小动脉闭塞性和大动脉粥样硬化性卒中的危险因素比较分析

Comparative Analysis of Risk Factors for Small Artery Occlusive and Large Artery Atherosclerotic Stroke

目的研究大动脉粥样硬化性(large artery atherosclerosis,LAA)卒中和小动脉闭塞性(small artery occlusion,SAO)卒中的危险因素差异,为该两型卒中的二级预防提供思路,进而改善卒中患者的预后。方法回顾性选择2019年1月—2020年12月就诊于西林县人民医院和深圳大学附属第三医院神经内科并确诊为急性缺血性脑卒中并检查完善的626例患者作为研究组,另选择同时期在本院进行体检的70名健康者作为对照组。按照TOAST分型标准,比较LAA和SAO患者的危险因素暴露率及暴露水平。结果3组高血压病史、糖尿病史、既往脑梗史、吸烟史、Hcy、糖化血红蛋白、低密度脂蛋白胆固醇、尿酸、空腹血糖、收缩压、舒张压比较,差异有统计学意义(P<0.05)。LAA组和SOA组高血压病史、糖尿病史、既往脑梗史、饮酒史例数及糖化血红蛋白、低密度脂蛋白胆固醇、尿酸、空腹血糖、收缩压、舒张压水平比较,差异无统计学意义(P>0.05),但LAA组吸烟史患者占比(86.41%)高于SOA组(57.56%),同型半胱氨酸水平高于SOA组,差异有统计学意义(χ^(2)=4.496,t=2.071,P<0.05)。结论LAA和SAO两种亚型卒中许多危险因素的暴露率和暴露水平存在一定的共同性,但也存在一些差异。LAA的吸烟史发生率和同型半胱氨酸水平显著高于SOA。危险因素的差异可能是导致不同卒中亚型的重要原因之一,这为两种重要卒中亚型的二级预防指出了预防的重点和方向。

Objective To study the differences in risk factors between large artery atherosclerosis(LAA)stroke and small artery occlusive(SAO)stroke,to provide ideas for secondary prevention of these two types of stroke,and thus im-prove the prognosis of stroke patients.Methods Retrospectively selected 626 patients who were admitted to the De-partment of Neurology of Xilin County People’s Hospital and the Third Affiliated Hospital of Shenzhen University from January 2019 to December 2020 with a confirmed diagnosis of acute ischemic stroke and perfect examination as the study group,and another 70 healthy individuals who underwent physical examination in our hospital during the same period as the control group.According to TOAST typing criteria The risk factor exposure rates and exposure lev-els of the patients with LAA and SAO were compared.Results The differences in the hypertension,diabetes mellitus,previous cerebral infarction,smoking,Hcy,glycated hemoglobin,LDL cholesterol,uric acid,fasting glucose,systolic blood pressure,and diastolic blood pressure were statistically significant(P<0.05).There was no statistically signifi-cant difference between LAA group and SOA group in terms of the number of cases of hypertension history,diabetes history,past cerebral infarction history,alcohol drinking history and levels of glycosylated hemoglobin,low-density li-poprotein cholesterol,uric acid,fasting blood glucose,systolic blood pressure and diastolic blood pressure(P>0.05),but the proportion of patients with smoking history in LAA group(86.41%)was higher than that in SOA group(57.56%),and the level of homocysteine was higher than that in SOA group,and the difference was statistically signifi-cant(χ^(2)=4.496,t=2.071,P<0.05).Conclusion The two subtypes of stroke,LAA and SAO,had some commonality in the exposure rates and exposure levels of many risk factors,but there were also some differences.The incidence of smoking history and homocysteine levels were significantly higher in the LAA than in the SOA.The differences in risk factors may be one of the important reasons for the different stroke subtypes,which points to the focus and direction of prevention in secondary prevention of the two important stroke subtypes.