颅内外动脉粥样硬化相关因素的差异

doi:10.3969/j.issn.1673-5765.2018.05.009

摘要/Abstract

摘要：

目的探讨颅内外动脉粥样硬化的相关因素是否存在差异。方法在中国颅内动脉粥样硬化研究的数据库中，将患者分为4组：无显著颅内外动脉狭窄或闭塞组、单纯颅内动脉病变组、单纯颅外动脉病变组及颅内合并颅外动脉病变组。以无显著颅内外动脉狭窄或闭塞组作为参考，应用多元Logistic回归分析，评估颅内外动脉病变的相关因素。结果共入组2864例缺血性脑血管病患者，其中无显著颅内外动脉狭窄或闭塞组1388例（48.5%）、单纯颅内动脉病变组1074例（37.5%）、单纯颅外动脉病变组141例（4.9%）、颅内合并颅外动脉病变组261例（9.1%）。多因素分析显示，单纯颅内动脉病变的独立相关因素包括：白质病变[比值比（odds ratio，OR）1.359，95%（confidence interval，CI）1.109～1.666，P =0.0031] 、白细胞计数（OR 1.045， 95%CI 1.007～1.084，P =0.0210）、空腹血糖（OR 1.054，95%CI 1.009～1.101，P =0.0182）、高密度脂蛋白（OR 0.644，95%CI 0.480～0.864，P =0.0034）；单纯颅外动脉病变的独立相关因素包括：高龄（OR 1.047，95%CI 1.026～1.069，P <0.0001）、吸烟（OR 1.887，95%CI 1.212～2.937，P =0.0050）、既往缺血性脑血管病史（OR 2.260，95%CI 1.352～3.778，P =0.0019）和白质病变（OR 0.603，95%CI 0.394～0.922，P =0.0196）。颅内合并颅外动脉病变组独立相关因素包括：高龄（OR 1.022，95%CI 1.006～1.039，P =0.0064）、糖尿病（OR 1.494，95%CI 1.053～2.118，P =0.0244）和卒中家族史（OR 1.964，95%CI 1.302～2.961，P =0.013）。高同型半胱氨酸血症是3组共同的独立相关因素。结论颅内外动脉粥样硬化病变的相关因素可能存在差异。白细胞计数、空腹血糖、高密度脂蛋白水平低与颅内动脉粥样硬化病变相关；高龄、吸烟、既往缺血性脑血管病史与颅外动脉粥样硬化相关。高同型半胱氨酸血症是颅内外动脉病变的共同相关因素。

文章导读： 本研究对中国颅内动脉粥样硬化研究的数据库患者颅内外动脉狭窄相关因素进行了回顾性分析，结果显示国人颅内外动脉狭窄相关的因素有所不同，其中高同型半胱氨酸血症是两者共同的危险因素。

关键词: 缺血性卒中; 颅内动脉粥样硬化; 相关因素; 危险因素

Abstract:

Objective To explore the differences in Related factors between intracranial and extracranial atherosclerosis. Methods From the Chinese Intracranial Atherosclerosis Study (CICAS), all the enrolled patients were divided into four groups: no significant intracranial or extracranial atherosclerosis group, only intracranial atherosclerosis group, only extracranial atherosclerosis group, and intracranial and extracranial atherosclerosis group. With no significant intracranial or extracranial atherosclerosis group as control, the logistic regression analysis was used to assess the possible factors associated with intracranial or extracranial atherosclerosis. Results Of 2864 patients, 1388 (48.5%) had no significant intracranial or extracranial atherosclerosis, 1074 (37.5%) had only intracranial atherosclerosis, 141 (4.9%) had only extracranial atherosclerosis, and 261 (9.1%) had intracranial and extracranial atherosclerosis. Multi-factors analysis showed that independent factors associated with intracranial atherosclerosis were white matter lesions [odds ratio (OR) 1.359, 95% confidence interval (CI) 1.109-1.666, P =0.0031], leukocyte count (OR 1.045, 95%CI 1.007-1.084, P =0.0210), fasting blood glucose (OR 1.054, 95%CI 1.009-1.101, P =0.0182), and high density lipoprotein (OR 0.644, 95%CI 0.480-0.864, P =0.0034); Independent factors associated with extracranial atherosclerosis were senior age (OR 1.047, 95%CI 1.026-1.069, P <0.0001), smoking (OR 1.887, 95%CI 1.212-2.937, P =0.0050), previous history of ischemic cerebrovascular disease (OR 2.260, 95%CI 1.352-3.778, P =0.0019), and leukoaraiosis (OR 0.603, 95%CI 0.394-0.922, P =0.0196). Senior age (OR 1.022, 95%CI 1.006-1.039, P =0.0064), diabetes mellitus (OR 1.494, 95%CI 1.053- 2.118, P =0.0244) and family history of stroke (OR 1.964, 95%CI 1.302-2.961, P =0.013) were the independent factors of intracranial and extracranial atherosclerosis. Hyperhomocysteinemia was a common independent factor in the three groups. Conclusion The related factors may have differences between intracranial and extracranial atherosclerotic lesions. Leucocyte count, fasting blood glucose, and high-density lipoprotein are associated with intracranial atherosclerotic lesions; while age, smoking and history of ischemic cerebrovascular disease are associated with extracranial atherosclerosis. Hyperhomocysteinemia is the common independent factor of intra-and extracranial lesions.

Key words: Ischemic stroke; Intracranial atherosclerosis; Related factor; Risk factor

濮月华, 邹昕颖, 王伊龙, 潘岳松, 向祥龙, 苏霭欣, 梁慧康, 赵性泉, 王春雪, 黄家星, 王拥军, 刘丽萍. 颅内外动脉粥样硬化相关因素的差异[J]. 中国卒中杂志, 2018, 13(05): 455-462.

PU Yue-Hua, ZOU Xin-Ying, WANG Yi-Long, PAN Yue-Song, XIANG Xiang-Long, Yannie Oi-Yan SOO, Thomas Wei-hong Leung, ZHAO Xing-Quan, WANG Chun-Xue, WONG Ka Sing, WANG Yong-Jun, LIU Li-Ping. Differences in Related Factors of Intracranial and Extracranial Atherosclerosis[J]. Chinese Journal of Stroke, 2018, 13(05): 455-462.

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