卒中及短暂性脑缺血发作患者不同部位脑萎缩的危险因素

目的脑萎缩是卒中后痴呆的重要危险因素,探索卒中及短暂性脑缺血发作患者不同部位脑萎缩的危险因素,为降低卒中后痴呆发的发生提供潜在干预靶点。方法纳入连续住院的卒中及短暂性脑缺血发作(transient ischemic attack,TIA)患者,采集患者一般危险因素及血管性危险因素,完成头颅MRI和/或头颅CT扫描及半定量测定,包括陈旧性腔隙性脑梗死数量、额叶萎缩、顶叶萎缩、颞中叶萎缩及广泛脑萎缩的程度。结果共519例卒中及TIA患者完成4种脑萎缩的测量。Logistic回归分析结果显示:除年龄外,女性(比数比OR=2.447,P=0.007)、腔隙性脑梗塞病灶数(OR=1.414,P=0.027)是额叶萎缩的独立危险因素;缺血性卒中病史(OR=2.224,P=0.024)是顶叶萎缩的独立危险因素;颅内/外大血管狭窄(OR=2.584,P=0.015)、脑白质变性评分(OR=1.112,P=0.007)及腔隙性脑梗塞病灶数(OR=1.158,P=0.042)是颞中叶萎缩的独立危险因素;而糖尿病(OR=2.109,P=0.001)、心房纤颤(OR=1.934,P=0.015)、脑白质变性评分(OR=1.098,P=0.002)是广泛脑萎缩的独立危险因素。结论糖尿病、心房纤颤、腔隙性脑梗塞数及脑白质变性是卒中及TIA患者脑萎缩的危险因素,可对对上述高危人群尽早干预,减小此类患者发生痴呆的可能。

Risk factors for different brain region atrophy among stroke and transient ischemic attack patients

Objectives Brain atrophy plays a key role in post-stroke dementia. The current study aims to explore risk factors for brain atrophy in different regions in order to find the ultimate therapeutic strategy. Methods Consecutive stroke and/or transient ischemic attack (TIA) patients were recruited from July 2012 to June . The clinical features, neuro?imaging findings and risk factors were collected during hospitalization. Logistic regression analysis showed that, except for age, female gender (Odds ratio, OR=2.447, P=0.007) and the number of silent lacuna infarcts (OR=1.414, P=0.027) were independent risk factors for frontal lobe atrophy. Ischemic stroke history (OR=2.224, P=0.024) was the independent risk factor for parietal lobe atrophy. All of extra-/intracranial larger artery diseases (OR=2.584, P=0.015) and white mat?ter severity score (OR=1.112, P=0.007) as well as the number of silent lacuna infarcts (OR=1.158,P=0.042) were inde?pendent risk factors for medial temporal lobe atrophy. Moreover, diabetes (OR=2.109, P=0.001),atrial fibrillation (OR=1.934, P=0.015) and white matter severity score (OR=1.098, P=0.002) were independent risk factors for global brain atro? phy. Conclusion Risk factors for brain atrophy included diabetes,atrial fibrillation, silent lacuna infarcts and white mat?ter changes. We should pay more attention to those patients with above risk factors in order to slow down the progression of brain atrophy and also prevent them from dementia by early interventions.