高海拔地区进展性脑梗死发生率、病因分型及相关因素分析
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摘要
目的探讨高海拔地区进展性脑梗死的发生率、病因分型及相关危险因素。方法采用前瞻性研究方法,连续收集2014年5月-2017年5月青海省人民医院神经内科急性脑梗死病例共1200例,采用美国国立卫生研究院卒中量表(NIHSS)评分与Glasgow昏迷评定量表(GCS)评分,分析进展性脑梗死发生率,同时进行病因分型,分析各亚型所占比例,并明确相关危险因素。结果 (1)进展性脑梗死的发生率为19%(228/1200),其中大动脉粥样硬化性卒中(LAA)占31.6%(72/228),心源性栓塞(CE)占28.9%(66/228),小动脉闭塞性卒中(SAO)占18.9%(43/228),其他原因(OE)占15.8%(36/228),原因不明型(UE)占4.8%(11/228)。(2)对两组各因素行χ2检验或t检验,发现房颤病史、高血压病史、糖尿病史、脑卒中病史、大动脉病变、血清同型半胱氨酸浓度(Hcy)、血红蛋白浓度;冬季、感染、吸烟、年龄等两组间比较差异有统计学意义(P<0.05,P<0.01)。进一步做多因素Logistic回归分析显示,高血压病史、糖尿病史、大动脉病变、房颤病史、血清同型半胱氨酸浓度(Hcy)、血红蛋白浓度等6个因素与脑梗死进展有显著相关。结论高海拔地区进展性脑梗死发生率较高,大动脉粥样硬化性脑梗死最易发生进展,相关危险因素为高血压病史、糖尿病史、大动脉病变、房颤病史、血清同型半胱氨酸浓度(Hcy)、血红蛋白浓度。
Objective To explore the incidence,TOAST classification and risk factors of progressive cerebral infarction in high altitude area.Methods A total of 1200 consecutive patients with acute ischemic stroke were recruited with a method of prospective study.All of patients was evaluated NIHSS and GCS.Analyzing the incidence of progressive cerebral infarction.The group of progressive cerebral infarction was performed by the etiological classification,Make clear the proportion of each subtypes and identify the risk factors.Results(1) The incidence of progressive cerebral infarction was 19%(228/1200).Among them,Large artery atherosclerosis(LAA) was 31.6%(72/228).Cardiogenic stroke(CE) was 28.9%(66/228).Small artery occlusion(SAO) was 18.9%(43/228).Other etiology(OE) was 15.8%(36/228).Undetermined etiology(UE) was 4.8%(11/228).(2) There were statistically significant differences in,infection,smoking and age between the two groups(P<0.05 or P<0.01).Multiple factor regression analysis showed the history of atrial fibrillation,hypertension,diabetes,macro artery disease,serum homocysteine(HCY) and concentration of hemoglobin were positively related with progression of cerebral infarction.Conclusion The incidence of progressive cerebral infarction in high altitude area is high,LAA is easiest to make progress.Risk factors of patients with progressive cerebral infarction include history of atrial fibrillation,hypertension,diabetes,macro artery disease,serum homocysteine(HCY) and concentration of hemoglobin.
Objective To explore the incidence,TOAST classification and risk factors of progressive cerebral infarction in high altitude area.Methods A total of 1200 consecutive patients with acute ischemic stroke were recruited with a method of prospective study.All of patients was evaluated NIHSS and GCS.Analyzing the incidence of progressive cerebral infarction.The group of progressive cerebral infarction was performed by the etiological classification,Make clear the proportion of each subtypes and identify the risk factors.Results(1) The incidence of progressive cerebral infarction was 19%(228/1200).Among them,Large artery atherosclerosis(LAA) was 31.6%(72/228).Cardiogenic stroke(CE) was 28.9%(66/228).Small artery occlusion(SAO) was 18.9%(43/228).Other etiology(OE) was 15.8%(36/228).Undetermined etiology(UE) was 4.8%(11/228).(2) There were statistically significant differences in,infection,smoking and age between the two groups(P<0.05 or P<0.01).Multiple factor regression analysis showed the history of atrial fibrillation,hypertension,diabetes,macro artery disease,serum homocysteine(HCY) and concentration of hemoglobin were positively related with progression of cerebral infarction.Conclusion The incidence of progressive cerebral infarction in high altitude area is high,LAA is easiest to make progress.Risk factors of patients with progressive cerebral infarction include history of atrial fibrillation,hypertension,diabetes,macro artery disease,serum homocysteine(HCY) and concentration of hemoglobin.
引文
[1]Birschel P,Ellul J,Barer D.Progressing Stroke:tow ards an internationally agreed definition[J].Cerbrovasc Dis,2004,17(2/3):242-252.
[2]王维治.神经病学[M].北京:人民卫生出版社,2006.740.
[3]吉维忠,吴世政,胡全忠,等.青海省城乡社区中老年卒中患病率及危险因素研究[J].中国卒中杂志,2016,11(3):191-195.
[4]Sumer M,Ozdemir,Ierturk O,et al.Progress in acute ischemic stroke,frequency risk factors and progress[J].J Clin Neurosci,2003,10(2):177-180.
[5]王冬冬,高政,郭子江,等.缺血性进展性脑卒中发病率与相关危险因素的单因素分析[J].中国临床康复,2005,9(33):1-3.
[6]杨伟民,刘鸣,郝子龙.进展性缺血性脑卒中的发生率及其与不同病因分型的关系[J].中国老年医学,2010,30(24):3635-3637.
[7]易兴阳,陈存术,池阴芬.等.颈动脉粥样硬化与进展性缺血性脑卒中的关系[J].中华神经科杂志,2000,39(6):388-391.
[8]陈黔妹,沈扬,樊东升.颈动脉粥样硬化与进展性脑卒中的相关因素研究[J].中国康复理论与实践,2004,10(12):731-732.
[9]杨宁,梁兵,浦蜀湘,等.进展性脑卒中与血脂、颈内动脉斑块和狭窄及降脂治疗的关系[J].临床神经疾病杂志,2012,25(5):381-382.
[10]王普清,罗韵文,张贵斌,等.进展性脑梗死危险因素Logistic回归分析[J].卒中与神经疾病杂志,2007,14(6):368-372.
[11]Mc Kay DL,Perone G,Rasmussen H,et al.Multivitamin mineralsupple mentation improves plasma B Vitamin status and homo-cysteine concentration in healthy older adults consuming fortified diet[J].J Nutr,2000,130(12):3090-3096.
[12]Mizrahie H,Noy S,Sela BA,et al.Further evidence of interrela-tion between homocystine and hypertension in stroke patients;across-sectional study[J].Isr Med Assoc,2003,5(4):791-794.
[13]Ribo M,Montaner J,Monasterio J,et al.Role of homocysteine inthe acute phase of stroke[J].Neurologia,2004,19(1):10-14.
[14]李万寿,吴天一,陈秋红,等.高原红细胞增多症流行病学的研究[J].高原医学杂志,1998,8(2):10-13.
[15]王君一,张刚,李琦,等.高海拔地区青年与中老年人群脑梗死发病的危险因素比较[J].山东医药,2015,55(13):69-70.
[2]王维治.神经病学[M].北京:人民卫生出版社,2006.740.
[3]吉维忠,吴世政,胡全忠,等.青海省城乡社区中老年卒中患病率及危险因素研究[J].中国卒中杂志,2016,11(3):191-195.
[4]Sumer M,Ozdemir,Ierturk O,et al.Progress in acute ischemic stroke,frequency risk factors and progress[J].J Clin Neurosci,2003,10(2):177-180.
[5]王冬冬,高政,郭子江,等.缺血性进展性脑卒中发病率与相关危险因素的单因素分析[J].中国临床康复,2005,9(33):1-3.
[6]杨伟民,刘鸣,郝子龙.进展性缺血性脑卒中的发生率及其与不同病因分型的关系[J].中国老年医学,2010,30(24):3635-3637.
[7]易兴阳,陈存术,池阴芬.等.颈动脉粥样硬化与进展性缺血性脑卒中的关系[J].中华神经科杂志,2000,39(6):388-391.
[8]陈黔妹,沈扬,樊东升.颈动脉粥样硬化与进展性脑卒中的相关因素研究[J].中国康复理论与实践,2004,10(12):731-732.
[9]杨宁,梁兵,浦蜀湘,等.进展性脑卒中与血脂、颈内动脉斑块和狭窄及降脂治疗的关系[J].临床神经疾病杂志,2012,25(5):381-382.
[10]王普清,罗韵文,张贵斌,等.进展性脑梗死危险因素Logistic回归分析[J].卒中与神经疾病杂志,2007,14(6):368-372.
[11]Mc Kay DL,Perone G,Rasmussen H,et al.Multivitamin mineralsupple mentation improves plasma B Vitamin status and homo-cysteine concentration in healthy older adults consuming fortified diet[J].J Nutr,2000,130(12):3090-3096.
[12]Mizrahie H,Noy S,Sela BA,et al.Further evidence of interrela-tion between homocystine and hypertension in stroke patients;across-sectional study[J].Isr Med Assoc,2003,5(4):791-794.
[13]Ribo M,Montaner J,Monasterio J,et al.Role of homocysteine inthe acute phase of stroke[J].Neurologia,2004,19(1):10-14.
[14]李万寿,吴天一,陈秋红,等.高原红细胞增多症流行病学的研究[J].高原医学杂志,1998,8(2):10-13.
[15]王君一,张刚,李琦,等.高海拔地区青年与中老年人群脑梗死发病的危险因素比较[J].山东医药,2015,55(13):69-70.