吴祖伟;周岚;

• 1:十堰市太和医院

摘要(Abstract)：

目的探讨MRI脑小血管病(CSVD)总体负担与中老年人远期首次症状性缺血性脑卒中的关系。方法选择2015-06—2019-05在十堰市太和医院神经内科住院治疗的138例首次腔隙性梗死的患者为病例组,另选择同期在神经内科住院治疗的非腔隙性梗死的脑小血管病患者138例为对照组,对比2组患者的一般资料、影像学标志物及小血管病评分(SVD)。通过Logistic回归分析腔隙性梗死的独立危险因素,并建立预测模型。采用Spearman等级相关分析CSVD总体负担的相关因素。结果病例组与对照组在男性、BMI、吸烟史、饮酒史、收缩压和舒张压、缺血性心脏病、动脉粥样硬化、空腹血糖(FBG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)等方面差异均有统计学意义(P<0.05)。病例组87例患者有1个以上的腔隙,66例患者表现为重度白质病变(室周WML Fazekas评分3分)和深部WMLs评分2分或3分,52例患者至少有1个脑微出血(CMBs),76例患者有中到重度血管周围间隙扩大(EPVSs),各项相对于对照组比例更高(P<0.05)。二元Logistic回归分析病例组相对于对照组的独立危险因素,结果表明吸烟史、高血压、缺血性心脏病、动脉粥样硬化以及SVD评分是腔隙性梗死发生的独立危险因素。基于腔隙性梗死的影响因素构建预测模型:预测值=EXP[1.557—0.941(SVD评分)—1.700(吸烟史)—1.546(高血压)—1.361(缺血性心脏病)—1.588(动脉粥样硬化)],该模型AUC为0.895。Spearman等级相关分析表明年龄、高血压、入院时NIHSS评分与SVD评分均呈正向等级相关(r=1.367、2.359、1.639,P<0.001)。结论 CSVD总体负担是中老年人远期首次腔隙性梗死的独立危险因素,SVD评分对于腔隙性梗死具有重要预测价值。此外,SVD评分与年龄、高血压、入院时NIHSS评分密切相关,对首次腔隙性梗死患者的预防及治疗具有一定的参考价值。

关键词(KeyWords)： 脑小血管病;总体负担;腔隙性梗死;缺血性脑卒中;影响因素

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 吴祖伟;周岚;

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