颈动脉粥样硬化患者发生脑卒中的危险因素

摘要

目的：探讨颈动脉粥样硬化（ CAS）患者发生脑卒中的危险因素。方法选择2013年11月至2014年2月重庆市綦江区人民医院收治的CAS患者280例，其中脑卒中患者133例，非脑卒中患者147例；多因素Logistic回归分析影响CAS患者发生脑卒中的危险因素。结果 CAS患者中脑卒中患者收缩压≥140 mmHg （1 mmHg ＝0.133 kPa ）、糖化血红蛋白≥6.5％、血清总胆固醇≥5.72 mmol／L、低密度脂蛋白胆固醇≥3.37 mmol／L、有脑卒中家族史、总胆红素≥20.5μmol／L、直接胆红素≥7μmol／L、颈动脉内膜-中层厚度（IMT）≥1.2 mm比例显著高于非脑卒中患者[76.7（102／133）比24.5％（36／147），90.2％（120／133）比15.6％（23／147），73.7％（98／133）比26.5％（39／147），73.7％（98／133）比31.3％（46／147），72.9％（97／133）比26.5％（39／147），80.5％（107／133）比23.8％（35／147），88.0％（117／133）比17.7％（26／147），58.6％（78／133）比42.2％（62／147）]（P＜0.05）。多因素分析显示，收缩压≥140 mmHg（OR＝21.854，95％CI 8.978～53.196）、糖化血红蛋白≥6.5％（OR ＝24.247，95％CI 7.681～76.542）、低密度脂蛋白胆固醇≥3.37 mmol／L（OR ＝13.671，95％CI 5.097～36.668）、总胆红素≥20.5μmol／L（OR＝7.831，95％CI 1.231～49.817）、直接胆红素≥7μmol／L（OR＝4.104，95％CI 3.129～5.383）、IMT≥1.2 mm（OR＝2.984，95％CI 1.781～5.000）是CAS患者发生脑卒中的危险因素（P＜0.05）。结论收缩压、糖化血红蛋白、低密度脂蛋白胆固醇、总胆红素、直接胆红素、IMT是CAS患者发生脑卒中的危险因素，在社区建立脑卒中干预体系中应采取积极的预防措施。%Objective To explore the risk factors of stroke in patients with carotid atherosclerosis ( CAS) .Methods A total of 280 cases of CAS in People′s Hospital of Qijiang District in Chongqing City from Nov.2013 to Feb.2014 were included in the study, including 133 cases with stroke and 147 cases without stroke.Multivariate logistic regression analysis was used to analyze the independent risk factors of stroke.Results Systolic pressure≥140 mmHg,glycosylated hemoglobin≥6.5%,serum total cholesterol≥5.72 mmol/L,low density lipoprotein cholesterol≥3.37 mmol/L,with family history of stroke,total bilirubin≥20.5 μmol/L,direct bilirubin≥7 μmol/L,IMT≥1.2 mm of stroke patients in patients with stroke were higher than patients without stroke[76.7(102/133) vs 24.5%(36/147),90.2%(120/133) vs 15.6%(23/147),73.7%(98/133) vs 26.5%(39/147),73.7%(98/133) vs 31.3%(46/147),72.9%(97/133) vs 26.5%(39/147),80.5%(107/133) vs 23.8% (35/147),88.0%(117/133) vs 17.7%(26/147),58.6%(78/133) vs 42.2%(62/147)](P<0.05).Multivariate analysis showed that systolic pres-sure≥140 mmHg(OR=21.854,95%CI 8.978-53.196),glycosylated hemoglobin≥6.5%(OR=24.247, 95%CI 7.681-76.542),low density lipoprotein cholesterol≥3.37 mmol/L(OR =13.671,95%CI 5.097-36.668),total bilirubin≥20.5 μmol/L(OR=7.831,95%CI 1.231-49.817),direct bilirubin≥7μmol/L (OR=4.104,95%CI 3.129-5.383),IMT≥1.2 mm (OR=2.984,95%CI 1.781-5.000) were independ-ent risk factors for carotid stroke in patients with CAS(P<0.05).Conclusion Systolic blood pressure,gly-cosylated hemoglobin,low density lipoprotein cholesterol,total bilirubin,direct bilirubin,IMT are the risk fac-tors of stroke in patients with CAS.Active prevention measures should be taken in the establishment of com-munity stroke intervention system.