症状性基底动脉粥样硬化狭窄患者的危险因素及预后分析
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摘要
目的探讨症状性基底动脉粥样硬化狭窄的危险因素及相关预后。方法收集2014年1月~2017年12月我院入院治疗的症状性基底动脉粥样硬化狭窄患者(基底动脉狭窄组)和症状性大脑前循环狭窄患者(前循环狭窄组)各80例,比较2组性别、血压等危险因素。另按血管狭窄程度、病情有无进展、出院1个月的生存情况,将症状性基底动脉粥样硬化狭窄患者分别分为狭窄率<70%的轻中度狭窄组43例和狭窄率70%~100%的重度狭窄组37例,进展组34例和未进展组46例,生存组42例和死亡组38例,分析各组危险因素的差异及其预后。结果与前循环狭窄组比较,基底动脉狭窄组男性(75.0%vs 57.5%)、高血压(80.0%vs 66.3%)明显升高(P<0.01)。重度狭窄组既往脑梗死及吸烟显著高于轻中度狭窄组,差异有统计学意义(P<0.05,P<0.01)。既往脑梗死及吸烟与基底动脉狭窄程度有关(P<0.05)。入院前驱症状与病情是否进展有关(P<0.01)。肺部感染及气管插管或气管切开与预后有关(P<0.01)。结论男性及高血压是症状性基底动脉粥样硬化狭窄的独立危险因素,吸烟及既往脑梗死是症状性基底动脉粥样硬化狭窄程度的独立危险因素,入院前有前驱症状患者病情进展可能性小,肺部感染及气管插管或气管切开为预后的独立危险因素。
Objective To study the risk factors and outcome of symptomatic BAAS.MethodsEighty symptomatic BAAS patients served as a BAAS group and 80 symptomatic anterior circulation stroke(ACS)patients served as a ACS group in this study.The risk factors for symptomatic BAAS were compared.The symptomatic BAAS patients were further divided into mild-moderate stenosis group(n=43)and severe stenosis group(n=37),progressive stenosis group(n=34)and non-gressive group(n=46),survival group(n=42)and death group(n=38)respectively.The relationship between risk factors and outcome of symptomatic BAAS was analyzed.Results The rate of male patients and the incidence of hypertention were significantly higher in BAAS group than in ACS group(75.0%vs 57.5%,80.0%vs 66.3%,P<0.01).The history of ischemic stroke and smoking was related with the severity of BAAS(P<0.05).Premonitory symptoms were related with the progression of BAAS(P<0.01).Pulmonary infection and tracheal intubation or tracheotomy were related with the outcome of BAAS(P<0.01).Conclusion Male gender,hypertension,and history of ischemic stroke and smoking are the independent risk factors for symptomatic BAAS which is less likely to progress in patients with premonitory symptoms.Pulmonary infection and tracheal intubation or tracheotomy are the independent risk factors.
Objective To study the risk factors and outcome of symptomatic BAAS.MethodsEighty symptomatic BAAS patients served as a BAAS group and 80 symptomatic anterior circulation stroke(ACS)patients served as a ACS group in this study.The risk factors for symptomatic BAAS were compared.The symptomatic BAAS patients were further divided into mild-moderate stenosis group(n=43)and severe stenosis group(n=37),progressive stenosis group(n=34)and non-gressive group(n=46),survival group(n=42)and death group(n=38)respectively.The relationship between risk factors and outcome of symptomatic BAAS was analyzed.Results The rate of male patients and the incidence of hypertention were significantly higher in BAAS group than in ACS group(75.0%vs 57.5%,80.0%vs 66.3%,P<0.01).The history of ischemic stroke and smoking was related with the severity of BAAS(P<0.05).Premonitory symptoms were related with the progression of BAAS(P<0.01).Pulmonary infection and tracheal intubation or tracheotomy were related with the outcome of BAAS(P<0.01).Conclusion Male gender,hypertension,and history of ischemic stroke and smoking are the independent risk factors for symptomatic BAAS which is less likely to progress in patients with premonitory symptoms.Pulmonary infection and tracheal intubation or tracheotomy are the independent risk factors.
引文
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[2]郭琳佳,刘文宏.后循环缺血的研究进展[J].中华老年心脑血管病杂志,2015,17(12):1332-1336.DOI:10.3969/j.issn.1009-0126.2015.12.031.
[3]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国临床医生,2011,39(3):67-73.DOI:10.3969/j.issn.1008-1089.2011.03.024.
[4]韩忠奎,夏元亮,锁六军,等.脑动脉粥样硬化评分与轻型缺血性卒中早期神经功能恶化的相关性研究[J].医学研究生学报,2016,29(11):1140-1143.DOI:10.16571/j.cnki.1008-8199.2016.11.005.
[5]董强,黄家星,黄一宁,等.症状性动脉粥样硬化性颅内动脉狭窄中国专家共识[J].中国神经精神疾病杂志,2012,38(3):129-145.DOI:10.3969/j.issn.1002-0152.2012.03.001.
[6]Henriksson KM,Farahmand B,sberg S,et al.Comparison of cardiovascular risk factors and survival in patients with ischemic or hemorrhagic stroke[J].Int J Stroke,2012,7(4):276-281.DOI:10.1111/j.1747-4949.2011.00706.x.
[7]Gorbachev VI,Lokhov AV,Gorbacheva SM,et al.An effect of cerebral hemodynamics in patients with cerebrovascular disorders on the in-hospital transportation[J].Zh nevrol psikhiatr im S S Korsakova,2017,117(3.Vyp.2):35-40.DOI:10.17116/jnevro20171173235-40.
[8]Landry KK,Alexander KS,Zakai NA,et al.Association of stroke risk biomarkers with stroke symptoms:the reasons for geographic and racial differences in stroke cohort[J].J Thromb Haemost,2017,15(1):21-27.DOI:10.1111/jth.13562.
[9]孙慧英,李涛.脑卒中及其危险因素分析[J].卒中与神经疾病,2012,19(3):167-170.DOI:10.3969/j.issn.1007-0478.2012.03.011.
[10]梅青,陈会生.基底动脉闭塞患者病情严重程度及病情进展的危险因素分析[J].解放军医药杂志,2016,28(3):33-36.DOI:10.3969/j.issn.2095-140X.2016.03.008.
[11]刘兰,刘筠,许亮.后循环缺血性眩晕患者椎-基底动脉形态学改变[J].中国脑血管病杂志,2016,13(2):62-66.DOI:10.3969/j.issn.1672-5921.2016.02.002.