小血管闭塞性卒中的危险因素分析

目的 探讨小血管闭塞性卒中(small artery occlusion,SAO)及其2种亚型的相关危险因素.方法 从南京卒中注册系统中收集2009年12月至2010年11月注册、符合TOAST标准中大血管动脉粥样硬化性卒中(large artery atherosclcrosis,LAA)或SAO的首发急性缺血性卒中患者的临床和影像学资料.病例分为LAA组和SAO组,后者再分为腔隙性脑梗死伴缺血性白质疏松(ischaemic leukoaraiosis,ILA)亚组和单纯腔隙性梗死(isolated lacunar infarction,ILI)亚组,比较LAA组与SAO组及其亚组的危险因素,并进行多变量logistic回归分析,筛选独立危险因素.结果 共纳入291例病例,其中LAA组120例,SAO组171例(ILI亚组87例,ILA亚组84例).SAO组平均年龄大于LAA患者,高血压患者比例和血清同型半胱氨酸(homocysteine,Hcy)水平显著高于LAA患者(P均＜0.05).多变量logistic分析表明,高龄[优势比(odds ratio,OR)1.041,95%可信区间(confidence interval,CI)1.02～1.06,P=0.045]、高血压(OR=2.912,95%CI 1.11～6.46,P=0.031)和血浆Hcy水平增高(OR=1.109,95%CI 1.11～1.32,P=0.001)是SAO的独立危险因素.在SAO的两亚组中,高龄(OR=1.047,95%CI 1.00～1.09,P=0.043)、高血压(OR=2.632,95%CI 1.08～6.41,P=0.033)和血浆Hcy水平增高(OR=1.211,95%CI 1.11～1.32,P＜0.001)是ILA的独立危险因素,而高胆固醇血症(OR=0.136,95%CI 0.05～0.37,P＜0.001)则是ILI的独立危险因素.结论 高龄、高血压和血浆Hcy水平增高可能在SAO的发病机制中起着重要作用.高胆固醇血症是ILI的独立危险因素,而高龄、高血压病和血浆Hcy水平增高是ILA的独立危险因素.

Abstract：

Objective To investigate the related risk factors for small artery occlusion (SAO) and its 2 subtypes. Methods The clinical and imaging data in 291 patients with first-ever stroke who met the TOAST criteria of large artery atherosclerotic stroke (LAA) or SAO were collected from the Nanjing Stroke Registry Prog-am from December 2009 to November 2010. All the patients were divided into a LAA group (n = 120) and a SAO group (n = 171). The latter was redivided into either a lacunar infarction with ischemic leukoaraiosis (ILA) subgroup (n = 84)or an isolated lacunar infarction (ILI) subgroup (n = 87). The risk factors of the LAA group and SAO group and its subgroups were compared. Multivariate logistic regression analysis was conducted and the independent risk factors were screened. Results The mean age in the SAO group was larger than that in the LAA group. The proportion of the patients with hypertension and the serum homocysteine (Hcy) level were significantly higher than those in the LAA group (all P ＜0. 05). Multivariate logistic analysis showed that the advanced age (odds ratio, [OR] = 1.041,95% confidence interval [CI] 1.02-1.06, P = 0.045), hypertension (OR = 2. 912,95% CI 1. 11-6. 46, P =0. 031) and increased plasma Hcy (OR = 1. 109, 95% CI 1. 11-1. 32, P =0. 001) were the independent risk factors for SAO. The advanced age (OR = 1. 047,95% CI 1.00-1.09, P = 0.043), hypertension (OR = 2. 632, 95% CI 1.08-6.41, P= 0.033) and increased plasma Hcy (OR = 1. 211, 95% CI 1. 11-1. 32, P ＜0. 001) were the independent risk factors for ILA, while the hypercholesterolemia (OR =0. 136, 95% CI 0. 05-0. 37, P ＜0. 001) was the independent risk factor for ILI. Conclusions The advanced age, hypertension and increased plasma Hcy level may play important roles in the pathogenesis of SAO. The hypercholesterolemia is an independent risk factor for ILI, while advanced age, hypertension and increased plasma Hcy level are the independent risk factors for ILA.

Analysis of the risk factors for small vessel occlusive stroke

Objective To investigate the related risk factors for small artery occlusion (SAO) and its 2 subtypes. Methods The clinical and imaging data in 291 patients with first-ever stroke who met the TOAST criteria of large artery atherosclerotic stroke (LAA) or SAO were collected from the Nanjing Stroke Registry Prog-am from December 2009 to November 2010. All the patients were divided into a LAA group (n = 120) and a SAO group (n = 171). The latter was redivided into either a lacunar infarction with ischemic leukoaraiosis (ILA) subgroup (n = 84)or an isolated lacunar infarction (ILI) subgroup (n = 87). The risk factors of the LAA group and SAO group and its subgroups were compared. Multivariate logistic regression analysis was conducted and the independent risk factors were screened. Results The mean age in the SAO group was larger than that in the LAA group. The proportion of the patients with hypertension and the serum homocysteine (Hcy) level were significantly higher than those in the LAA group (all P ＜0. 05). Multivariate logistic analysis showed that the advanced age (odds ratio, [OR] = 1.041,95% confidence interval [CI] 1.02-1.06, P = 0.045), hypertension (OR = 2. 912,95% CI 1. 11-6. 46, P =0. 031) and increased plasma Hcy (OR = 1. 109, 95% CI 1. 11-1. 32, P =0. 001) were the independent risk factors for SAO. The advanced age (OR = 1. 047,95% CI 1.00-1.09, P = 0.043), hypertension (OR = 2. 632, 95% CI 1.08-6.41, P= 0.033) and increased plasma Hcy (OR = 1. 211, 95% CI 1. 11-1. 32, P ＜0. 001) were the independent risk factors for ILA, while the hypercholesterolemia (OR =0. 136, 95% CI 0. 05-0. 37, P ＜0. 001) was the independent risk factor for ILI. Conclusions The advanced age, hypertension and increased plasma Hcy level may play important roles in the pathogenesis of SAO. The hypercholesterolemia is an independent risk factor for ILI, while advanced age, hypertension and increased plasma Hcy level are the independent risk factors for ILA.