急性腔隙性腦梗死與頸部動脈狹窄的相關性及危險因素分析

戴琦 鄭建軍 金銀華

摘 要：目的 探討急性腔隙性腦梗死與頸部動脈狹窄的關系以及LI發病的危險因素。方法 選取2015年6月～2018年4月在寧波市第二醫院神經內科確診的急性LI患者162例，根據發現的梗死病灶數目分為A組（病灶數目≤3個）115例和B組（病灶數目>3個）47例，記錄病灶的位置、數目，同時選取75例陰性患者為對照組，記錄頸部動脈狹窄情況，分析急性LI發病與頸部動脈狹窄的相關性，以及患者的年齡、性別、嚴重心律失常、高血壓病、糖尿病、高脂血癥、嗜煙、酗酒等因素與LI發病的關系。結果 A組與B組病灶的分布比較，差異無統計學意義（P>0.05），A組、B組與對照組之間的頸部動脈狹窄率比較，差異有統計學意義（P<0.05），但狹窄位置差異無統計學意義（P>0.05）。急性LI病灶數量與動脈狹窄程度的Spearman相關系數為0.25（P<0.05）。急性LI發病的獨立危險因素是糖尿病（OR=2.391，P<0.05）和嗜煙（OR=2.865，P<0.05）。結論 急性LI病灶數目與頸部動脈狹窄程度存在弱正相關性，有效控制血糖水平、盡早戒煙可能對急性LI的二級預防有利。

關鍵詞：腔隙性腦梗死；頸部動脈狹窄；糖尿病；嗜煙

中圖分類號：R743.3；R543.4 文獻標識碼：A DOI：10.3969/j.issn.1006-1959.2018.23.019

文章編號：1006-1959（2018）23-0067-05

Abstract：Objective To explore the relationship between acute lacunar infarction and carotid artery stenosis and analysis risk factors of LI. Methods A total of 162 patients with acute LI diagnosed in our hospital were selected and divided into group A （number of lesions≤3） 115 cases and group B （number of lesions>3） 47 cases，according to the number of infarcted lesions. The location and number of acute lesions were recorded. 75 case-negative patients were selected as the control group at the same time. Cervical artery stenosis of all subjects was recorded. The correlation between the incidence of acute LI and carotid artery stenosis was analyzed. The risk factors about age， sex， severe arrhythmia， hypertension， diabetes， hyperlipidemia， smoking and alcoholism were analyzed as well. Results There was no statistical difference between the A and B group （P>0.05）. There was a significant difference in the stenosis rate between the A， B and the control group （P<0.05）， but the artery stenosis position was not statistically significant （P>0.05）， and the Spearman correlation coefficient between the number of acute LI lesions and the degree of arterial stenosis was 0.25 （P<0.05）. The independent risk factors for acute LI were diabetes （OR=2.391，P<0.05） and smoking （OR=2.865，P<0.05）. Conclusion There is a weak positive correlation between the number of acute LI lesions and the extent of carotid artery stenosis. Effective control of blood glucose levels and early cessation of smoking may be beneficial for secondary prevention of acute LI.

Key words：Lacunar infarction；Carotid artery stenosis；Diabetes；Smoking

腔隙性腦梗死（lacunar infarction，LI）是較常見的腦血管疾病，通常起病較隱匿，短期內功能恢復完全而容易被臨床所忽視。近年來，積累的循證醫學證據提示LI患者的死亡率、抑郁以及癡呆的發病率隨著隨訪時間延長而逐漸上升[1]。此外，普遍認為LI是因單個穿支小動脈病變引起，大動脈粥樣硬化所致的穿支小動脈閉塞常常被忽視。磁共振擴散加權成像（diffusion-weighted imaging，DWI）是目前診斷急性LI的金標準，CT血管造影（CT angiography，CTA）檢查便捷快速、安全無創，是評估動脈粥樣硬化病變的重要手段[2]。本研究擬通過影像學方法尋找診急性LI的責任大血管證據，并初步分析急性LI的致病危險因素，為研究疾病的發生發展和二級預防提供一定參考。