老年患者颅内动脉粥样硬化性狭窄的分布和危险因素研究

目的 探讨老年患者颅内动脉粥样硬化性狭窄的分布特征和相关危险因素。方法 收集2013年1月~2016年10月我院颅内动脉粥样硬化性狭窄的老年患者178例设为狭窄组，选取同期非动脉粥样硬化151例患者作为对照组，收集患者一般人口学资料明确颅内动脉狭窄诊断前后3 d内行空腹血糖（FPG）、糖化血红蛋白（HBA1c）、血脂、血尿酸（UA）、血同型半胱氨酸（Hcy）、纤维蛋白原（FIB）等检查。结果 前循环颅内动脉狭窄、后循环颅内动脉狭窄和前后循环兼有的颅内动脉狭窄患者例数分别为80例（44.90%）、55例（30.90%）和43例（24.20%）。脑血管病家族史（OR=6.762，P=0.048）、高血压（OR=4.173，P=0.021）、糖尿病（OR=5.005，P=0.038）、高低密度脂蛋白胆固醇（LDL-C）（OR=3.454，P=0.036）是老年患者前循环颅内动脉硬化性狭窄的危险因素；吸烟（OR=3.799，P=0.036）、高总胆固醇（TC）（OR=1.479，P=0.022）、高甘油三酯（TG）（OR=1.110，P=0.041）、高LDL-C（OR=4.172，P=0.010）是后循环狭窄的危险因素；而前、后循环狭窄的危险因素包括高血压（OR=5.8585，P=0.043）、高LDL-C（OR=2.924，P=0.038）、高载脂蛋白B（ApoB）（OR=3.589，P=0.025）、高Hcy（OR=5.529，P=0.007）和高FIB（OR=1.460，P=0.029）。结论 在老年颅内动脉粥样硬化性狭窄患者中，以前循环狭窄最为多见。高LDL-C是三种类型老年颅内动脉狭窄共有的危险因素，高血压是前循环和前后循环狭窄类型的危险因素，FIB是后循环、前后循环狭窄共有的危险因素。

Distribution and Risk Factors of Intracranial Atherosclerotic Stenosis in Elderly Patients

Objective To investigate the distribution characteristics and related risk factors of intracranial atherosclerotic stenosis in elderly patients. Methods 178 elderly patients with intracranial atherosclerotic stenosis from January 2013 to October 2016 were enrolled in the stenosis group. 151 patients with non-atherosclerosis were selected as the control group. Fasting intracranial stenosis was confirmed within 3 d before and after diagnosis of fasting blood glucose (FPG), glycosylated hemoglobin (HBA1c), blood lipids, blood uric acid (UA), blood homocysteine (Hcy), fibrinogen (FIB) and other tests.Results The number of patients with anterior circulation intracranial artery stenosis, posterior circulation intracranial artery stenosis, and anterior and posterior circulatory intracranial stenosis were 80 (44.90%), 55(30.90%), and 43(24.20%), respectively. Family history of cerebrovascular disease (OR=6.762, P=0.048), hypertension (OR=4.173, P=0.021), diabetes (OR=5.005, P=0.038), high-low-density lipoprotein cholesterol (LDL-C) OR=3.454, P=0.036) was a risk factor for anterior circulation intracranial arteriosclerotic stenosis in elderly patients; smoking (OR=3.799, P=0.036), high total cholesterol (TC) (OR=1.479, P=0.022), High triglyceride (TG) (OR=1.110, P=0.041) and high LDL-C (OR=4.172, P=0.010) were risk factors for posterior circulation stenosis; risk factors for anterior and posterior circulation stenosis included hypertension (OR=5.8585, P=0.043), high LDL-C (OR=2.924, P=0.038), high apolipoprotein B (ApoB) (OR=3.589, P=0.025), high Hcy (OR=5.529, P =0.007) and high FIB (OR=1.460, P=0.029).Conclusion In patients with senile intracranial atherosclerotic stenosis, previous circulation stenosis is the most common. High LDL-C is a common risk factor for three types of elderly intracranial artery stenosis. Hypertension is a risk factor for anterior circulation and anterior and posterior circulation stenosis. FIB is a common risk factor for posterior circulation and anterior and posterior circulation stenosis.