单侧大脑中动脉重度狭窄及闭塞患者侧支循环形成的影响因素及其相关性分析

目的 分析急性缺血性脑卒中大脑中动脉M1段重度狭窄及闭塞患者侧支循环形成的因素及其与NHISS、mRS评分的相关性。方法 连续纳入2017年9月-2019年3月就诊于新乡医学院第一附属医院神经内科发病72 h内的大脑中动脉M1段重度狭窄及闭塞的52例患者,其中侧支循环不良组21例和侧支循环良好组31例; 收集患者的临床资料、实验室检查指标,并进行临床量表评估; 采用多因素Logistic回归分析影响侧支循环形成的因素,Spearman秩相关分析同型半胱氨酸与NHISS、mRS评分的相关性及Mann.Whitney U检验分析侧支循环形成与NHISS、mRS评分的关系。结果 多因素Logistic回归分析显示血同型半胱氨酸与侧支循环的形成有关(OR=1.097,95%CI=1.020～1.179,P=0.013); 血总胆固醇水平与侧支循环的形成有关(OR=2.129,95%CI=1.038～4.370,P=0. 039); Spearman秩相关分析显示血同型半胱氨酸水平与NIHSS评分(r=0.456,P=0.001)、mRS评分(r=0.402,P=0.003)呈正相关。Mann.Whitney U检验分析显示侧支循环良好组NIHSS(z=-2.339,P=0.019)评分、mRS(z=-2.233,P=0.026)评分明显低于侧支循环不良组评分。结论 高血总胆固醇、同型半胱氨酸水平不利于大脑中动脉重度狭窄及闭塞患者侧支循环的形成; 低血同型半胱氨酸水平、侧支循环良好可减轻脑梗死后神经功能缺损,改善生活质量。

Influencing factors of collateral circulation formation in patients with severe unilateral middle cerebral artery stenosis and occlusion and their correlation analysis

ObjectiveTo analyze the factors of collateral circulation formation in patients with severe stenosis and occlusion of M1 segment of middle cerebral artery in acute ischemic stroke and its correlation with NHISS and mRS scores.Methods From September 2017 to March 2019,52 patients with severe stenosis and occlusion of M1 segment of middle cerebral artery(MCA)were admitted to the Department of Neurology, First Affiliated Hospital of Xinxiang Medical College.Among them, 21 patients had poor collateral circulation and 31 patients had good collateral circulation. Clinical data, laboratory test paramaters were collected,and the clinical scale was evaluated. Multivariate logistic regression analysis was used to analyze the factors affecting the formation of collateral circulation.Spearman rank correlation analysis was used to study the correlation between homocysteine and NHISS, mRS scores and Mann.Whitney U test was used to analyze the relationship between collateral circulation formation and NHISS, mRS scores.Results Multivariate logistic regression analysis showed that homocysteine was correlated with collateral circulation formation(OR=1.097, 95%CI=1.020～1.179,P=0.013),total cholesterol level was correlated with collateral circulation formation(OR=2.129, 95%CI=1.038～4.370, P=0.039). Spearman rank correlation analysis showed that homocysteine level was positively correlated with NIHSS score(r=0.456, P=0.001), MRS score(r=0.402, P=0.003). Mann. Whitney U test analysis showed that NIHSS(z=-2.339, P=0.019)score and mRS(z=-2.233, P=0.026)score in the group with good collateral circulation were significantly lower than those in the group with poor collateral circulation.Conclusion Hightotalcholesterol and hyperhomocysteine were not conducive to the formation of collateral circulation in patients with severe middle cerebral artery stenosis and occlusion.Lower homocysteine level and good collateral circulation could alleviate the neurological deficit and improve the quality of life after stroke.