首发缺血性卒中患者无症状性腔隙性梗死严重程度的相关因素分析

中国卒中杂志 ›› 2015, Vol. 10 ›› Issue (10): 861-866.

首发缺血性卒中患者无症状性腔隙性梗死严重程度的相关因素分析

张长青，王伊龙，王春雪，赵性泉，王拥军

1北京首都医科大学附属北京天坛医院神经病学中心脑血管病科
2国家神经系统疾病临床医学研究中心
3首都医科大学附属北京天坛医院神经精神医学与临床心理科
4首都医科大学附属北京天坛医院临床试验与临床研究中心
5首都医科大学附属北京天坛医院神经病学中心

收稿日期:2015-06-22 出版日期:2015-10-20 发布日期:2015-10-20
通讯作者: 王拥军 yongjunwang1962@gmail.com
基金资助:
国家科技支撑计划-脑血管病急性期诊疗技术规范化应用和医疗质量评价与持续改进技术研究（2011BAI08B02）
北京市科技计划- 缺血性脑血管病患者二级预防、康复技术的综合疾病管理模式的推广（Z131100002613005）

Risk Factors of Silent Lacunar Infarction in First-ever Ischemic Stroke Patients

Received:2015-06-22 Online:2015-10-20 Published:2015-10-20

摘要/Abstract

摘要：

目的分析与无症状性腔隙性梗死严重程度相关的危险因素，并评价无症状性腔隙性梗死与缺血性卒中病因亚型的相关性。方法连续选取791例7天以内首次发病的非心源性缺血性卒中患者。收集患者的人口学信息和血管病的危险因素，评价患者的头颅磁共振成像包括无症状性腔隙性梗死的数量、脑白质疏松的严重程度、缺血性卒中的病因亚型以及急性梗死灶的分布特征，并通过多元Logistic回归分析其与无症状性腔隙性梗死相关的危险因素。结果 296例患者（37.4%）伴无症状性腔隙性梗死。单因素分析发现：高龄、高血压、入院时血压较高、糖尿病、脑出血病史、Fazekas评分≥3分、小动脉闭塞性卒中、单发梗死灶、无小的皮层梗死灶、无分水岭梗死和流域性梗死与无症状性腔隙性梗死患病相关。多元Logistic回归发现：男性、高血压、较高的舒张压、糖尿病、脑出血病史、Fazekas评分≥3分、小动脉闭塞性卒中是无症状性腔隙性梗死患病的危险因素。结论首发非心源性缺血性卒中患者无症状性腔隙性梗死的患病率较高。伴无症状性腔隙性梗死的首发非心源性缺血性卒中患者常有较重的脑白质疏松，并且所患缺血性卒中以小动脉闭塞性卒中常见。

文章导读： 本研究发现首发非心源性缺血性卒中患者无症状性腔隙性梗死的患病率较高。伴无症状性腔隙性梗死的首发非心源性缺血性卒中患者常有较重的脑白质疏松，并且以小动脉闭塞性卒中常见。

关键词: 无症状性腔隙性梗死; 脑小血管病; 危险因素; 脑梗死

Abstract:

Objective To investigate the risk factors of silent lacunar infarction(SLI), and analyze the relationship between SLI and the etiologic subtype of ischemic stroke. Methods Over all, 791 patients within 7 days of their first-ever non-cardiogenic ischemic stroke were enrolled consecutively. Demographic information, vascular risk factors were recorded. We evaluated cranial magnetic resonance imaging including number of SLI, severity of leukoaraiosis, etiologic subtype of ischemic stroke, and topographic patterns of acute cerebral infarcts. Factors associated with the presence of SLI were analyzed. Results A total of 296 patients (37.4%) had SLI. In univariate analysis, older age, hypertension, higher admission blood pressure, diabetes, history of cerebral hemorrhage, Fazekas scores ≥3, ischemic stroke due to small artery occlusion(SAO), single infarct, absence of small cortical infarct, absence of watershed infarcts and absence of territorial infarctwere significantly associated with the presence of SLI. In multivariable logistic regression analysis, male, hypertension, higher diastolic blood pressure, diabetes, history of cerebral hemorrhage, Fazekas scores ≥3, and SAO subtype stroke were significantly associated with the presence of SLI. Conclusion First-ever non-cardiogenic ischemic stroke patients with SLI often have severe leukoaraiosis and more often suffer from SAO subtype stroke than those without SLI.

Key words: Lacunar infarction; Cerebral small vessel disease; Risk factors; Cerebral infarction

张长青，王伊龙，王春雪，赵性泉，王拥军. 首发缺血性卒中患者无症状性腔隙性梗死严重程度的相关因素分析[J]. 中国卒中杂志, 2015, 10(10): 861-866.

ZHANG Chang-Qing, WANG Yi-Long, WANG Chun-Xue, et al.. Risk Factors of Silent Lacunar Infarction in First-ever Ischemic Stroke Patients[J]. Chinese Journal of Stroke, 2015, 10(10): 861-866.

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