经DSA观察缺血性脑血管病患者动脉狭窄分布及危险因素分析
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摘要
目的：通过数字减影血管造影观察缺血性脑血管病患者颅内外动脉血管狭窄分布情况,分析血管狭窄与缺血性脑血管病危险因素的关系,从而为缺血性脑血管病的预防及治疗提供参考。
方法：将396例经DSA检查的缺血性脑血管病患者按动脉狭窄部位不同分为三组,分别为：Ⅰ组：单纯颅内动脉狭窄；Ⅱ组：单纯颅外动脉狭窄；Ⅲ组：颅内、外动脉均存在狭窄,同时设立一个阴性对照组进行研究。全部患者测定：甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、载脂蛋白A(ApoA)、载脂蛋白B (ApoB)、C反应蛋白(CRP)、纤维蛋白原(FIB)。红细胞压积(HCT)。自行设计问卷收集影响因素指标,包括性别、年龄、长期吸烟(≥10支／天×5年)、长期饮酒(白酒≥100克／天×5年)、高血压、糖尿病,危险因素非条件二分类采用单因素方差分析(One-Way ANOVA)及logistic回归分析。
结果：276例脑梗死、37例TIA及83例椎基底动脉供血不足,三组病例中以单纯颅外动脉狭窄最为多见(P<0.01)；单支动脉狭窄分别多于双支、三支及四支以上狭窄(P<0.01)；血管狭窄部位以颅外动脉狭窄多见,且以颈内动脉起始部、椎动脉开口部多见,颅内狭窄以大脑中动脉M1段多见；276例脑梗死患者的395处病变中,以Ⅰ级狭窄最多(41.77%),37例TIA患者44处病交中,以Ⅲ级狭窄最多(38.64%),83例椎基底动脉供血不足患者73处病变中,以Ⅰ级狭窄最多(45.21%)；单因素方差分析及logistic回归分析：随年龄增长颅内段及颅外段脑动脉狭窄的风险增大(OR=1.046),脑血管病男性显著多于女性(P<0.05),吸烟者中重度颅外段狭窄比例最高(37.3%),饮酒者颅内段狭窄组比例最高(50.7%)。糖尿病者颅内段狭窄组达(35.3%),高血压者以颅外段狭窄和中重度颅内+颅外狭窄组为多达(77.1%)。ApoA降低(OR=0.001), TG(OR=1.034)、LDL(OR=1.068)、ApoB(OR=2.522)升高脑动脉狭窄的危险随之增大。
结论：
(1)在脑梗死、TIA和椎基底动脉供血不足三组病例中以单支动脉狭窄及单纯颅外动脉狭窄最为多见。
(2)颅外动脉单支动脉狭窄以颈内动脉起始部及椎动脉起始段狭窄最多,颅内狭窄以大脑中动脉M1段多见。
(3)脑血管狭窄以Ⅰ级狭窄最多(41.77%),提示其亦与缺血性脑血管病密切相关。
(4)高龄、男性、高血压、吸烟者糖尿病、饮酒、ApoA降低、ApoB升高是脑动脉狭窄的危险因素。高龄、男性、高血压、吸烟者发生颅外动脉狭窄较多；糖尿病、饮酒、ApoA降低、ApoB升高发生颅内动脉狭窄较多。
Objective:
Observing Distribution of intracranial and extra cranial Arteriostenosis in Patients with Ischemic Cerebral Vascular Disease(ICVD) by DSA,analyze relationship between the distribution of 1 arteriostenosis and the risk factors of ICVD,provide reference for preventing and treating ICVD.
Methods
396 patients of ICVD detected by DSA were detached three groups. as follows:Ⅰgroup, pure intra cranial artery stenosis;Ⅱgroup, pure extra cranial artery stenosisⅢgroup, intra and extra cranial artery stenosis.Meanwhile,establish one group which were negative. We measured biochemical indicators such as TG, TC, HDL, LDL, Apo A, Apo B, CRP, FIB and so on., And collected these risk factors with self-design questionnaire such as sex, age, long-term smoking, long-term drinking, hypertension,etc of all patients.The risk factors were analyzed by One-Way ANOVA and Binary Logistic Regression Analysis.
Research Results
Pure extra cranial artery stenosis occupied the great majority of these three groups (P<0.01).The majority of sigle artery stenosis were bigger than that of two or more artery stenosis (P＜0.01). The positions of lesion were mostly in extra cranial artery.These lesions mostly were sinus of ICA and the beginning of VA,moreover,the lesions of intra cranial artery mostly were MCA(M1).395 lesions in 276 patients of CI were mostly the first grade (41.77%);44 lesions in 37 patients of TIA were mostly the third grade(38.64%);while,73 lesions in 83 patients of VBI were mostly the first grade(45.21%). One-Way ANOVA and Binary Logistic Regression Analysis prompted: The risk of intra cranial or extra cranial artery stenosis will enlarge
When growing (OR=1.046);the male are more liably to fall ICVD(P<0.05),severe extra cranial artery stenosis occupied the great proportion long-term smoker(37.3%),while intra cranial artery stenosis occupied the great proportion long-term drinker(50.7%).In patients of DM,they were mostly intra cranial artery stenosises(35.3%),while extra cranial artery stenosis or middle/severe intra and extra cranial artery stenosises in patients of HBP(77.1%).The descending of ApoA (OR=0.001),the ascending of TG(OR=1.034)、LDL(OR=1.068)、ApoB(OR=2.522) will enlarge the risk of cerebral artery stenosis.
Conclusion:
1 Single artery stenosis and pure extra cranial artery stenosis occupied the great majority of these three groups such as group of CI, group of TIA and group of VBI.
2 Single artery stenosises of extra cranial artery stenosis are mostly in sinus of ICA and the beginning of VA,while the lesions of intra cranial artery mostly are MCA(M1).
3 The first grade artery stenosis occupies the greatest proportion of these three groups(41.77%), which indicates that closely relationship is being between the first grade artery stenosis and ICVD.
4 Age,different nature,HBP,DM,long-term smoking,long-term drinking,descending of ApoA and ery stenosis.ascending of TG,LDL,or ApoB are the risk factors of artery stenosis. Patients of advanced age,male,HBP, long-term smoking are liably fall extra cranial artery stenosis,while those of DM,long-term drinking,descending of ApoA ascending of ApoB are liably to fall intra cranial artery stenosis.
方法：将396例经DSA检查的缺血性脑血管病患者按动脉狭窄部位不同分为三组,分别为：Ⅰ组：单纯颅内动脉狭窄；Ⅱ组：单纯颅外动脉狭窄；Ⅲ组：颅内、外动脉均存在狭窄,同时设立一个阴性对照组进行研究。全部患者测定：甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、载脂蛋白A(ApoA)、载脂蛋白B (ApoB)、C反应蛋白(CRP)、纤维蛋白原(FIB)。红细胞压积(HCT)。自行设计问卷收集影响因素指标,包括性别、年龄、长期吸烟(≥10支／天×5年)、长期饮酒(白酒≥100克／天×5年)、高血压、糖尿病,危险因素非条件二分类采用单因素方差分析(One-Way ANOVA)及logistic回归分析。
结果：276例脑梗死、37例TIA及83例椎基底动脉供血不足,三组病例中以单纯颅外动脉狭窄最为多见(P<0.01)；单支动脉狭窄分别多于双支、三支及四支以上狭窄(P<0.01)；血管狭窄部位以颅外动脉狭窄多见,且以颈内动脉起始部、椎动脉开口部多见,颅内狭窄以大脑中动脉M1段多见；276例脑梗死患者的395处病变中,以Ⅰ级狭窄最多(41.77%),37例TIA患者44处病交中,以Ⅲ级狭窄最多(38.64%),83例椎基底动脉供血不足患者73处病变中,以Ⅰ级狭窄最多(45.21%)；单因素方差分析及logistic回归分析：随年龄增长颅内段及颅外段脑动脉狭窄的风险增大(OR=1.046),脑血管病男性显著多于女性(P<0.05),吸烟者中重度颅外段狭窄比例最高(37.3%),饮酒者颅内段狭窄组比例最高(50.7%)。糖尿病者颅内段狭窄组达(35.3%),高血压者以颅外段狭窄和中重度颅内+颅外狭窄组为多达(77.1%)。ApoA降低(OR=0.001), TG(OR=1.034)、LDL(OR=1.068)、ApoB(OR=2.522)升高脑动脉狭窄的危险随之增大。
结论：
(1)在脑梗死、TIA和椎基底动脉供血不足三组病例中以单支动脉狭窄及单纯颅外动脉狭窄最为多见。
(2)颅外动脉单支动脉狭窄以颈内动脉起始部及椎动脉起始段狭窄最多,颅内狭窄以大脑中动脉M1段多见。
(3)脑血管狭窄以Ⅰ级狭窄最多(41.77%),提示其亦与缺血性脑血管病密切相关。
(4)高龄、男性、高血压、吸烟者糖尿病、饮酒、ApoA降低、ApoB升高是脑动脉狭窄的危险因素。高龄、男性、高血压、吸烟者发生颅外动脉狭窄较多；糖尿病、饮酒、ApoA降低、ApoB升高发生颅内动脉狭窄较多。
Objective:
Observing Distribution of intracranial and extra cranial Arteriostenosis in Patients with Ischemic Cerebral Vascular Disease(ICVD) by DSA,analyze relationship between the distribution of 1 arteriostenosis and the risk factors of ICVD,provide reference for preventing and treating ICVD.
Methods
396 patients of ICVD detected by DSA were detached three groups. as follows:Ⅰgroup, pure intra cranial artery stenosis;Ⅱgroup, pure extra cranial artery stenosisⅢgroup, intra and extra cranial artery stenosis.Meanwhile,establish one group which were negative. We measured biochemical indicators such as TG, TC, HDL, LDL, Apo A, Apo B, CRP, FIB and so on., And collected these risk factors with self-design questionnaire such as sex, age, long-term smoking, long-term drinking, hypertension,etc of all patients.The risk factors were analyzed by One-Way ANOVA and Binary Logistic Regression Analysis.
Research Results
Pure extra cranial artery stenosis occupied the great majority of these three groups (P<0.01).The majority of sigle artery stenosis were bigger than that of two or more artery stenosis (P＜0.01). The positions of lesion were mostly in extra cranial artery.These lesions mostly were sinus of ICA and the beginning of VA,moreover,the lesions of intra cranial artery mostly were MCA(M1).395 lesions in 276 patients of CI were mostly the first grade (41.77%);44 lesions in 37 patients of TIA were mostly the third grade(38.64%);while,73 lesions in 83 patients of VBI were mostly the first grade(45.21%). One-Way ANOVA and Binary Logistic Regression Analysis prompted: The risk of intra cranial or extra cranial artery stenosis will enlarge
When growing (OR=1.046);the male are more liably to fall ICVD(P<0.05),severe extra cranial artery stenosis occupied the great proportion long-term smoker(37.3%),while intra cranial artery stenosis occupied the great proportion long-term drinker(50.7%).In patients of DM,they were mostly intra cranial artery stenosises(35.3%),while extra cranial artery stenosis or middle/severe intra and extra cranial artery stenosises in patients of HBP(77.1%).The descending of ApoA (OR=0.001),the ascending of TG(OR=1.034)、LDL(OR=1.068)、ApoB(OR=2.522) will enlarge the risk of cerebral artery stenosis.
Conclusion:
1 Single artery stenosis and pure extra cranial artery stenosis occupied the great majority of these three groups such as group of CI, group of TIA and group of VBI.
2 Single artery stenosises of extra cranial artery stenosis are mostly in sinus of ICA and the beginning of VA,while the lesions of intra cranial artery mostly are MCA(M1).
3 The first grade artery stenosis occupies the greatest proportion of these three groups(41.77%), which indicates that closely relationship is being between the first grade artery stenosis and ICVD.
4 Age,different nature,HBP,DM,long-term smoking,long-term drinking,descending of ApoA and ery stenosis.ascending of TG,LDL,or ApoB are the risk factors of artery stenosis. Patients of advanced age,male,HBP, long-term smoking are liably fall extra cranial artery stenosis,while those of DM,long-term drinking,descending of ApoA ascending of ApoB are liably to fall intra cranial artery stenosis.
引文
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