颅内动脉粥样硬化性狭窄与急性脑梗死进展发生的关系

目的探讨脑动脉粥样硬化性狭窄与急性脑梗死进展发生的联系。方法回顾性分析2011年1月²014年1月在我院住院治疗的急性单发皮质下小梗死患者272例,根据入院3d是否发生进展性神经功能障碍(PND)分为PND组64例,非PND组208例。所有患者神经功能评估采用美国国立卫生研究院卒中量表(NIHSS)评分,以入院3d内复评NIHSS评分,入院时增加≥2分或运动功能缺损波动≥1分为PND。根据脑血管检查结果将入组患者的脑血管动脉粥样硬化病变分为颅内、颅外及前、后循环系统,比较2组患者间各系统动脉粥样硬化性狭窄发生的差异。结果与非PND组比较,PND组女性比例明显升高(45.3%vs 31.7%,P=0.046)、NIHSS评分明显升高[7(4,9)分vs 6(3,8)分,P=0.033]、病灶≥15mm比例更高(42.2%vs 28.8%,P=0.045)、颅内动脉粥样硬化性狭窄(45.3%vs 29.8%,P=0.022)和颅外动脉粥样硬化性狭窄比例更高(53.1%vs 38.0%,P=0.032),差异有统计学意义。logistic回归分析显示,颅内动脉粥样硬化性狭窄是PND发生的独立危险因素(OR=1.961,95%CI:1.0702014年1月在我院住院治疗的急性单发皮质下小梗死患者272例,根据入院3d是否发生进展性神经功能障碍(PND)分为PND组64例,非PND组208例。所有患者神经功能评估采用美国国立卫生研究院卒中量表(NIHSS)评分,以入院3d内复评NIHSS评分,入院时增加≥2分或运动功能缺损波动≥1分为PND。根据脑血管检查结果将入组患者的脑血管动脉粥样硬化病变分为颅内、颅外及前、后循环系统,比较2组患者间各系统动脉粥样硬化性狭窄发生的差异。结果与非PND组比较,PND组女性比例明显升高(45.3%vs 31.7%,P=0.046)、NIHSS评分明显升高[7(4,9)分vs 6(3,8)分,P=0.033]、病灶≥15mm比例更高(42.2%vs 28.8%,P=0.045)、颅内动脉粥样硬化性狭窄(45.3%vs 29.8%,P=0.022)和颅外动脉粥样硬化性狭窄比例更高(53.1%vs 38.0%,P=0.032),差异有统计学意义。logistic回归分析显示,颅内动脉粥样硬化性狭窄是PND发生的独立危险因素(OR=1.961,95%CI:1.070³.592,P=0.029)。结论颅内动脉粥样硬化性狭窄是急性缺血性脑卒中早期发生PND的独立危险因素。

Relation between intracranial atherosclerotic stenosis and acute ischemic stroke progression

Objective To study the relation between intracranial atherosclerotic stenosis and acute ischemic stroke(AIS)progression.Methods Two hundred and seventy-two AIS patients admitted to our hospital from January 2011 and January 2014 were divided into progressive neurological dysfunction(PND)group(n=64)and non-PND group(n=208).Cerebral atherosclerotic lesions were divided into intracranial circulation system lesion,extracranial circulation system lesion,anterior circulation system lesion,and posterior circulation system lesion according to their angiographic findings.Incidence of atherosclerotic stenosis in different circulation systems was compared.Results The proportion of female patients,lesion size≥15mm,intracranial atherosclerotic stenosis,and extracranial atherosclerotic stenosis was significantly higher in PND group than in non-PND group(45.3%vs 31.7%,P=0.046;42.2%vs 28.8%,P=0.045;45.3%vs 29.8%,P=0.022;53.1%vs 38.0%,P=0.032).The NIHSS scale was significantly higher in PND group than in non-PND group[7(4,9)vs 6(3,8),P=0.033].Logistic regression analysis showed that intracranial atherosclerotic stenosis was an independent risk factor for PND(OR=1.961,95%CI:1.070-3.592,P=0.029).Conclusion Intracranial atherosclerotic stenosis is an independent risk factor for early PND in AIS patients.