单纯颅内动脉狭窄性缺血性脑血管病预后评估

doi:10.3969/j.issn.1673-5765.2017.11.007

摘要/Abstract

摘要：

目的探讨单纯颅内动脉狭窄性缺血性脑血管病1年卒中复发的影响因素。方法筛选经数字减影血管造影（digital subtraction angiography，DSA）证实存在单纯颅内动脉粥样硬化性狭窄的缺血性脑血管病患者86例，随访1年，将卒中事件作为终点事件。分析颅内动脉狭窄的分布特征，Cox回归模型分析年龄、性别、高血压、高血脂、糖尿病、吸烟、饮酒、超敏C反应蛋白（high sensitive C reactive protein，hsCRP）、动脉狭窄数目、动脉狭窄程度、前后循环狭窄、缺血类型、冠状动脉粥样硬化性心脏病史、缺血性脑血管病史等对终点事件的影响。结果结果显示颅内动脉狭窄好发于大脑中动脉（35.51%），80例符合入组标准的患者完成1年随访。多因素Cox回归分析显示：年龄≥60岁[危险比（risk ratio，RR）2.628，95%可信区间（confidence interval， CI）1.066～6.478，P =0.036] 、女性（RR 2.645，95%CI 1.133～6.178，P =0.025）、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分＞1（RR 3.644，95%CI 1.280～10.369， P =0.015）和多发性颅内动脉狭窄（RR 2.712，95%CI 1.048～7.019，P =0.040）是终点事件的危险因素。结论年龄、性别、NIHSS评分和颅内动脉狭窄数目可能是颅内动脉狭窄性缺血性脑血管病患者1年内再发卒中事件的独立危险因素。

文章导读： 通过对单纯颅内动脉狭窄患者数目可能是其1年内再发卒中事件的独立危险因素，是评估其预后的重要预测指标。

关键词: 颅内动脉狭窄; 缺血性脑血管病; 数字减影血管造影; 危险因素; 预后

Abstract:

Objective To explore the influence factors of one-year stroke recurrence in patients with ischemic cerebrovascular disease of symptomatic isolated intracranial arterial stenosis. Methods A total of 86 patients with symptomatic isolated intracranial atherosclerotic stenosis confirmed by the digital subtraction angiography (DSA) were followed up for 1 year. The major outcome was stroke events. The characteristics of distribution of intracranial arterial stenosis were analyzed. The multiple Cox regression analysis was used to evaluate the association between the risk factors including age, gender, hypertension, diabetes, smoking, drinking alcohol, high sensitive creative protein (hsCRP), number of arteriostenosis, stenosis degree, anterior and posterior circulation, ischemia types, history of atherosclerosis of coronary artery, ischemic cerebrovascular diseases, and the outcome. Results The results showed that intracranial artery stenosis mostly occurred in the middle cerebral artery (35.51%). A total of 80 patients who met the criteria were followed up for 1 year. Multifactors Cox regression analysis showed that age≥60 years old [risk ratio (RR) 2.628, 95% confidence interval (CI) 1.066-6.478, P =0.036], female (RR 2.645, 95%CI 1.133-6.178, P =0.025), National Institutes of Health Stroke Scale (NIHSS) score >1 (RR 3.644, 95%CI 1.280-10.369, P =0.015) and multiple intracranial arterial stenosis (RR 2.712, 95%CI 1.048-7.019, P =0.040) were risk factors of endpoint events .

Conclusion Age, gender, NIHSS score and the number of intracranial arterial stenosis of patients with ischemic cerebrovascular disease of symptomatic isolated intracranial arterial stenosis may be the predictors of stroke recurrence within one year.

Key words: Intracranial arterial stenosis; Ischemic cerebrovascular disease; Digital subtraction angiography; Risk factors; Prognosis

邵晓军，杨静，王遐，张晨. 单纯颅内动脉狭窄性缺血性脑血管病预后评估[J]. 中国卒中杂志, 2017, 12(11): 1005-1009.

SHAO Xiao-Jun, YANG Jing, WANG Xia, ZHANG Chen. Prognosis Evaluation of Patients with Symptomatic Isolated Intracranial Arterial Stenosis of Ischemic Cerebrovascular Disease[J]. Chinese Journal of Stroke, 2017, 12(11): 1005-1009.

参考文献

[1] SCHUMACHER H C，KHAW A V，MEYERS P M，

et al. Intracranial angioplasty and stent placement

for cerebral atherosclerosis[J]. J Vasc Interv Radiol，

2004，15（1Pt2）：S123-S132.

[2] WONG K S，LI H，CHAN Y L，et al. Use of

transcranial Doppler ultrasound to predict outcome

in patients with intracranial large-artery occlusive

disease[J]. Stroke，2000，31（11）：2641-2647.

[3] The SSYLVIA Study Investigators. Stenting of

symptomatic atheroscleroticlesions in the vertebral

or intracranial arteries（SSYLVIA）：study results[J].

Stroke，2004，35（6）：1388-1392.

[4] Warfarin-Aspirin Symptomatic Intracranial Disease

（WASID） Trial Investigators. Design，progress

and challenges of a double-blind trial of warfarin

versus aspirin for symptomatic intracranial arterial

stenosis[J]. Neuroepidemiology，2003，22（2）：106-

117.

[5] BUSKENS E，NEDERKOORN P J，BUIJS-VANDER-

WOUDE T，et al. Imaging of carotid arteries

in symptomatic patients：cost-effectiveness of

diagnostic strategies[J]. Radiology，2004，233（1）：

101-112.

[6] 中华神经科学会中华神经外科学会. 各类脑血管

疾病诊断要点[J]. 中华神经科杂志，1996，29（6）：

379-380.

[7] SAMESHIMA T，FTAM I S，MORITA Y，et al.

Clinical usefulness of and problems with threedimensional

CT angiography for the evaluation

of arteriosclerotic stenosis of the carotid artery：

comparison with conventional angiography，MRA，

and ultrasound Sonograpy[J]. Surg Neurol，1999，51

（3）：301-309.

[8] WITYK R J，LEHMAN D，KLAG M，et al. Race

and sex differences in the distribution of cerebral

atherosclerosis[J]. Stroke，1996，27（11）：1974-1980.

[9] KIM J S，BONOVICH D. Research on intracranial

atherosclerosis from the east and west：why are the

results different?[J]. J Stroke，2014，16（3）：105-113.

[10] KASNER S E，CHIMOWITZ M I，LYNN M J，et

al. Predictors of Ischemic Stroke in the Territory

of a Symptomatic Intracranial Arterial Stenosis[J].

Circulation，2006，113（4）：555-563.

[11] ASIL T，BALCI K，UZUNCA I，et al. Six-month

follow-up study in patients with symptomatic

intracranial arterial stenosis[J]. J Clin Neurosci，

2006，13（9）：913-916.

[12] KANG J，KIM N，PARK T H，et al. Early statin

use in ischemic stroke patients treated with

recanalization therapy：retrospective observational

study[J/OL]. BMC Neurol，2015，15：122-131. DOI

10.1186/s12883-015-0367-4. https://bmcneurol.

biomedcentral.com/track/pdf/10.1186/s12883-015-

0367-4?site=bmcneurol.biomedcentral.com.

[13] GUPTA R，AL-ALI F，THOMAS A J，et al. Safety，

feasibility，and short-term follow-up of drug-eluting

stent placement in the intracranial and extracranial

circulation[J]. Stroke，2006，37（10）：2562-2566.

[14] ROTHWELL P M，ELIASZIW M，GUTNIKOV S

A，et al. Endarterectomy for symptomatic carotid

stenosis in relation to clinical subgroups and timing

of surgery[J]. Lancet，2004，363（94）：915-924.

[15] SCHULZ U G，ROTHWELL P M. Sex differences

in carotid bifurcation anatomy and the distribution

of atherosclerotic plaque[J]. Stroke，2001，32（7）：

1525-1531.

[16] MESSE S R，KASNER S E，MEHTA Z，et al.

Effect of body size on operative risk of carotid

endarterectomy[J]. J Neurol Neurosurg Psychiatry，

2004，75（12）：1759-1761.

[17] FERRARIS V A，HARRAH J D，MORITZ D M，

et al. Long-term angiographic results of coronary

endarterectomy[J]. Ann Thorac Surg，2000，69（6）：

1737-1743.

[18] WILLIAMS J E，CHIMOWITZ M I，COTSONIS

G A，et al. Gender Differences in Outcomes Among

Patients With Symptomatic Intracranial Arterial

Stenosis[J]. Stroke，2007，38（7）：2055-2062.

[19] 范常锋，黄一宁. 2711例社区居民脑血管狭窄的流行

病学调查[J]. 中华老年心脑血管病杂志，2007，9（1）：

36-38.

[20] KIM Y D，CHOI H Y，JUNG Y H，et al. Classic risk

factors for atherosclerosis are not major determinants

for location of extracranial or intracranial cerebral

atherosclerosis[J]. Neuroepidemiology，2009，32（3）：

201-207.

[21] OLHABERRIAGUE L D，LITVAN I，MITSIAS P，

et al. A reappraisal of reliability and validity studies

in stroke[J]. Stroke，1996，27（12）：2331-2336.

[22] LEE K B，LEE J Y，CHOI N，et al. Association

between insufficient medication of antihypertensives

and the severity of acute ischemic stroke[J/OL].

Clin Hypertens，2016，12：11-16. DOI 10.1186/

s40885-016-0047-8. https://clinicalhypertension.

biomedcentral.com/articles/10.1186/s40885-016-

0047-8.