隐匿性脑梗死和多血管床病变相关性研究

隐匿性脑梗死和多血管床病变相关性研究 ［摘要］目的研究隐匿性脑梗死（SCO和多血管床病变

（PolyVD）的相关性，为识别脑梗死高危人群提供依据。方

法纳入2015年2月〜2016年6月入住台州市中心医院神经 内科的患者， 95 例被确诊为首次隐匿性脑梗死的患者作为脑 梗死组， 95 例同期头晕、 头痛而经头颅 MRI 证实无梗死灶者 作为对照组。检测外周动脉区（颈动脉、锁骨下动脉、下肢 动脉）及冠状动脉、颅内动脉，比较各个区域血管床病变情 况。结果两组患者在性别、年龄、烟酒史及高血压病史、糖 尿病史、冠心病史、血脂基线水平等方面差异无统计学意义

（P>0.05）。检测外周血管区（颈动脉、锁骨下动脉、下肢动

脉）及冠状动脉、颅内动脉，相应动脉病变检出率，脑梗死 组分别为 65.3%、 24.2%、 33.7%， 21.1%、 32.6%，对照组分

别为 49.5%、 17.9%、 25.3%、 15.8%、 24.2%，其中脑梗死组 颈动脉斑块检出率高于对照组，差异有统计学意义（ 2=4.842， P=0.028） 两组病变血管检出条数率分别为 35.4%、

27.4%,脑梗死组咼于对照组，差异有统计学差异（X 2=8.689,

P=0.003）。外周动脉、冠状动脉、颅内动脉的三个区域，两

组 1 个区域发生动脉粥样硬化病变分别是 37.9%、 72.6%，存 在 2个区域血管病变分别为 47.4%、 22.1%，存在 3个区域血 管病变分别为 14.7%、 5.3%，两组病变区域比较，差异有统 计学意义（ Z=4.761， P=0.000 [关键词 ] 脑梗死；多血管床；外周动脉；冠状动脉

[中图分类号 ] R743.3；R766 [文献标识码 ] A [文章编号 ] 1673-9701（2016）33-0008-04 [Abstract] Objective To study the correlation between

silent cerebral infarction （ SCI） and polyvascular disease

PolyVD）， and to provide evidence for identifying high risk population of cerebral infarction. Methods From February 2015 to June 2016， patients admitted to Department of Neurology ，

the Central Hospital of Taizhou City were enrolled in this study.

Among them ， 95 patients who were diagnosed as first SCI were enrolled in the cerebral infarction group ， 95 patients with dizziness and headache while had no cerebral infarction confirmed by head MRI were enrolled in the control group.

Peripheral arterial areas （ carotid artery ， subclavian artery ，

lower extremity artery ）， coronary artery and intracranial artery were examined ， the vascular bed lesions were compared in each region. Results There were no significant differences in sex ， age， history of alcohol and tobacco ，

hypertension ， diabetes mellitus ， coronary heart disease and blood lipid baseline level between the two groups （P>0.05） . The detection rate of cerebral arteries was 65.3% ，

24.2%，

33.7%， 21.1% and 32.6% respectively in the peripheral arterial areas (carotid artery ， subclavian artery，

lower extremity artery )， coronary artery and intracranial artery ， while the

control group was 49.5% ， 17.9%， 25.3%，

15.8%， 24.2% respectively ，

in which， the carotid plaque detected was significantly higher in the cerebral infarction group than that in the control group ， the difference was statistically significant

x 2=4.842， P=0.028) . The ratio of the number of blood vessels detected in the two groups were 35.4% and 27.4% ，

respectively ， which was higher in the cerebral infarction group than the control group ， the difference between the two groups was statistically significant ( x 2=8.689, P=0.003) . The incidence of one atherosclerotic lesion occured in the three regions of peripheral artery ， coronary artery and intracranial artery between the two groups was 37.9% and 72.6% ， while the incidence of two lesions occurred was 47.4% and 22.1% ，

respectively ， the incidence of three lesions occurred was 14.7%

and 5.3%， respectively ， showed statistically significant

differences between the two groups ( Z=4.761， P=0.000 [Key words] Cerebral infarction ； Polyvascular； Peripheral artery ； Coronary artery 脑血管病已居我国疾病死亡率首位，脑梗死具有高发病 率、高死亡率和高致残率 ［1］ 。其中，隐匿性脑梗死（ silent

cerebral infarction，SC）或称无症状性脑梗死，是指经头颅

磁共振成像（MRI）等检查发现脑梗死，而在临床上无明显 相应的神经系统缺损症状和体征，或表现轻微容易被忽视，

disease，PolyVD），成为新的研究课题。 动脉粥样硬化是全身

性疾病，是脑梗死发生、发展的重要病因，被认为是预测脑 卒中发生的主要危险因素［2］。PolyVD指临床确认的2〜3处 动脉区域，主要表现为脑血管病（ cerebrovascular disease， CVD）、冠心病（coronary artery disease，CAD）、外周动脉

疾 病（peripheral arterial disease， PAD）［3］。本研究探？SCI和 PolyVD 是否相关，为预测脑梗死高危人群提供依据。

1 资料与方法

1.1 一般资料

脑梗死组：纳入 2015 年 2 月〜 2016 年 6 月入住台州市

颅 MRI 确诊。纳入标准：依据全国第 4 届脑血管会议提出的 脑梗死的诊断标准［4］。排除标准：①出血性脑梗死；②动脉 炎致脑梗死； ③有明确栓子来源如心房颤动、 风湿性心脏病、

脂肪栓塞等所致脑梗死；④血液成分改变导致的脑梗死；⑤

列在 2015 年脑血管病分类中。 SCI是非致残性卒中 ，如何针 对病因精准有效干预，尤其是多血管床病变（ polyvascular

中心医院神经内科患者， 95例为首次确诊SCI患者，通过头

肿瘤、全身免疫性疾病；⑥有脑卒中史。对照组：纳入 95