大动脉粥样硬化性卒中患者脑白质疏松危险因素分析

目的探讨大动脉粥样硬化性卒中(LAA)患者脑白质疏松(LA)的危险因素。方法回顾性分析312例经改良急性卒中Org 10172治疗试验(TOAST)分型的LAA患者的临床资料(年龄、性别及高血压、糖尿病、吸烟、血脂水平、同型半胱氨酸水平、狭窄或闭塞脑动脉数等),采用年龄相关性白质改变(ARWMC)量表评估LA,依据MRI T2加权像或液体衰减反转恢复(FLAIR)序列将患者分为无LA组72例及有LA组240例,同时依据ARWMC评分将有LA组患者分为轻度LA组140例、中度LA组42例及重度LA组58例,并对患者多种危险因素进行单因素和多因素Logistic回归分析。结果 (1)312例LAA患者中男227例(72.8%),平均年龄(64±11)岁,其中240例(76.9%)存在LA。多因素Logistic回归分析显示年龄(OR=2.911,95%CI:1.647~5.146,P0.01)、高血压(OR=2.583,95%CI:1.373~4.857,P0.01)、糖尿病(OR=1.882,95%CI:1.058~3.348,P0.05)、狭窄或闭塞动脉支数(OR=1.851,95%CI:1.018~3.367,P0.05)、腔隙性脑梗死(LI)(OR=1.493,95%CI:1.202~1.853,P0.01)是LA的危险因素。(2)不同严重程度LA组患者临床资料比较显示,3组间年龄、高血压、糖尿病、狭窄或闭塞动脉支数及LI差异有统计学意义(均P0.05)。结论年龄、高血压、糖尿病、狭窄或闭塞动脉数及LI是LAA患者LA的危险因素,且与LA的严重程度相关。

Analysis of risk factors for leukoaraiosis in patients with large artery atherosclerosis

Objective To investigate the risk factors for leukoaraiosis（LA） in patients with large artery atherosclerosis（LAA）.Methods The clinical data（age,sex,hypertension,diabetes,smoking, serum lipid level,hyperhomocysteinemia,and numbers of stenosis or occluded cerebral arteries）of 312 patients with LAA classified by the modified stop stroke study trial of Org 10172 in acute stroke treatment （SSS-TOAST ） were analyzed retrospectively. The age-related white matter changes （age related white matter changes,ARWMC）scale was used to evaluate LA. All the 312 patients were divided into non-LA group（n=72）and LA group（n=240）according the T2 weighted magnetic resonance imaging （MRI） and fluid attenuated inversion recovery（FLAIR）sequence,and 3 groups according to the （age-related white matter changes,ARWMC）scores：mild LA,moderate LA,and severe LA groups. The patients with multiple risk factors were analyzed by the univariate and multivariate Logistic regression analyses. Results （1）Of the 312 patients with LA,227 were males （72. 8%）. Their average age was 64 ± 11 years,and 240 of them （76. 9%）had LA. Multivariate Logistic regression analysis showed that age （OR,2. 911,95%CI 1. 647-5.146,P=0. 000）,hypertension （OR,2. 583,95%CI 1. 373-4.857,P〈0. 01）,diabetes （OR,1. 882, 95%CI 1. 058-3. 348,P 〈0. 05）,the numbers of stenosis or occlusion arteries （OR,1. 851,95%CI 1.018-3. 367,P〈0. 05）,and lacunar infarction （LI）（OR,1.493,95%CI 1. 202-1. 853,P〈0. 01）were the risk factors for LA. （2）The comparison of the clinical data in patients with different severity in the LA group found that there were significant differences in age,hypertension,diabetes,the numbers of stenosis or occlusionarteries,and LI among the 3 groups（all P〈0.05）.Conclusion Age,hypertension,diabetes, the numbers of stenosis or occlusion arteries,and LI are the independent risk factors for patients with LAA,and it is associated with the severity of LA.