摘要
目的探讨不同部位的血管周围间隙扩大(EPVS)与脑梗死患者中国缺血性脑卒中亚型(CISS)分型及复发的相关性。方法选择在我院神经内科住院的老年脑梗死EPVS患者278例,根据EPVS位于基底节区(BG)和半卵圆中心区(CSO)分别分组,BG-EPVS的轻度组113例,中重度组165例;CSO-EPVS的轻度组156例,中重度组122例。按CISS分为大动脉粥样硬化型、穿支动脉疾病及心源性卒中。还分为首发脑梗死173例和复发脑梗死105例。分析EPVS与CISS及复发脑梗死的关系,用多因素logistic回归分析。结果 BG-EPVS中,中重度组入院美国国立卫生研究院卒中量表评分(P=0.002)、脑白质高信号分级(P=0.003)、年龄(P=0.001)、高血压(75.2%vs 54.9%,P=0.000)、前循环梗死(69.7%vs 50.4%,P=0.001)和复发脑梗死比例(45.5%vs 26.5%,P=0.001)明显高于轻度组。CSO-EPVS中,中重度组仅年龄明显高于轻度组,差异有统计学意义(P=0.032)。BG-EPVS的中重度组高血压(75.2%vs 62.3%,P=0.019)、复发脑梗死(45.5%vs 32.8%,P=0.030)和穿支动脉疾病比例(47.9%vs 32.8%,P=0.028)明显高于CSO-EPVS的中重度组,差异有统计学意义。复发脑梗死患者中重度的BG-EPVS(70.5%vs 52.6%,P<0.01)、糖尿病(55.2%vs 42.8%,P<0.05)、穿支动脉疾病(51.4%vs 31.8%,P<0.01)均高于首发脑梗死患者。多因素logistic分析发现,中重度的BG-EPVS及穿支动脉疾病仍是复发脑梗死的相关危险因素。结论中重度的BG-EPVS与CISS分型中的穿支动脉疾病密切相关,是复发脑梗死的独立危险因素。
Objective To study the correlation between enlarged perivascular space(EPVS) and Chinese ischemic stroke subclassification(CISS) and its recurrence in cerebral infarction patients.Methods Two hundred and seventy-eight elderly cerebral infarction patients admitted to our hospital were divided into mild basal gangalia(BG)-EPVS group(n=113) and moderate-severe BG-EPVS group(n=165) according to the location of EPVS in BG or into mild central semiorale(CSO)-EPVS group(n=156) and moderate-severe CSO-EPVS group(n=122) according to the location of EPVS in CSO.Ischemic stroke was divided into large artery atherosclerotic stroke,perforating artery disease and cardiogenic stroke in the CISS.The patients were further divided into first-ever cerebral infarction group(n=173) and recurrent cerebral infarction group(n=105).The correlation of EPVS with CISS and recurrent cerebral infarction was analyzed by multivariate logistic regression analysis.Results In BG-EPVS,the NIHSS score(P=0.002),white matter hypersignal grade(P=0.003),age(P=0.001),hypertension(75.2% vs 54.9%,P=0.000),anterior circulation infarction(69.7% vs 50.4%,P=0.001) and recurrent cerebral infarction(45.5% vs 26.5%,P=0.001) were significantly higher in moderate-severe group than in mild group.In CSO-EPVS,only the age was significantly higher in moderate-severe group than in mild group(P=0.033).The proportion of hypertention(75.2% vs 62.3%,P=0.019),recurrent cerebral infarction(45.5% vs 32.8%,P=0.030) and perforating artery disease(47.9% vs 32.8%,P=0.028) was significantly higher in moderate-severe BG-EPVS group than in moderate-severe CSO-EPVS group.The incidence of moderate-severe BG-EPVS,DM and perforating artery disease was significantly higher in recurrent cerebral infarction group than in first-ever cerebral infarction group(70.5% vs 52.6%,P<0.01;55.2% vs 42.8%,P<0.05;51.4% vs 31.8%,P<0.01).Multivariate logistic regression analysis showed that moderate-severe BG-EPVS and perforating artery disease were the risk factors for recurrent cerebral infarction.Conclusion Moderate-severe BG-EPVS is closely related with perforating artery disease in CISS and is an independent risk factor for recurrent cerebral infarction.
作者
黄珊
张敏
黄宽宽
梅雨晴
恽文伟
Huang Shan;Zhang Min;Huang Kuankuan;Mei Yuqing;Yun Wenwei(Department of Neurology,Dalian Medical University Postgraduate School,Dalian 116044,Liaoning Province,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2020年第9期942-946,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
江苏省卫生健康委面上项目(H2019051)
常州市卫计委青年人才科技项目(QN201714)
常州市科技项目(CJ20180071)。
关键词
脑梗死
动脉粥样硬化
卒中
高血压
复发
brain infarction
atherosclerosis
stroke
hypertension
recurrence
