缺血性卒中合并脑白质病变的危险因素研究

目的 探讨缺血性卒中合并脑白质病变的患病情况及相关危险因素，通过对其干预以降低脑白质病变的发生率。方法 本研究连续入选2007年8月至2008年10月在北京天坛医院神经内科住院的缺血性卒中患者共483例，依据有无脑白质病变分成伴脑白质病变组和无白质病变两组，得出我院住院的缺血性卒中患者合并脑白质病变的患病率，以有无脑白质病变作为因变量，各种血管病危险因素作为自变量进行Logistic回归多因素分析。结果 我院住院的缺血性卒中患者脑白质病变的患病率为53.8%，随年龄增长发生率和病变严重程度增加（P均<0.01）。Logistic回归显示高龄［比值比（odds ratio，OR）=1.03，95%可信区间（confidence interval，CI）1.00～1.05，P<0.05］、高血压病（OR=1.77，95%CI 1.07～2.91，P<0.05）、卒中病史（OR=1.71，95%CI 1.02～2.88，P<0.05）、高血糖（OR=1.07，95%CI 1.00～1.15，P<0.05）和腔隙性脑梗死（OR=1.89，95%CI 1.17～3.06，P<0.05）是脑梗死患者合并脑白质病变的独立危险因素。结论 随年龄增长，脑白质病变的患病率和严重程度增加；高龄、高血压病、卒中病史、高血糖和腔隙性脑梗死是缺血性卒中患者合并脑白质病变的独立危险因素。

Research on the Risk Factors for White Matter Lesions in Ischemic Stroke

Objective To evaluate the situation and risk factors of cerebral white matter lesions in ischemic stroke patients to decrease the prevalence. Methods Four hundred and eighty-three consecutive inpatients from Aug. 2007 to Oct. 2008 with acute ischemic stroke were enrolled into our study that was divided into two groups （with and without white matter lesions）. Incidence and risk factors of white matter lesions were evaluated. Logistic regressions were applied to analyze related independent influencing factors. Results Of all the 483 patients, white matter lesions presented in 58.3%, the prevalence and severity of white matter lesions increasing with age（P〈0.01）. Logistic regression analysis indentified advanced age（OR=1.03, 95%CI 1.00-1.05, P〈0.05）, history of hypertension（OR=1.77, 95%CI 1.07-2.91, P〈0.05）, history of stroke（OR=l.71, 95%CI 1.02-2.88, P〈0.05）, the level of glucose（OR= 1.07, 95%CI 1.00- 1.15, P〈0.05） and lacunar infarction（OR= 1.89, 95%CI 1.17-3.06, P〈0.05） as being significantly and independently associated with presence of white matter lesions. Conclusion The prevalence and severity of white matter lesions increasing with age. The presence of white matter lesions is significantly associated with age, history of hypertention and stroke, the level of glucose and lacunar infarction.