复旦大学附属华山医院  赵鸿琛 王亮 董强 吴征瑜 周磊 张扬

【摘 要】目的  研究已公认的卒中危险因素（性别、年龄、BMI指数、高血压、糖尿病、高血脂、冠心病、吸烟、酗酒等）在脑梗死合并或不合并颅内外大血管病变患者中的分布情况。方法  回顾性统计2006年3月至2008年6月在华山医院神经内科诊治的脑梗死患者的一般信息、卒中危险因素、头颈部血管影像学资料，并对上述患者根据头颈部血管影像学资料（B超、CTA、MRA及DSA）对其是否合并有责任大血管狭窄进行分组；应用单因素χ2检验分析各个危险因素在不同分组间的差异，并对危险因素与不同血管病变分组之间的相关性进行多元logistic回归分析。结果  在纳入的304例患者中，腔隙性脑梗死（Lacunar stroke, Lac-s）患者95例，大动脉粥样硬化性脑梗死（Large artery artherosclerosis stroke, LAA-s）209例；209例LAA-s患者分为47例脑梗死合并非责任大血管病变（Stroke with none-criminal artery artherosclerosis, None-CAA-s）和162例脑梗死合并责任大血管病变（Stroke with criminal artery artherosclerosis, CAA-s）；162例CAA-s患者中脑梗死合并颅内责任血管病变（Stroke with intracranial criminal artery artherosclerosis, ICAA-s）（55.56%）多于合并颅外责任血管病变（Stroke with extracranial criminal artery artherosclerosis, ECAA-s）（44.44%）。在Lac-s组和LAA-s组之间，年龄>65岁与LAA-s具有更密切的相关性，年龄>65岁的患者发生LAA-s的风险比Lac-s高2倍；在吸烟人群中，这种风险增高2.3倍；对血糖水平的分层分析发现，血糖稳定机制异常患者发生LAA-s的风险比Lac-s高将近2.8倍，而糖尿病人群中这种风险增高2.3倍，其他卒中危险因素在两组间的分布未见统计学差异（P>0.05）。在None-CAA-s组和CAA-s组之间，卒中危险因素的分布未见统计学差异（P>0.05）。在ECAA-s组和ICAA-s组，男性与ECAA-s组相关性更加密切（P=0.001，OR=0.15），男性发生ECAA-s的风险是发生ICAA-s的6.7倍；虽然糖尿病未能显示在两组间的差异，但是血糖增高的患者却显示出与ICAA-s的高风险（P=0.012，OR=2.61），在血糖增高的人群中，发生ICAA-s的风险是发生ECAA-s的2.6倍，其他卒中危险因素在两组间的分布未见统计学差异（P>0.05）。结论 在脑梗塞中，年龄>65岁、吸烟和糖尿病患者更容易发生大动脉粥样硬化性脑梗塞，性别、肥胖、冠心病史、卒中史、卒中家族史、酗酒、高血压、血脂异常等明确的卒中危险因素在腔隙性脑梗死和大动脉粥样硬化性脑梗死之间的分布没有明显差异；脑梗死合并责任/非责任大血管病变患者中上述所有的卒中危险因素没有显著差异；血糖的异常增高的带来脑梗死合并颅内大血管风险的增高，男性卒中患者更加容易发生颅外大血管责任性病变。由于存在选择性偏倚以及动脉病变检测方法不足等原因，研究结论尚需要进一步的研究进行证实，为卒中的分层治疗和预防提供依据。

【关键词】  脑梗塞；危险因素；动脉粥样硬化


Retrospective study of the relevant risk factors in the cerebral infarction patients with intra/extra-cranial artherosclerosis

Zhao Hongchen, Wang Liang Dong Qiang, Zhou Lei, Wu Zhengyu, Zhang Yang
Department of Neurology Huashan Hospital Fudan University

【Abstract】Purpose：It is generally acknowledged that age, sex, obesity, hypertension, diabetes, hyperlipidemia, coronary artery disease, smoke and alcoholism are risk factors of ischemic stroke. This study is aimed to evaluate the distribution of these risk factors among the stroke patients with or without large artery artherosclerosis intracerebral/extracerebral.Method： Patients with ischemia stroke admitted to neurology department of Huashan hospital were reviewed with their data, including general information, medical history, risk factors of stroke and angiographic images; According to the angiographic images, the patients were classified into subtypes as lacunar stroke, large artery artherosclerosis stroke, stroke with none-criminal artery artherosclerosis, stroke with criminal artery artherosclerosis, stroke with intracranial criminal artery artherosclerosis and stroke with extracranial criminal artery artherosclerosis. Risk factor differences among subtypes were examined with theχ2 test or CMHχ2 test for significance. The multiple logistic regression analysis was also employed to evaluate the interrelationship among subtypes and risk factors. Results：Of 304 patients, there were 95 lacunar stroke patients and 209 LAA-s patients, which included 47 None-CAA-s patients and 162 CAA-s patients;  In the group of CAA-s patients, there were more ICAA-s patients(55.56%) than ECAA-s(44.44%) ones. Between Lac-s and LAA-s, increased risk for LAA-s was associated with the age(>65y)(P=0.018, OR=2.07), smoke(P=0.013, OR=2.33) and hyperglycemia(P=0.005, OR=1.57); With patients above the age of 65, the risk for large artery artherosclerosis stroke was twice that of lacunar stroke; With smokers, the risk for large artery artherosclerosis stroke was 2.3 times that of lacunar stroke; With patients of hyperglycemia , the risk for large artery artherosclerosis stroke was 1.5 times that of lacunar stroke; However, other target risk factors didn’t show significant differences, and neither did all factors between None-CAA-s and CAA-s(P>0.05). Between ECAA-s and ICAA-s, decreased risk for ICAA-s was associated with male(P=0.001, OR=0.15), and increased risk for ICAA-s was associated with hyperglycemia(P=0.012, OR=2.61), none the less, diabetes didn’t raise the risk for either subtype(P>0.05).Conclusion：Risk factors like age (above 65), smoking and hyperglycemia would increase the danger for large artery artherosclerosis stroke, compared with lacunar stroke. Other stroke risk factors, such as sex, obesity, history of coronary artery disease and stroke, hypertension, serum lipid sequence abnormal, did not make much difference between lacunar stroke and large artery artherosclerosis stroke. There was no significant diversity between strokes with and without criminal artery artherosclerosis. The male members are more likely to suffer from stroke with extracranial artery artherosclerosis, while hyperglycemia sufferers tend to catch stroke with intracranial artery artherosclerosis.
【Key words】cerebral infarction; artherosclerosis; risk factors