颈内动脉系统脑梗死患者早期代偿途径形成的影响因素
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摘要
目的探讨颈内动脉系统脑梗死患者早期代偿途径形成的影响因素。方法回顾性连续纳入2016年2月至2018年3月贵州省毕节市第一人民医院神经内科收治的颈内动脉系统脑梗死患者88例,按侧支循环开放情况将其分为低度开放组(26例)和高度开放组(62例)。比较两组患者性别、年龄、吸烟史、饮酒史、高血压病、糖尿病、高脂血症、脑梗死家族史、颈内动脉狭窄程度、脑梗死体积、美国国立卫生研究院卒中量表(NIHSS)评分等的差异,并通过多因素Logistic回归分析筛选侧支循环高度开放的影响因素。两组患者出院3个月行门诊随访,比较其日常生活活动能力(ADL)量表评分。结果 (1)侧支循环低度开放组患者合并高血压病、糖尿病、高脂血症的比例高于高度开放组,组间差异均有统计学意义[80. 8%(21/26)比58. 1%(36/62),57. 7%(15/26)比14. 5%(9/62),96. 2%(25/26)比53. 2%(33/62);均P <0. 05];男性、年龄≥60岁及脑梗死家族史、吸烟史、饮酒史比例的组间差异均无统计学意义(均P> 0. 05)。(2)侧支循环低度开放组NIHSS评分、梗死灶体积均高于高度开放组,颈内动脉重度狭窄的比例低于高度开放组,组间差异均有统计学意义[(18±5)分比(10±3)分,89(46,145) mm~3比35(12,70) mm~3,42. 3%(11/26)比66. 1%(41/62);均P <0. 05]。发病至CTA时间的组间差异无统计学意义(P> 0. 05)。(3)以侧支循环高度开放为因变量,经变量筛选,将高血压病、糖尿病、颈内动脉重度狭窄进行多因素Logistic回归分析,结果显示,糖尿病是侧支循环高度开放的危险因素(OR=1. 361,95%CI 1. 277～2. 475,P=0. 032),颈内动脉重度狭窄是侧支循环高度开放的保护因素(OR=0. 614,95%CI 0. 513～0. 724,P=0. 027),高血压病与侧支循环开放程度无关(P> 0. 05)。(4)侧支循环低度开放组ADL量表评分低于高度开放组,组间差异有统计学意义[(51±15)分比(67±18)分,t=3. 746,P <0. 01]。结论颈内动脉系统脑梗死患者合并糖尿病不利于早期良好侧支循环的建立,而伴颈动脉重度狭窄有利于良好侧支循环的建立。
Objective To investigate the influencing factors of early compensation pathway formation in patients with cerebral infarction of internal carotid artery system. Methods Eighty-eight consecutive patients with cerebral infarction in the internal carotid artery system admitted to the Department of Neurology,the First People' s Hospital of Bijie,Guizhou Province from February 2016 to March 2018 were enrolled retrospectively. They were divided into low-open group( n = 26) and high-open group( n = 62) according to the degree of collateral circulation opening. The differences of sex,age,smoking history,drinking history,hypertension,diabetes,hyperlipidemia,family history of cerebral infarction,degree of internal carotid artery stenosis,volume of cerebral infarction,National Institutes of Health Stroke Scale( NIHSS) score in patients of the two groups were compared. Multivariate logistic regression analysis was used to screen the influencing factors of highly open collateral circulation. Outpatient follow-up was performed in the two groups of patients at 3 months after discharge. Their activities of daily living( ADL) scale scores were compared.Results( 1) The proportion of hypertension,diabetes mellitus,and hyperlipidemia in the patients of the collateral circulation low-open group was higher than that in those of the collateral circulation high-open group,and the differences between groups were statistically significant( 80. 8% [21/26]vs. 58. 1% [36/62],57. 7% [15/26] vs. 14. 5% [9/62],96. 2% [25/26] vs. 53. 2% [33/62 ],all P < 0. 05). There was no significant difference in the proportion of male,age ≥60,family history of cerebral infarction,smoking history,and drinking history between the groups( all P > 0. 05).( 2) The NIHSS score and infarct volume of the collateral circulation low-open group were higher than those of the high-open group,and the proportion of severe stenosis of internal carotid artery was lower than that of the high-open group( [18 ± 5] vs. [10 ± 3],89 [46,145]mm~3 vs. 35 [12,70]mm~3,42. 3%( 11/26) vs. 66. 1%( 41/62); all P < 0. 05〗. There was no significant difference in the time from onset to CTA( P > 0. 05).( 3) With the collateral circulation high-open degree as the dependent variable,after variable screening,multivariate logistic regression analysis of hypertension,diabetes,and severe stenosis of internal carotid artery was performed. The results showed that diabetes was a risk factor for the collateral circulation high-open degree( OR,1. 361,95% CI 1. 277-2. 475,P = 0. 032),and severe internal carotid artery stenosis was a protective factor of collateral circulation low-open degree( OR,0. 614,95% CI 0. 513-0. 724,P = 0. 027). Hypertension was not associated with the degree of collateral circulation opening( P < 0. 05).( 4) The ADL scale score of the collateral circulation low-open group was lower than that of the high-open group,and the difference between the groups was statistically significant( [51 ± 15] vs. [67 ± 18 ],t = 3. 746,P < 0. 01). Conclusion Cerebral infarction of internal carotid artery system patients with diabetes was not conducive to the establishment of early good collateral circulation,and with severe carotid stenosis was conducive to the establishment of good collateral circulation.
Objective To investigate the influencing factors of early compensation pathway formation in patients with cerebral infarction of internal carotid artery system. Methods Eighty-eight consecutive patients with cerebral infarction in the internal carotid artery system admitted to the Department of Neurology,the First People' s Hospital of Bijie,Guizhou Province from February 2016 to March 2018 were enrolled retrospectively. They were divided into low-open group( n = 26) and high-open group( n = 62) according to the degree of collateral circulation opening. The differences of sex,age,smoking history,drinking history,hypertension,diabetes,hyperlipidemia,family history of cerebral infarction,degree of internal carotid artery stenosis,volume of cerebral infarction,National Institutes of Health Stroke Scale( NIHSS) score in patients of the two groups were compared. Multivariate logistic regression analysis was used to screen the influencing factors of highly open collateral circulation. Outpatient follow-up was performed in the two groups of patients at 3 months after discharge. Their activities of daily living( ADL) scale scores were compared.Results( 1) The proportion of hypertension,diabetes mellitus,and hyperlipidemia in the patients of the collateral circulation low-open group was higher than that in those of the collateral circulation high-open group,and the differences between groups were statistically significant( 80. 8% [21/26]vs. 58. 1% [36/62],57. 7% [15/26] vs. 14. 5% [9/62],96. 2% [25/26] vs. 53. 2% [33/62 ],all P < 0. 05). There was no significant difference in the proportion of male,age ≥60,family history of cerebral infarction,smoking history,and drinking history between the groups( all P > 0. 05).( 2) The NIHSS score and infarct volume of the collateral circulation low-open group were higher than those of the high-open group,and the proportion of severe stenosis of internal carotid artery was lower than that of the high-open group( [18 ± 5] vs. [10 ± 3],89 [46,145]mm~3 vs. 35 [12,70]mm~3,42. 3%( 11/26) vs. 66. 1%( 41/62); all P < 0. 05〗. There was no significant difference in the time from onset to CTA( P > 0. 05).( 3) With the collateral circulation high-open degree as the dependent variable,after variable screening,multivariate logistic regression analysis of hypertension,diabetes,and severe stenosis of internal carotid artery was performed. The results showed that diabetes was a risk factor for the collateral circulation high-open degree( OR,1. 361,95% CI 1. 277-2. 475,P = 0. 032),and severe internal carotid artery stenosis was a protective factor of collateral circulation low-open degree( OR,0. 614,95% CI 0. 513-0. 724,P = 0. 027). Hypertension was not associated with the degree of collateral circulation opening( P < 0. 05).( 4) The ADL scale score of the collateral circulation low-open group was lower than that of the high-open group,and the difference between the groups was statistically significant( [51 ± 15] vs. [67 ± 18 ],t = 3. 746,P < 0. 01). Conclusion Cerebral infarction of internal carotid artery system patients with diabetes was not conducive to the establishment of early good collateral circulation,and with severe carotid stenosis was conducive to the establishment of good collateral circulation.
引文
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[7]蒋超,王月娟,张静,等.急性颈内动脉系统脑梗死患者侧支循环建立情况与预后关系的研究[J].中华行为医学与脑科学杂志,2017,26(7):615-619.
[8]周艳雯,戴亚辉,靳令经,等.急性多发性后循环脑梗死的危险因素及病因学分析[J].医学临床研究,2016,33(3):420-423.
[9]中华医学会内分泌学分会脂代谢学组.中国2型糖尿病合并血脂异常防治专家共识(2017年修订版)[J].中华内分泌代谢杂志,2017,33(11):925-936.
[10]中华医学会心血管病学分会高血压学组.肥胖相关性高血压管理的中国专家共识[J].中华心血管病杂志,2016,44(3):212-219.
[11]牛朋影,蒋磊,刘渊,等.双能量CT不同技术在低剂量对比剂头颈CTA图像优化中的对比[J].中国医学影像技术,2017,33(2):285-289.
[12]刘雅宝,纪盛章,张伯生,等.颈动脉斑块与急性脑梗死体积的相关性研究[J].中国临床医学影像杂志,2018,29(3):153-157.
[13]陈忠军,孙强,孙威,等.应用r LMC评分预测急性大脑中动脉M1段或颈内动脉闭塞卒中患者临床预后[J].中风与神经疾病杂志,2016,33(8):732-734.
[14]Collin C,Wade DT,Davies S,et al.The Barthel ADLIndex:a reliability study[J].Int Disabil Stud,1988,10(2):61-63.
[15]Mahoney FI,Barthel DW.Functional evaluation:the barthel index[J].Md State Med J,1965,14:61-65.
[16]李怡,王振海,马斌武.203例急性脑梗死患者脑供血动脉分布特点与分析[J].中风与神经疾病杂志,2014,31(3):240-243.
[17]Iwasawa E,Ichijo M,Ishibashi S,et al.Acute development of collateral circulation and therapeutic prospects in ischemic stroke[J].Neural Regen Res,2016,11(3):368-371.
[18]张萍,张永巍,吴涛,等.静脉溶栓联合血管内治疗对急性中重症脑梗死患者预后的影响因素分析[J].中国脑血管病杂志,2016,13(7):343-347.
[19]谭玉,陈皆春,张照婷,等.急性脑梗死患者颈动脉和椎动脉超声特征[J].中国动脉硬化杂志,2016,24(10):1011-1014.
[20]Wufuer A,Wubuli A,Mijiti P,et al.Impact of collateral circulation status on favorable outcomes in thrombolysis treatment:a systematic review and meta-analysis[J].Exp Ther Med,2018,15(1):707-718.
[21]杜娟,蔡艺灵,吴铮,等.短暂性脑缺血发作临床表现与病变血管及侧支循环的关系[J].中国脑血管病杂志,2013,10(8):401-405.
[22]Martinon E,Lefevre PH,Thouant P,et al.Collateral circulation in acute stroke:assessing methods and impact:a literature review[J].J Neuroradiol,2014,41(2):97-107.
[23]Jung S,Wiest R,Gralla J,et al.Relevance of the cerebral collateral circulation in ischaemic stroke:time is brain,but collaterals set the pace[J].Swiss Med Wkly,2017,147:w14538.
[24]吴钢,许映雪,胡志坚.后循环脑梗死的相关危险因素及可能影响预后因素分析[J].中华神经医学杂志,2015,14(1):37-42.
[25]刘伟,杨兴东,唐晓梅,等.基底动脉高密度征与急性后循环脑梗死患者短期预后的相关性[J].中国脑血管病杂志,2013,10(7):365-368.
[2]Hernández-Pérez M,Puig J,Blasco G,et al.Dynamic magnetic resonance angiography provides collateral circulation and hemodynamic information in acute ischemic stroke[J].Stroke,2016,47(2):531-534.
[3]Kim JJ,Fischbein NJ,Lu Y,et al.Regional angiographic grading system for collateral flow:correlation with cerebral infarction in patients with middle cerebral artery occlusion[J].Stroke,2004,35(6):1340-1344.
[4]钟维章,黄光坚,陈渊,等.症状性颈内动脉系统狭窄或闭塞患者的侧支循环特点及其与神经功能的关系[J].实用医学杂志,2014,30(1):61-64.
[5]Piedade GS,Schirmer CM,Goren O,et al.Cerebral collateral circulation:a review in the context of ischemic stroke and mechanical thrombectomy[J].World Neurosurg,2019,122:33-42.
[6]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[7]蒋超,王月娟,张静,等.急性颈内动脉系统脑梗死患者侧支循环建立情况与预后关系的研究[J].中华行为医学与脑科学杂志,2017,26(7):615-619.
[8]周艳雯,戴亚辉,靳令经,等.急性多发性后循环脑梗死的危险因素及病因学分析[J].医学临床研究,2016,33(3):420-423.
[9]中华医学会内分泌学分会脂代谢学组.中国2型糖尿病合并血脂异常防治专家共识(2017年修订版)[J].中华内分泌代谢杂志,2017,33(11):925-936.
[10]中华医学会心血管病学分会高血压学组.肥胖相关性高血压管理的中国专家共识[J].中华心血管病杂志,2016,44(3):212-219.
[11]牛朋影,蒋磊,刘渊,等.双能量CT不同技术在低剂量对比剂头颈CTA图像优化中的对比[J].中国医学影像技术,2017,33(2):285-289.
[12]刘雅宝,纪盛章,张伯生,等.颈动脉斑块与急性脑梗死体积的相关性研究[J].中国临床医学影像杂志,2018,29(3):153-157.
[13]陈忠军,孙强,孙威,等.应用r LMC评分预测急性大脑中动脉M1段或颈内动脉闭塞卒中患者临床预后[J].中风与神经疾病杂志,2016,33(8):732-734.
[14]Collin C,Wade DT,Davies S,et al.The Barthel ADLIndex:a reliability study[J].Int Disabil Stud,1988,10(2):61-63.
[15]Mahoney FI,Barthel DW.Functional evaluation:the barthel index[J].Md State Med J,1965,14:61-65.
[16]李怡,王振海,马斌武.203例急性脑梗死患者脑供血动脉分布特点与分析[J].中风与神经疾病杂志,2014,31(3):240-243.
[17]Iwasawa E,Ichijo M,Ishibashi S,et al.Acute development of collateral circulation and therapeutic prospects in ischemic stroke[J].Neural Regen Res,2016,11(3):368-371.
[18]张萍,张永巍,吴涛,等.静脉溶栓联合血管内治疗对急性中重症脑梗死患者预后的影响因素分析[J].中国脑血管病杂志,2016,13(7):343-347.
[19]谭玉,陈皆春,张照婷,等.急性脑梗死患者颈动脉和椎动脉超声特征[J].中国动脉硬化杂志,2016,24(10):1011-1014.
[20]Wufuer A,Wubuli A,Mijiti P,et al.Impact of collateral circulation status on favorable outcomes in thrombolysis treatment:a systematic review and meta-analysis[J].Exp Ther Med,2018,15(1):707-718.
[21]杜娟,蔡艺灵,吴铮,等.短暂性脑缺血发作临床表现与病变血管及侧支循环的关系[J].中国脑血管病杂志,2013,10(8):401-405.
[22]Martinon E,Lefevre PH,Thouant P,et al.Collateral circulation in acute stroke:assessing methods and impact:a literature review[J].J Neuroradiol,2014,41(2):97-107.
[23]Jung S,Wiest R,Gralla J,et al.Relevance of the cerebral collateral circulation in ischaemic stroke:time is brain,but collaterals set the pace[J].Swiss Med Wkly,2017,147:w14538.
[24]吴钢,许映雪,胡志坚.后循环脑梗死的相关危险因素及可能影响预后因素分析[J].中华神经医学杂志,2015,14(1):37-42.
[25]刘伟,杨兴东,唐晓梅,等.基底动脉高密度征与急性后循环脑梗死患者短期预后的相关性[J].中国脑血管病杂志,2013,10(7):365-368.