CAJ | 학술논문

目的探讨小血管闭塞性卒中(small artery occlusion,SAO)及其2种亚型的相关危险因素.方法从南京卒中注册系统中收集2009年12月至2010年11月注册、符合TOAST标准中大血管动脉粥样硬化性卒中(large artery atherosclcrosis,LAA)或SAO的首发急性缺血性卒中患者的临床和影像学资料.病例分为LAA组和SAO组,后者再分为腔隙性脑梗死伴缺血性白质疏松(ischaemic leukoaraiosis,ILA)亚组和单纯腔隙性梗死(isolated lacunar infarction,ILI)亚组,比较LAA组与SAO组及其亚组的危险因素,并进行多变量logistic回归分析,筛选独立危险因素.结果共纳入291例病例,其中LAA组120例,SAO组171例(ILI亚组87例,ILA亚组84例).SAO组平均年龄大于LAA患者,高血压患者比例和血清同型半胱氨酸(homocysteine,Hcy)水平显著高于LAA患者(P均＜0.05).多变量logistic分析表明,高龄[优势比(odds ratio,OR)1.041,95%可信区间(confidence interval,CI)1.02～1.06,P=0.045]、高血压(OR=2.912,95%CI 1.11～6.46,P=0.031)和血浆Hcy水平增高(OR=1.109,95%CI 1.11～1.32,P=0.001)是SAO的独立危险因素.在SAO的两亚组中,高龄(OR=1.047,95%CI 1.00～1.09,P=0.043)、高血压(OR=2.632,95%CI 1.08～6.41,P=0.033)和血浆Hcy水平增高(OR=1.211,95%CI 1.11～1.32,P＜0.001)是ILA的独立危险因素,而高胆固醇血症(OR=0.136,95%CI 0.05～0.37,P＜0.001)则是ILI的独立危险因素.结论高龄、高血压和血浆Hcy水平增高可能在SAO的发病机制中起着重要作用.高胆固醇血症是ILI的独立危险因素,而高龄、高血压病和血浆Hcy水平增高是ILA的独立危险因素.
목적 탐토소혈관폐새성졸중(small artery occlusion,SAO)급기2충아형적상관위험인소.방법 종남경졸중주책계통중수집2009년12월지2010년11월주책、부합TOAST표준중대혈관동맥죽양경화성졸중(large artery atherosclcrosis,LAA)혹SAO적수발급성결혈성졸중환자적림상화영상학자료.병례분위LAA조화SAO조,후자재분위강극성뇌경사반결혈성백질소송(ischaemic leukoaraiosis,ILA)아조화단순강극성경사(isolated lacunar infarction,ILI)아조,비교LAA조여SAO조급기아조적위험인소,병진행다변량logistic회귀분석,사선독립위험인소.결과 공납입291례병례,기중LAA조120례,SAO조171례(ILI아조87례,ILA아조84례).SAO조평균년령대우LAA환자,고혈압환자비례화혈청동형반광안산(homocysteine,Hcy)수평현저고우LAA환자(P균＜0.05).다변량logistic분석표명,고령[우세비(odds ratio,OR)1.041,95%가신구간(confidence interval,CI)1.02～1.06,P=0.045]、고혈압(OR=2.912,95%CI 1.11～6.46,P=0.031)화혈장Hcy수평증고(OR=1.109,95%CI 1.11～1.32,P=0.001)시SAO적독립위험인소.재SAO적량아조중,고령(OR=1.047,95%CI 1.00～1.09,P=0.043)、고혈압(OR=2.632,95%CI 1.08～6.41,P=0.033)화혈장Hcy수평증고(OR=1.211,95%CI 1.11～1.32,P＜0.001)시ILA적독립위험인소,이고담고순혈증(OR=0.136,95%CI 0.05～0.37,P＜0.001)칙시ILI적독립위험인소.결론 고령、고혈압화혈장Hcy수평증고가능재SAO적발병궤제중기착중요작용.고담고순혈증시ILI적독립위험인소,이고령、고혈압병화혈장Hcy수평증고시ILA적독립위험인소.
Objective To investigate the related risk factors for small artery occlusion (SAO) and its 2 subtypes. Methods The clinical and imaging data in 291 patients with first-ever stroke who met the TOAST criteria of large artery atherosclerotic stroke (LAA) or SAO were collected from the Nanjing Stroke Registry Prog-am from December 2009 to November 2010. All the patients were divided into a LAA group (n = 120) and a SAO group (n = 171). The latter was redivided into either a lacunar infarction with ischemic leukoaraiosis (ILA) subgroup (n = 84)or an isolated lacunar infarction (ILI) subgroup (n = 87). The risk factors of the LAA group and SAO group and its subgroups were compared. Multivariate logistic regression analysis was conducted and the independent risk factors were screened. Results The mean age in the SAO group was larger than that in the LAA group. The proportion of the patients with hypertension and the serum homocysteine (Hcy) level were significantly higher than those in the LAA group (all P ＜0. 05). Multivariate logistic analysis showed that the advanced age (odds ratio, [OR] = 1.041,95% confidence interval [CI] 1.02-1.06, P = 0.045), hypertension (OR = 2. 912,95% CI 1. 11-6. 46, P =0. 031) and increased plasma Hcy (OR = 1. 109, 95% CI 1. 11-1. 32, P =0. 001) were the independent risk factors for SAO. The advanced age (OR = 1. 047,95% CI 1.00-1.09, P = 0.043), hypertension (OR = 2. 632, 95% CI 1.08-6.41, P= 0.033) and increased plasma Hcy (OR = 1. 211, 95% CI 1. 11-1. 32, P ＜0. 001) were the independent risk factors for ILA, while the hypercholesterolemia (OR =0. 136, 95% CI 0. 05-0. 37, P ＜0. 001) was the independent risk factor for ILI. Conclusions The advanced age, hypertension and increased plasma Hcy level may play important roles in the pathogenesis of SAO. The hypercholesterolemia is an independent risk factor for ILI, while advanced age, hypertension and increased plasma Hcy level are the independent risk factors for ILA.