9 vs.8, P = 0.003 and 10 vs.5, P= 0.013). The proportion of hypertension(50% vs.25%, P=0.009) and hyperlipidemia(56% vs.28%,P=0.004) in the cerebral infarction group was higher than the non-cerebral infarction group. The proportion of intracranial artery involvement in patients with cerebral infarction was higher than the non-cerebral infarction group(62.5%vs.26%, P< 0.001). The most common involved vessels were the intracranial segment of the internal carotid artery and the middle cerebral artery, mainly severe stenosis or occlusion. The differences had statistical significance. The most common sites of cerebral infarction are frontoparietal lobe and basal ganglia. Binary logistic regression analysis indicated that hyperlipidemia(OR= 3.286, 95% CI:1.435 –7.521, P = 0.005), intracranial artery involvement(OR= 3.831, 95% CI: 1.585 – 9.262, P= 0.003),middle cerebral artery involvement(OR= 7.517, 95% CI: 1.302-43.393, P= 0.024) were significantly associated with cerebral infarction in TA patients. Conclusions: Cerebral infarction is not rare in TA patients,a few are silent lacunar infarcts. The most common sites of cerebral infarction are the frontal, parietal and basal ganglia.Hyperlipidemia, intracranial artery involvement and middle cerebral artery involvement are independent risk factors for cerebral infarction in patients with TA.