基于影像学诊断前、后循环脑梗死危险因素的比较分析

Comparative analysis of risk factors between anterior and posterior circulationterritory infarction based on radiological diagnosis

目的探讨不同部位(前、后循环)脑梗死危险因素是否存在差异。方法连续收集2013年1月至2014年12月发病并于太原市三所三甲医院神经内科住院的脑梗死患者病历资料,依据其头颅影像学检查将患者分为前、后循环脑梗死,分析两组患者之间危险因素的差异,二分类Logistic回归分析各危险因素与前、后循环脑梗死的关系。结果 2 678例患者纳入本研究,其中后循环脑梗死885例(33.05%),前循环脑梗死1 793例(66.95%)。糖尿病和高脂血症的构成比在后循环组显著高于前循环组(分别为32.9%vs.26.7%,P=0.001;47.0%vs.40.4%,P=0.002),而前循环组心房颤动的发生率显著高于后循环组(7.1%vs.4.6%,P=0.012)。多因素分析显示,相对于前循环脑梗死而言,后循环脑梗死显著相关的危险因素为糖尿病[优势比(odds ratio,OR)=1.295;95%置信区间(confidence interval,CI):1.079~1.555]和高脂血症(OR=1.275;95%CI:1.074~1.555);而目前吸烟(OR=0.826;95%CI:0.665~0.998)和心房颤动(OR=0.686;95%CI:0.468~0.993)与前循环脑梗死的关联性较后循环脑梗死更显著。结论前、后循环脑梗死之间危险因素存在差异,糖尿病、高脂血症与后循环脑梗死关系更密切,而吸烟和心房颤动倾向于前循环脑梗死。

Objective To investigate the association between the territory of ischemic stroke(posterior circulation versus anterior circulation) and risk factors. Methods Between January 2013 and December 2014, data of consecutive inpatient, with acute ischemic stroke, admitted to the Department of Neurology of three tertiary hospitals were collected. The infarctions were divided into anterior circulation territory and posterior circulation territory by computed tomography and/or magnetic resonance imaging. The association between risk factors and posterior(compared with anterior circulation infarction) were analyzed by binary logistic regression. Results 2 678 patients were included in the present study. There were 885 patients(33.05%) suffered posterior circulation ischemic stroke and 1 793 patients(66.95%) with anterior circulation ischemic stroke. The prevalence of diabetes mellitus and hyperlipidemia was significantly higher in posterior circulation ischemic stroke than anterior circulation ischemic stroke(32.9% versus 26.7%, P=0.001 and 47.0% versus 40.4%, P=0.002, respectively), while the proportion of atrial fibrillation was significantly higher in anterior circulation ischemic stroke than posterior circulation ischemic stroke(7.1% versus 4.6%, P=0.012). Multivariable analysis showed diabetes mellitus(odds ratio [OR]=1.295; 95% confidence interval [CI]: 1.079-1.555) and hyperlipidemia(OR=1.275; 95% CI: 1.074-1.555) were associated with posterior circulation ischemic stroke over anterior circulation ischemic stroke, while current smoking(OR=0.826; 95% CI: 0.665-0.998) and atrial fibrillation(OR=0.686; 95% CI: 0.468-0.993) were related an increased odds of anterior circulation ischemic stroke compared to posterior circulation ischemic stroke. Conclusions Risk factors between posterior and anterior circulation ischemic stroke were different. Diabetes mellitus and hyperlipidemia associated more with posterior circulation ischemic stroke than anterior circulation ischemic stroke, while current smoking and atrial fibrillation increased odds of anterior circulation ischemic stroke compared to posterior circulation ischemic stroke.