单侧大动脉粥样硬化型大脑中动脉闭塞侧枝形成的临床因素分析

廖照亮; 董海燕; 卢振产

doi:10.16766/j.cnki.issn.1674-4152.001730

单侧大动脉粥样硬化型大脑中动脉闭塞侧枝形成的临床因素分析

doi: 10.16766/j.cnki.issn.1674-4152.001730

1.
苍南县人民医院神经内科，浙江温州 325800
2.
龙港市人民医院内三科, 浙江温州 325802
3.
湖州市中心医院神经内科，浙江湖州 313000

基金项目:

浙江省医药卫生科技计划项目 2018RC070

详细信息

通讯作者:
廖照亮，E-mail：370358112@qq.com

中图分类号: R743
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- 被引次数: 0
出版历程
- 收稿日期: 2020-03-12
- 网络出版日期: 2022-02-19

Clinical factors of the collateral formation of unilateral atherosclerotic middle cerebral artery occlusion

1.
Department of Neurology, Cangnan People's Hospital, Wenzhou, Zhejiang 325800, China

摘要

摘要: 目的探究临床因素与生化指标对单侧大动脉粥样硬化型大脑中动脉闭塞(MCAO)侧枝形成的影响，为其治疗提供依据。方法选择2016年2月—2019年9月于苍南县人民医院神经内科住院治疗的单侧大动脉粥样硬化型MCAO患者198例作为研究对象，根据侧枝形成的情况将其分为侧枝良好组(GC组)和侧枝不良组(PC组)，比较2组患者的基线资料、用药资料以及生化检验等，采用多因素logistic回归分析影响单侧大动脉粥样硬化型MCAO侧枝形成的相关因素。结果 GC组48例，PC组150例。GC组高密度脂蛋白(HDL)水平为(1.21±0.14)mmol/L，高于PC组[(0.94±0.11)mmol/L, t=13.810，P＜0.05]；GC组低密度脂蛋白(LDL)、同型半胱氨酸(Hcy)和空腹血糖(FBG)水平分别为(2.41±0.85)mmol/L、(11.52±4.20)mmol/L、(5.45±1.84)mmol/L，PC组上述指标分别为(2.93±0.89)mmol/L、(13.71±4.06)mmol/L、(6.02±1.39)mmol/L，差异有统计学意义(t值分别为3.560、3.226、2.276，均P＜0.05)。GC组美国国立卫生研究院卒中量表(NIHSS)评分低于PC组(t=3.201，P＜0.05)，他汀类用药占比高于PC组(χ²=6.406，P＜0.05)。高血压、HDL、Hcy、NIHSS、他汀类药物是影响单侧大动脉粥样硬化型MCAO侧支循环形成的独立相关因素。结论使用他汀类药物、高HDL水平能够促进单侧大动脉粥样硬化型MCAO侧支循环的形成，高Hcy与NIHSS不利于侧枝良好建立。
- 大脑中动脉闭塞 /
- 单侧 /
- 大动脉硬化 /
- 侧枝 /
- 他汀类
Abstract: Objective To explore the effect of clinical factors and biochemical indexes on the formation of unilateral large-artery atherosclerotic middle cerebral artery occlusion (MCAO) collaterals and to provide basis for its treatment. Methods A total of 198 unilateral aortic atherosclerotic patients with MCAO who were hospitalised in the Department of Neurology at Cangnan People's hospital from February 2016 to September 2019 were selected as the research subjects. They were divided into the good collateral (GC) and poor collateral (PC) groups on the basis of the formation of collaterals. The baseline data, medication data and biochemical tests of the two groups were compared. Multivariate logistic regression analysis was used to analyse the independent factors that affected the formation of unilateral aortic MCAO collaterals. Results Forty-eight cases were included in the GC group, and 150 cases were included in the PC group. The high-density lipoprotein (HDL) level in the GC group was (1.21±0.14) mmol/L, which was higher than that in the PC group [(0.94±0.11) mmol/L, t=13.810, P < 0.05]; the low-density lipoprotein (LDL), homocysteine (Hcy) and fasting blood glucose levels in the GC group were (2.41±0.85) mmol/L, (11.52±4.20) mmol/L and (5.45±1.84) mmol/L, respectively, whereas those in the PC group were (2.93±0.89) mmol/L, (13.71±4.06) mmol/L and (6.02±1.39) mmol/L, respectively, and the difference was statistically significant (t=3.560, 3.226, 2.276, respectively, P < 0.05). The National Institutes of Health Stoke Scale (NIHSS) in the GC group was lower than that in the PC group (t=3.201, P < 0.05), and the proportion of statins was higher than that in the PC group (χ²=6.406, P < 0.05). Hypertension, HDL, Hcy, NIHSS and statins affected the formation of collateral circulation of unilateral large-artery atherosclerotic MCAO independently. Conclusion Statins and high HDL levels can promote the formation of unilateral aortic MCAO collateral circulation, but high Hcy level and high NIHSS are not conducive to good collateral establishment.
- Middle cerebral artery occlusion /
- Unilateral /
- Aortic sclerosis /
- Collateral /
- Statins

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表 1 单侧大动脉粥样硬化型MCAO患者临床资料比较(x±s)

组别	例数	性别(例)		年龄(岁)	糖尿病 (例)	吸烟 (例)	房颤 (例)	冠心病 (例)	高血压 (例)	既往TIA (例)	HDL (mmol/L)
组别	例数	男性	女性	年龄(岁)	糖尿病 (例)	吸烟 (例)	房颤 (例)	冠心病 (例)	高血压 (例)	既往TIA (例)	HDL (mmol/L)
GC组	48	28	20	65.08±9.54	16	18	4	8	25	2	1.21±0.14
PC组	150	96	54	68.57±10.58	52	78	10	36	54	6	0.94±0.11
统计量		0.499^a		2.035^b	0.029^a	3.061^a	0.154^a	1.131^a	3.923^a	0.003^a	13.810^b
P值		0.480		0.043	0.866	0.080	0.690	0.287	0.048	0.959	＜0.001

组别	例数	LDL (mmol/L)		TG (mmol/L)	CHOL (mmol/L)	Hcy (mmol/L)	FBG (mmol/L)	NIHSS (分)	他汀类药物 (例)
GC组	48	2.41±0.85		1.68±0.85	4.59±1.14	11.52±4.20	5.45±1.84	8.48±3.58	24
PC组	150	2.93±0.89		1.75±0.88	4.62±1.20	13.71±4.06	6.02±1.39	10.56±4.02	45
统计量		3.560^b		0.484^b	0.153^b	3.226^b	2.276^b	3.201^b	6.406^a
P值		＜0.001		0.629	0.819	0.001	0.024	0.002	0.011
注：^a为χ²值，^b为t值；TIA为短暂性脑缺血发作。

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表 2 影响侧支循环良好的多因素logistic回归分析

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄	-0.053	0.852	-0.847	0.185	1.385	0.958~1.812
吸烟	-0.005	0.021	-0.001	0.698	0.768	0.315~1.221
高血压	0.957	0.174	8.705	0.027	1.480	1.124~1.836
HDL	1.999	0.328	20.482	0.001	4.921	1.118~8.724
LDL	-0.018	0.017	-0.001	0.598	0.895	0.327~1.463
Hcy	-0.938	0.216	-7.351	0.001	0.555	0.385~0.725
FBG	-0.005	0.022	-0.002	0.195	0.965	0.859~1.071
NIHSS	-1.205	0.315	-15.263	0.001	0.865	0.768~0.962
他汀类	1.598	0.214	6.745	0.005	1.862	1.298~2.426

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