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缺血性脑卒中约占脑卒中80%左右,然而缺血性脑血管病的临床表现可从无症状到致死性表现,最初病情的严重性直接影响到病人的治疗及预后。因此调查影响缺血性脑卒中病情严重性的因素至关重要。目前,影响脑梗死病情严重性血管因素渐被报道,但颅内血管狭窄数目与病情严重性是否相关目前仍不明确。双侧颈内动脉及椎动脉四支主要血管供应脑部血流,脑梗死病人可呈现出不止一支颅内血管狭窄,双侧的颈内动脉或椎动脉狭窄在脑梗死中经常被发现,且研究[1]发现24%的人群中有一支椎动脉发育不良或不参与基底动脉供血。多支血管病变在临床上一直被忽视,评估多支血管病变对临床症状的影响尚不清楚,探讨狭窄的颅内动脉的数量与缺血性脑血管疾病严重程度的相关性至关重要。
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颅内动脉狭窄组病人的NIHSS评分、年龄、空腹血糖、总胆固醇、低密度脂蛋白均高于非狭窄组(P < 0.01)。但在性别、体质量指数、吸烟、家族史、血压、三酰甘油及高密度脂蛋白等方面,2组之间差异无统计学意义(P>0.05)(见表 1)。
危险因素 非狭窄组(n=46) 狭窄组(n=54) t P NIHSS评分/分 7.67±3.20 9.76±3.14 3.29 < 0.01 年龄/岁 59.41±11.41 66.02±11.20 2.92 < 0.01 男/女 22/24 30/24 0.60 >0.05 体质量指数/(kg/m2) 22.78±3.18 23.85±3.17 1.66 >0.05 血糖/(mmol/L) 6.12±1.72 7.36±2.32 3.06△ < 0.01 吸烟[n;百分率(%)] 13(28.30) 20(37.00) 0.87* >0.05 家族史[n;百分率(%)] 3(6.52) 5(9.26) 0.25* >0.05 收缩压/mmHg 142.59±18.60 148.67±20.72 1.53 >0.05 舒张压/mmHg 87.83±11.48 89.07±11.82 0.53 >0.05 总胆固醇/(mmol/L) 4.24±1.10 4.97±1.39 2.88 < 0.01 三酰甘油/(mmol/L) 1.83±1.32 1.86±1.32 0.11 >0.05 高密度脂蛋白/(mmol/L) 1.70±0.80 1.55±0.70 1.00 >0.05 低密度脂蛋白/(mmol/L) 3.28±1.16 4.32±1.50 3.83 < 0.01 *示χ2值; △示t′值 表 1 颅内动脉狭窄的单因素分析(x±s)
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不同颅内动脉狭窄数目病人的NIHSS评分差异均有统计学意义(P < 0.01),单支低于多支(P < 0.01),单支和双支、双支和多支NIHSS评分差异均无统计学意义(P>0.05)(见表 2)。
颅内动脉狭窄数目 n NIHSS评分/分 单支 24 7.75±3.61 双支 18 9.56±4.12 多支 12 12.75±6.31** F — 4.98 P — < 0.01 MS组内 — 20.123 q检验:与单支比较**P < 0.01 表 2 颅内动脉狭窄数目与脑梗死病情严重程度之间的关系(x±s)
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将影响颅内动脉狭窄单因素分析有统计学意义的指标及颅内动脉狭窄数目为自变量,颅内动脉狭窄脑梗死病人的病情严重程度为因变量,进行多因素logistic回归分析。结果表明年龄、颅内动脉狭窄数目及空腹血糖为缺血性脑卒中病情严重程度的危险因素(P < 0.05~P < 0.01)(见表 3)。
影响因素 β SE waldχ2 P OR(95%CI) 空腹血糖 0.853 1.327 3.786 < 0.05 1.643(1.004~3.572) 胆固醇 1.256 1.340 0.858 >0.05 1.295(0.243~2.657) 低密度脂蛋白 0.725 1.564 0.258 >0.05 2.014(0.158~3.643) 颅内动脉狭窄数目年龄 0.623 1.254 3.535 < 0.01 2.056(1.127~3.264) 年龄 0.045 0.013 10.620 < 0.01 1.143(1.034~2.207) 表 3 脑梗死病人病情严重程度影响因素的多因素分析
颅内动脉狭窄数目与脑梗死严重程度的相关性研究
Study on the correlation between the number of intracranial artery stenosis and severity of cerebral infarction
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摘要:
目的探讨颅内动脉狭窄数目与脑梗死的病情严重程度的相关性。 方法回顾性分析100例经头颅磁共振确诊的脑梗死病人;脑梗死的临床症状严重程度采用美国国立卫生研究院卒中量表(NIHSS评分量表)衡量;颅内狭窄的血管采用颈部MRA评估,统计双侧的颈内动脉和椎动脉狭窄血管的数目,分析颅内动脉狭窄数目与NIHSS评分之间的关系。 结果年龄、颅内动脉狭窄数目及空腹血糖为脑梗死病情严重程度的危险因素(P < 0.05~P < 0.01);不同颅内动脉狭窄的数目NIHSS评分差异有统计学意义(P < 0.01),单支低于多支(P < 0.01),单支和双支、双支和多支NIHSS评分差异无统计学意义(P>0.05)。 结论颅内动脉狭窄数目与脑梗死病情的严重程度显著相关,且为脑梗死病情的严重程度的独立危险因素。 Abstract:ObjectiveTo investigate the correlation between the number of intracranial artery stenosis and severity of cerebral infarction. MethodsThe clinical data of 100 patients with acute cerebral infarction were retrospectively analyzed.The clinical symptom severity and vascular stenosis of patients were evaluated using the national institutes of health stroke scale(NIHSS) and cervical MRA, respectively.The number of bilateral internal carotid artery and vertebral artery stenosis were counted, and the correlation between the number of intracranial artery stenosis and NIHSS score was analyzed. ResultsThe age, number of intracranial artery stenosis and fasting blood glucose were the risk factors of the severity of ischemic stroke(P < 0.05 to P < 0.01).The difference of the NIHSS score in patients with different number of intracranial artery stenosis was statistically significant(P < 0.01), and which in patients with single branch stenosis was lower than that in patients with multiple branches stenosis(P < 0.01), and the differences of the NIHSS score between single and double branches, and between double and multiple branches were not statistically significant(P>0.05). ConclusionsThe number of intracranial artery stenosis is significantly related to the severity of cerebral infarction, and the independent risk factor of the severity of cerebral infarction. -
表 1 颅内动脉狭窄的单因素分析(x±s)
危险因素 非狭窄组(n=46) 狭窄组(n=54) t P NIHSS评分/分 7.67±3.20 9.76±3.14 3.29 < 0.01 年龄/岁 59.41±11.41 66.02±11.20 2.92 < 0.01 男/女 22/24 30/24 0.60 >0.05 体质量指数/(kg/m2) 22.78±3.18 23.85±3.17 1.66 >0.05 血糖/(mmol/L) 6.12±1.72 7.36±2.32 3.06△ < 0.01 吸烟[n;百分率(%)] 13(28.30) 20(37.00) 0.87* >0.05 家族史[n;百分率(%)] 3(6.52) 5(9.26) 0.25* >0.05 收缩压/mmHg 142.59±18.60 148.67±20.72 1.53 >0.05 舒张压/mmHg 87.83±11.48 89.07±11.82 0.53 >0.05 总胆固醇/(mmol/L) 4.24±1.10 4.97±1.39 2.88 < 0.01 三酰甘油/(mmol/L) 1.83±1.32 1.86±1.32 0.11 >0.05 高密度脂蛋白/(mmol/L) 1.70±0.80 1.55±0.70 1.00 >0.05 低密度脂蛋白/(mmol/L) 3.28±1.16 4.32±1.50 3.83 < 0.01 *示χ2值; △示t′值 表 2 颅内动脉狭窄数目与脑梗死病情严重程度之间的关系(x±s)
颅内动脉狭窄数目 n NIHSS评分/分 单支 24 7.75±3.61 双支 18 9.56±4.12 多支 12 12.75±6.31** F — 4.98 P — < 0.01 MS组内 — 20.123 q检验:与单支比较**P < 0.01 表 3 脑梗死病人病情严重程度影响因素的多因素分析
影响因素 β SE waldχ2 P OR(95%CI) 空腹血糖 0.853 1.327 3.786 < 0.05 1.643(1.004~3.572) 胆固醇 1.256 1.340 0.858 >0.05 1.295(0.243~2.657) 低密度脂蛋白 0.725 1.564 0.258 >0.05 2.014(0.158~3.643) 颅内动脉狭窄数目年龄 0.623 1.254 3.535 < 0.01 2.056(1.127~3.264) 年龄 0.045 0.013 10.620 < 0.01 1.143(1.034~2.207) -
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