进展性脑卒中的影响因素研究

摘要

Objective To investigate the risk factors of progressive stroke,to provide references for clinic. Methods From January 2011 to June 2013,27 patients with progressive stroke in our hospital were enrolled as observation group,49 pa-tients with non - progressive stroke as control group. Past medical history and personal history,biochemical index,incidence of fever,stenosis and plaques of carotid artery between the two groups were compared,and brain MRI/ MRA examination results of observation group was retrospectively analyzed. Results Positive rate of diabetes history of observation group was higher than that of control group(P < 0. 05),while there was no significant differences of positive rates of hypertension history,stroke histo-ry,coronary heart disease history,smoking history and drinking history between the two groups( P > 0. 05). Fasting plasma glucose(FPG)of observation group was higher,high density lipoprotein cholesterol(HDL - C)was lower than that of control group,respectively(P < 0. 05),while there was no significant differences of total cholesterol(TC),triacylglycerol,low den-sity lipoprotein cholesterin(LDL - C),homocysteine,fibrinogen,uric acid between the two groups(P > 0. 05). Incidence of unstable plaques of carotid artery of observation group was higher than that of control group(P < 0. 05),while there was no sig-nificant differences of incidence of fever and carotid artery stenosis between the two groups(P > 0. 05). Brain MRI examination results showed that,infarction positions were mostly located in basal ganglia area,including 18 cases with anterior circulation in-farction,4 cases with posterior circulation infarction,5 cases with multiple lacunar infarction. Brain MRA examination results showed angiostenosis in 8 cases,including 5 cases with middle cerebral artery stenosis,2 cases with anterior cerebral artery ste-nosis,1 case with posterior cerebral artery stenosis. Conclusion The major influencing factors of progressive stroke includes di-abetes history,higher FPG,lower HDL - C and unstable plaques of carotid artery,clinicians should pay more attention to stoke patients with above influencing factors.%目的：探讨进展性脑卒中的影响因素，为临床提供参考。方法选择2011年1月-2013年6月在我科住院的进展性脑卒中患者27例作为研究组，非进展性脑卒中患者49例作为对照组。回顾性分析两组患者的既往史和个人史，生化指标，发热情况及颈动脉狭窄程度、斑块情况，同时分析研究组患者颅脑 MRI 和/或 MRA 检查结果。结果研究组患者糖尿病病史阳性率高于对照组（P <0.05）；两组患者高血压、脑卒中、冠心病病史及吸烟、饮酒史阳性率比较，差异均无统计学意义（P >0.05）。研究组患者空腹血糖高于对照组，高密度脂蛋白胆固醇低于对照组（P <0.05）；两组患者总胆固醇、三酰甘油、低密度脂蛋白胆固醇、同型半胱氨酸、纤维蛋白原、血尿酸比较，差异均无统计学意义（P >0.05）。研究组患者颈动脉不稳定斑块检出率高于对照组（P <0.05）；两组患者发热率、颈动脉狭窄率比较，差异均无统计学意义（P >0.05）。颅脑 MRI 检查结果示，研究组患者梗死灶多位于基底核区，其中前循环梗死18例、后循环梗死4例、多发腔隙性梗死5例；8例患者颅脑 MRA 检查示血管狭窄，其中大脑中动脉狭窄5例、大脑前动脉狭窄2例、大脑后动脉狭窄1例。结论有糖尿病病史、空腹血糖升高、高密度脂蛋白胆固醇降低及颈动脉不稳定斑块是进展性脑卒中的主要影响因素，临床上应重视合并上述影响因素的脑卒中患者。