脑小血管病总负荷对大动脉粥样硬化型脑梗死急性期病情进展的影响

目的探讨脑小血管病(cerebral small vessel disease,CSVD)总负荷与大动脉粥样硬化(large artery atherosclerosis,LAA)型脑梗死急性期病情进展的关系。方法143例急性LAA型脑梗死患者,依据MRI检查及CSVD总负荷评分量表计算患者的CSVD总负荷评分(总分0~4分)。根据急性期病情有无进展,将患者分为两组:非进展性脑梗死组(non-progressive cerebral infarction,NPCI)和进展性脑梗死组(progressive cerebral infarction,PCI),比较两组间基线资料及CSVD各分项及总负荷评分间的差异,并应用Logistic回归法分析CSVD总负荷评分等指标与LAA型脑梗死急性期进展的关系。结果PCI组与NPCI组间CSVD总负荷评分程度有显著性差异(P<0.05)。PCI组吸烟史、糖尿病史、基线舒张压、空腹血糖、血管源性腔隙、中重度脑白质病变(WMH)、脑微出血(CMBs)及CSVD总负荷评分均高于NPCI组(P<0.05),低密度脂蛋白胆固醇(LDL-C)低于NPCI组(P<0.05);Logistic回归分析显示:空腹血糖、中重度WMH以及CSVD总负荷评分是LAA型脑梗死急性期病情进展的独立危险因素(P<0.05)。结论LAA型脑梗死患者CSVD总负荷严重程度与急性期病情进展密切相关。

Effect of cerebral small vessel disease on the progress of acute stage of large artery atherosclerotic cerebral infarction

Objective To explore the relationship between the total burden of cerebral small vessel disease(CSVD)and the progression of large artery atherosclerosis(LAA)cerebral infarction in acute stage.Methods One hundred and forty-three patients with acute LAA cerebral infarction were collected.The CSVD total load score(0~4 points)was calculated according to MRI and CSVD total load scale.According to the progress of the disease in the acute phase,the patients were divided into two groups:non progressive cerebral infarction group(NPCI)and progressive cerebral infarction group(PCI).The baseline data,CSVD sub items and total load scores were compared between two groups.Logistic regression analysis was used to analyze the relationship between CSVD total load score and the progression of LAA type cerebral infarction.Results There was significant difference in CSVD total load score between PCI group and NPCI group(P<0.05).In group PCI,smoking history,diabetes history,baseline diastolic blood pressure,fasting blood glucose,vascular lacuna,moderate and severe WMH,CMBs and CSVD total load score were all higher than those in NPCI group(P<0.05),and LDL-C level was lower than that in NPCI group(P<0.05).Logistic regression analysis showed that fasting blood glucose,moderate and severe WMH and CSVD total load score were independent risk factors for the progression of LAA cerebral infarction in acute stage(P<0.05).Conclusion The severity of CSVD in patients with LAA type cerebral infarction is closely related to the progress of the disease in acute phase.