急性脑梗死患者侧支循环形成影响因素的Logistic回归分析

Logistic regression analysis on influencing factors of the collateral circulation formation in patients with acute cerebral infarction

目的 探讨急性脑梗死患者脑侧支循环形成的影响因素.方法 分析352例住院治疗行头颈部256层螺旋CT血管造影(CTA)检查的急性脑梗死患者的临床资料.依据头颈部CTA影像结果观察到的侧支循环形成情况,分为有侧支循环组和无侧支循环组,对两组患者的临床资料进行比较,采用单因素分析和多因素Logistic回归分析方法分析急性脑梗死患者侧支循环形成的影响因素.结果(1)352例急性脑梗死中,有侧支循环者197例(56.0%),无侧支循环者155例(44.0%).(2)单因素分析结果显示,年龄(t=-2.860,P=0.004)、高血压合并糖尿病(χ2=10.709,P=0.001)、既往短暂性脑缺血发作史(χ2=4.626,P=0.034)、低密度脂蛋白胆固醇(t=-2.176,P=0.030)、高同型半胱氨酸(t=2.885,P=0.004)、脑血管狭窄程度(Z=-5.936,P=0.000)、后循环病变(χ2=8.548,P=0.004)为侧支循环形成的影响因素.(3)多因素 Logistic 回归分析结果显示,高龄(OR=1.031,95%CI 为1.008~1.054,P=0.007)、高血压合并糖尿病(OR=2.009,95%CI为1.159~3.482,P=0.013)、高同型半胱氨酸(OR=1.023,95%CI为1.005~1.041,P=0.014)、后循环病变(OR=1.727,95%CI 为1.063~2.804,P=0.027)是急性脑梗死患者无侧支循环形成的相对独立危险因素.脑血管狭窄程度(OR=0.507,95%CI为0.389~0.661,P=0.000)、低密度脂蛋白胆固醇(OR=0.723,95%CI为0.532~0.982,P=0.038)为保护性因素.结论 高龄、高血压合并糖尿病、高同型半胱氨酸和后循环病变是急性脑梗死患者侧支循环形成的危险因素,脑血管血管狭窄程度和低密度脂蛋白胆固醇可促进侧支循环的形成.

Objective To explore the influencing factors of the collateral circulation formation in patients with acute cerebral infarction.Methods Three hundred and fifty-two patients with acute cerebral infarction were included in this study,the clinical date of their head and neck 256 slice spiral CT angiography (CTA)examination was analyzed.According to the formation of collateral circulation in the head and neck CTA imaging results,it is divided into the collateral circulation group and the non-collateral circulation group.The clinical data of the two groups were compared.The influencing factors of the formation of collateral circulation in patients with acute cerebral infarction were analyzed by single factor analysis and multivariate logistic regression analysis.Results (1)In 352 cases of acute cerebral infarction,197 cases(56.0%)had collaterals,155 cases (44.0%)had none collateral.(2)Single factor analysis showed that age(t=-2.860,P=0.004),hypertension combined with diabetes(χ2 = 10.709,P= 0.001),history of TIA(χ2 = 4.626,P= 0.034),low density lipoprotein(t=-2.176,P=0.030),high homocysteine(t=2.885,P=0.004),cerebral vascular stenosis(Z=-5.936,P=0.000),posterior circular lesions(χ2=8.548,P=0.004)were the influencing factors in the formation of collateral circulation.(3)Multivariate Logistic regression analysis showed that old age(OR=1.031;95%CI=1.008-1.054;P=0.007),hypertension combined with diabetes(OR= 2.009;95%CI=1.159-3.482;P=0.013),high homocysteine(OR=1.023;95%CI,1.005-1.041;P=0.014),circular lesions(OR=1.727;95%CI=1.063-2.804;P=0.027)were relatively independent risk factors in acute cerebral infarction patients with none circulation,the degree of cerebral vascular stenosis(OR=0.507;95%CI=0.389-0.661;P=0.000),low density lipoprotein(OR=0.723;95%CI=0.532-0.982;P=0.038)served as protective factor.Conclusion Old age,hypertension combined with diabetes,high homocysteine and posterior circulation lesions are risk factors for the formation of collateral circulation in patients with acute cerebral infarction,cerebral vascular stenosis degree and low density lipoprotein can promote the formation of collateral circulation.