脑梗死患者脑白质疏松症发病率及其相关因素分析

目的研究脑白质疏松症（leukoaraiosis，LA）的相关危险因素，探讨大动脉闭塞性病变对小动脉的保护作用及其与LA的相关性。方法对108例脑梗死患者常规行头部CT、MRI、TCD和MRA检查，评估脑梗死患者LA的发生率、程度及相关危险因素，分析大动脉闭塞性病变与LA的相关性。结果108例脑梗死患者中，LA的发病率为50．9％，伴有颅内外大动脉闭塞性病变患者LA发生率为38％，无颅内外大动脉闭塞性病变患者为65％，两者比较P=0．004，而伴有大动脉闭塞性病变的腔隙性梗死患者LA发病率为36％，单纯腔隙性梗死患者为73％，两者比较P=0．001。Logistic回归分析显示脑梗死患者LA的发生与高龄（P=0．0001）、腔隙性梗死（P=0．004）明显相关，是LA发生的独立危险因素，且脑梗死患者LA的严重程度与年龄呈正相关（r=0．9384）。结论高龄是脑梗死患者LA发生的最重要危险因素。腔隙性梗死与脑梗死患者LA间的关系支持小血管病变是LA发生的最主要发病机制，而大动脉闭塞性病变的存在对于小血管有保护性作用。

Incidence and risk factors of leukoaraiosis in patients with cerebral infarction

Objective To study the risk factors of leukoarailsis (LA) in patients with cerebral infarct and the protective effect of large artery occlusion for small artery diseases. Methods 108 patients with cerebral infarct had undergone cranial CT, MRI, TCD and/or MRA. Incidence and risk factors of LA were estimated. And the relationship between LA and large artery occlusive disease were analyzed. Results The incidence of LA was 50.9% in 108 patients with cerebral infarct. The incidence of LA in patients with large artery occlusion was significantly lower than that without it (P=0.004). However, the incidence of LA in lacunar infarct patients accompanied by large artery occlusion was significantly lower than that without it (P=0.001). With a logistic regression analysis, both aging and lacunar infarct were significantly associated with LA in patients with cerebral infarct (P=0.0001, 0.004). And the degree of LA positively correlated with aging. Conclusion Aging is the strongest risk factor for LA in patients with cerebral infarct. And the correlation between the lacunar infarct and LA hints that small artery disease plays an important part in mechanism of LA and the small artery diseases may be protected by large artery occlusion.