颅内前后循环缺血性卒中危险因素、卒中机制和梗死模式的对比分析

Comparison analysis of risk factors, stroke mechanisms and infarct patterns between intracranial anterior and posterior circulation in ischemic stroke patients

目的探讨颅内前后循环动脉粥样硬化性狭窄致缺血性卒中(IS)患者危险因素、卒中机制和梗死模式的差异。方法回顾性连续纳入2014年12月—2017年12月于我院神经内科住院的颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis,ICAS)致IS的患者257例。依据责任血管的位置,分为前循环组170例和后循环组87例。收集患者的临床资料,分析比较2组患者危险因素、卒中机制和梗死模式的特点及差异。结果 (1)前循环组中男性、吸烟史比例高于后循环组,而高血压和糖尿病比例、糖化血红蛋白(HbA1c)水平低于后循环组(均P<0.05)。二分类Logistic回归分析显示,高血压、糖尿病、高HbA1c水平是颅内后循环动脉粥样硬化性狭窄致IS的独立危险因素。(2)卒中机制的分布,前循环组低灌注和混合机制的构成比高于后循环组,而穿支动脉闭塞低于后循环组(均P<0.05)。(3)梗死模式的分布,前循环组单发皮质-皮质下梗死的构成比高于后循环组,而单发皮质下梗死的构成比低于后循环组(均P<0.05)。结论颅内前后循环IS存在危险因素、卒中机制和梗死模式的差异。针对不同部位的血管制定不同的防治策略,可能有利于减少相关IS的发生。

Objective To investigate risk factors,stroke mechanisms and infarct patterns of anterior and posterior circulation in ischemic stroke(IS)patients caused by intracranial atherosclerotic stenosis(ICAS).Methods Data of 257 ICSA related IS patients admitted to the department of neurology in our hospital were retrospectively collected from December 2014 to December 2017.According to the location of responsible vessel,all patients were divided into anterior circulation group(n=170)and posterior circulation group(n=87).The clinical data of those patients were collected.The risk factors,stroke mechanisms and infarct patterns were analyzed and compared between the two groups.Results(1)The proportion of male and smoking history was separately higher in anterior circulation group than that in posterior circulation group,while the proportion of hypertension and diabetes,and the level of HbA1 c were lower in anterior circulation group than those of posterior circulation group(P<0.05).Binary logistic regression analysis revealed that hypertension,diabetes and high level of HbA1 c were independent risk factors for IS patients caused by intracranial posterior circulation atherosclerotic stenosis.(2)The proportion of hemodynamic impairment and multiple mechanisms were higher in anterior circulation group than those of posterior circulation group,but the proportion of local branch occlusion was lower in anterior circulation group than that of posterior circulation group(P<0.05).(3)The proportion of single corticosubcortical infarction was higher in anterior circulation group than that of posterior circulation group,however,the proportion of single subcortical infarction was lower than posterior circulation group(P<0.05).Conclusion There are differences in risk factors,stroke mechanisms and lesion patterns between anterior and posterior circulation in IS patients caused by ICAS.The development of different control strategies for different parts of blood vessels may be beneficial to reduce the occurrence of related IS.