目的 探讨后循环缺血性卒中的主要危险因素以及合并糖尿病的后循环缺血性卒中患者的临床和影像学特征.方法 收集急性缺血性卒中患者的临床资料,并对后循环缺血性卒中组与前循环缺血性卒中组进行比较；后循环卒中患者进一步分为糖尿病组和非糖尿病组,比较两组血管危险因素和影像学特征；将后循环缺血性卒中患者按病变血管分布分为近段组、中段组、远段组和混合组,分析糖尿病与各组之间的相关性和影像学特征.结果 共纳入328例后循环缺血性卒中病例,其中男性194例,糖尿病组108例；前循环缺血性卒中336例,其中男性214例,糖尿病组59例.后循环缺血性卒中组糖尿病(32.9％ 对21.7％;x2=10.501,P=0.001)、高脂血症(60.1％对47.9％;x2=9.852,P=0.002)、既往卒中或短暂性脑缺血发作史(29.0％对22.0％;x2 =4.213,P=0.040)患者构成比均显著性高于前循环缺血性卒中组(P均＜0.05),而吸烟患者构成比显著性低于前循环缺血性卒中组(18.3％对26.2％；x2 =5.977,P=0.014)；总胆固醇[(4.72±1.07) mmol/L对(4.56 ±0.98) mmol/L;t =2.079,P=0.038]、三酰甘油[(1.54±1.07) mmot/L对(1.33±0.71)mmol/L;t3.085,P=0.002]和低密度脂蛋白胆固醇[(2.91±0.90) mmol/L对(2.75±0.80)mmol/L;t 2.373,P=0.018]均显著性高于前循环缺血性卒中组,而高密度脂蛋白胆固醇显著性低于前循环缺血性卒中组[(1.13 ±0.31) mmol/L对(1.18±0.32)mmol/L;t2.045,P=0.041].多变量logistic回归分析显示,糖尿病[优势比(odds ratio,OR)1.560,95％可信区间(confidence interval,CI)1.086～2.239；P=0.016]和既往卒中或短暂性脑缺血发作史(OR 1.455,95％ CI 1.013～2.090;P=0.042)是后循环缺血性卒中的独立危险因素.在后循环缺血性卒中患者中,糖尿病组(n=108)高脂血症(66.7％对55.5％;x2=5.069,P=0.024)和饮酒(13.0％对4.5％;x2=7.568,P =0.006)患者构成比显著性高于非糖尿病组(n =220),心房颤动患者的构成比显著性低于非糖尿病组(3.7％对11.4％;x2=5.274,P=0.022)；三酰甘油[(1.70±0.93) mmol/L对(1.45±1.11)mmol/L; t=1.989,P=0.048]、空腹血糖[(8.46±2.96) mmol/L对(5.30±0.96) mmol/L;t 10.706,P=0.000]和糖基化血红蛋白[(8.36±1.94)％对(6.07±0.55)％；t=10.576,P=0.000]显著性高于非糖尿病组；大动脉粥样硬化性卒中患者构成比显著性高于非糖尿病组(73.1％对60.0％;x2=5.457,P=0.019),而心源性脑栓塞显著性低于非糖尿病组(2.8％对9.1％;x2=4.428,P=0.035)；后循环中段梗死患者构成比显著性高于非糖尿组(49.1％对31.4％;x2 =9.726,P=0.002)；脑干梗死(60.2％对48.2％;x2 =4.182,P=0.041)和单发性脑干梗死(55.6％对30.5％;x2=19.235,P=0.000)患者构成比均显著性高于非糖尿病组.在单发性脑干梗死患者中,糖尿病组脑桥梗死(43.5％对25.9％;x2=10.374,P=0.001)和延髓梗死(7.4％对1.8％；P =0.023)患者构成比均显著性高于非糖尿病组.结论 糖尿病和既往卒中或短暂性脑缺血发作史是后循环缺血性卒中的独立危险因素.糖尿病与脑干梗死关系密切,更易导致脑桥梗死.
目的 探討後循環缺血性卒中的主要危險因素以及閤併糖尿病的後循環缺血性卒中患者的臨床和影像學特徵.方法 收集急性缺血性卒中患者的臨床資料,併對後循環缺血性卒中組與前循環缺血性卒中組進行比較；後循環卒中患者進一步分為糖尿病組和非糖尿病組,比較兩組血管危險因素和影像學特徵；將後循環缺血性卒中患者按病變血管分佈分為近段組、中段組、遠段組和混閤組,分析糖尿病與各組之間的相關性和影像學特徵.結果 共納入328例後循環缺血性卒中病例,其中男性194例,糖尿病組108例；前循環缺血性卒中336例,其中男性214例,糖尿病組59例.後循環缺血性卒中組糖尿病(32.9％ 對21.7％;x2=10.501,P=0.001)、高脂血癥(60.1％對47.9％;x2=9.852,P=0.002)、既往卒中或短暫性腦缺血髮作史(29.0％對22.0％;x2 =4.213,P=0.040)患者構成比均顯著性高于前循環缺血性卒中組(P均＜0.05),而吸煙患者構成比顯著性低于前循環缺血性卒中組(18.3％對26.2％；x2 =5.977,P=0.014)；總膽固醇[(4.72±1.07) mmol/L對(4.56 ±0.98) mmol/L;t =2.079,P=0.038]、三酰甘油[(1.54±1.07) mmot/L對(1.33±0.71)mmol/L;t3.085,P=0.002]和低密度脂蛋白膽固醇[(2.91±0.90) mmol/L對(2.75±0.80)mmol/L;t 2.373,P=0.018]均顯著性高于前循環缺血性卒中組,而高密度脂蛋白膽固醇顯著性低于前循環缺血性卒中組[(1.13 ±0.31) mmol/L對(1.18±0.32)mmol/L;t2.045,P=0.041].多變量logistic迴歸分析顯示,糖尿病[優勢比(odds ratio,OR)1.560,95％可信區間(confidence interval,CI)1.086～2.239；P=0.016]和既往卒中或短暫性腦缺血髮作史(OR 1.455,95％ CI 1.013～2.090;P=0.042)是後循環缺血性卒中的獨立危險因素.在後循環缺血性卒中患者中,糖尿病組(n=108)高脂血癥(66.7％對55.5％;x2=5.069,P=0.024)和飲酒(13.0％對4.5％;x2=7.568,P =0.006)患者構成比顯著性高于非糖尿病組(n =220),心房顫動患者的構成比顯著性低于非糖尿病組(3.7％對11.4％;x2=5.274,P=0.022)；三酰甘油[(1.70±0.93) mmol/L對(1.45±1.11)mmol/L; t=1.989,P=0.048]、空腹血糖[(8.46±2.96) mmol/L對(5.30±0.96) mmol/L;t 10.706,P=0.000]和糖基化血紅蛋白[(8.36±1.94)％對(6.07±0.55)％；t=10.576,P=0.000]顯著性高于非糖尿病組；大動脈粥樣硬化性卒中患者構成比顯著性高于非糖尿病組(73.1％對60.0％;x2=5.457,P=0.019),而心源性腦栓塞顯著性低于非糖尿病組(2.8％對9.1％;x2=4.428,P=0.035)；後循環中段梗死患者構成比顯著性高于非糖尿組(49.1％對31.4％;x2 =9.726,P=0.002)；腦榦梗死(60.2％對48.2％;x2 =4.182,P=0.041)和單髮性腦榦梗死(55.6％對30.5％;x2=19.235,P=0.000)患者構成比均顯著性高于非糖尿病組.在單髮性腦榦梗死患者中,糖尿病組腦橋梗死(43.5％對25.9％;x2=10.374,P=0.001)和延髓梗死(7.4％對1.8％；P =0.023)患者構成比均顯著性高于非糖尿病組.結論 糖尿病和既往卒中或短暫性腦缺血髮作史是後循環缺血性卒中的獨立危險因素.糖尿病與腦榦梗死關繫密切,更易導緻腦橋梗死.
목적 탐토후순배결혈성졸중적주요위험인소이급합병당뇨병적후순배결혈성졸중환자적림상화영상학특정.방법 수집급성결혈성졸중환자적림상자료,병대후순배결혈성졸중조여전순배결혈성졸중조진행비교；후순배졸중환자진일보분위당뇨병조화비당뇨병조,비교량조혈관위험인소화영상학특정；장후순배결혈성졸중환자안병변혈관분포분위근단조、중단조、원단조화혼합조,분석당뇨병여각조지간적상관성화영상학특정.결과 공납입328례후순배결혈성졸중병례,기중남성194례,당뇨병조108례；전순배결혈성졸중336례,기중남성214례,당뇨병조59례.후순배결혈성졸중조당뇨병(32.9％ 대21.7％;x2=10.501,P=0.001)、고지혈증(60.1％대47.9％;x2=9.852,P=0.002)、기왕졸중혹단잠성뇌결혈발작사(29.0％대22.0％;x2 =4.213,P=0.040)환자구성비균현저성고우전순배결혈성졸중조(P균＜0.05),이흡연환자구성비현저성저우전순배결혈성졸중조(18.3％대26.2％；x2 =5.977,P=0.014)；총담고순[(4.72±1.07) mmol/L대(4.56 ±0.98) mmol/L;t =2.079,P=0.038]、삼선감유[(1.54±1.07) mmot/L대(1.33±0.71)mmol/L;t3.085,P=0.002]화저밀도지단백담고순[(2.91±0.90) mmol/L대(2.75±0.80)mmol/L;t 2.373,P=0.018]균현저성고우전순배결혈성졸중조,이고밀도지단백담고순현저성저우전순배결혈성졸중조[(1.13 ±0.31) mmol/L대(1.18±0.32)mmol/L;t2.045,P=0.041].다변량logistic회귀분석현시,당뇨병[우세비(odds ratio,OR)1.560,95％가신구간(confidence interval,CI)1.086～2.239；P=0.016]화기왕졸중혹단잠성뇌결혈발작사(OR 1.455,95％ CI 1.013～2.090;P=0.042)시후순배결혈성졸중적독립위험인소.재후순배결혈성졸중환자중,당뇨병조(n=108)고지혈증(66.7％대55.5％;x2=5.069,P=0.024)화음주(13.0％대4.5％;x2=7.568,P =0.006)환자구성비현저성고우비당뇨병조(n =220),심방전동환자적구성비현저성저우비당뇨병조(3.7％대11.4％;x2=5.274,P=0.022)；삼선감유[(1.70±0.93) mmol/L대(1.45±1.11)mmol/L; t=1.989,P=0.048]、공복혈당[(8.46±2.96) mmol/L대(5.30±0.96) mmol/L;t 10.706,P=0.000]화당기화혈홍단백[(8.36±1.94)％대(6.07±0.55)％；t=10.576,P=0.000]현저성고우비당뇨병조；대동맥죽양경화성졸중환자구성비현저성고우비당뇨병조(73.1％대60.0％;x2=5.457,P=0.019),이심원성뇌전새현저성저우비당뇨병조(2.8％대9.1％;x2=4.428,P=0.035)；후순배중단경사환자구성비현저성고우비당뇨조(49.1％대31.4％;x2 =9.726,P=0.002)；뇌간경사(60.2％대48.2％;x2 =4.182,P=0.041)화단발성뇌간경사(55.6％대30.5％;x2=19.235,P=0.000)환자구성비균현저성고우비당뇨병조.재단발성뇌간경사환자중,당뇨병조뇌교경사(43.5％대25.9％;x2=10.374,P=0.001)화연수경사(7.4％대1.8％；P =0.023)환자구성비균현저성고우비당뇨병조.결론 당뇨병화기왕졸중혹단잠성뇌결혈발작사시후순배결혈성졸중적독립위험인소.당뇨병여뇌간경사관계밀절,경역도치뇌교경사.
Objective To investigate the major risk factors for posterior circulation stroke and the clinical and imaging features of posterior circulation stroke patients with diabetes.Methods The patients with acute cerebral infarction were enrolled.The clinical data of patients with posterior circulation and anterior circulation stroke were compared.The patients with posterior circulation stroke were further divided into either a diabetic group or a non-diabetic group,and the vascular risk factors and imaging features of both groups were compared.The patients with posterior circulation stroke were divided into proximal segment,middle segment and distal segment and mixed groups according to the distribution of vascular lesions.The correlations between diabetes and each group and the imaging features were analyzed.Results A total of 328 patients with posterior circulation stroke (male 194,the diabetic group 108) and 336 patients with anterior circulation stroke (male 214,the diabetes group 59)were enrolled.The proportions of patients with diabetes (32.9％ vs.21.7％ ; x2 =10.501,P =0.001),hyperlipidemia (60.1％ vs.47.9％ ;x2 =9.852,P =0.002),previous stroke or transient ischemic attack (TIA) (29.0％ vs.22.0％ ;x2 =4.213,P =0.040) in the posterior circulation ischemic stroke group were significantly higher than those in the anterior circulation ischemic stroke group,and the proportion of smoking patients was significantly lower than that in the anterior circulation ischemic stroke group (18.3％ vs.26.2％ ; x2 =5.977,P =0.014).The levels of total cholesterol (4.72 ±1.07 mmol/L vs.4.56 ± 0.98 mmol/L; t =2.079,P =0.038),triglycerides (1.54 ± 1.07 mmol/L vs.1.33±0.71 mmol/L; t=3.085,P=0.002) and low-density lipoprotein cholesterol (2.91±0.90 mmol/L vs.2.75 ±0.80 mmol/L; t =2.373,P =0.018) were significantly higher than those in the anterior circulation ischemic stroke group,and the level of high-density lipoprotein cholesterol was significantly lower than that in the anterior circulation ischemic stroke group (1.13 ± 0.31 mmol/L vs.1.18 ±0.32 mmol/L; t =2.045,P=0.041).Multivariate logistic regression analysis showed that diabetes (odds ratio [OR] 1.560,95％ confidence interval [CI] 1.086-2.239; P =0.016) and previous stroke or TIA history (OR 1.455,95％ CI 1.013-2.090; P =0.042) were the independent risk factors for posterior circulation ischemic stroke.In patients with posterior circulation ischemic stroke,the patient's proportions of hyperllpidemia (66.7％ vs.55.5％ ;x2 =5.069,P =0.024) and drinking (13.0％ vs.4.5％;x2 =7.568,P=0.006) in the diabetic group (n =108) were significantly higher than those in the non-diabetic group (n =220); the proportion of atrial fibrillation patients was significantly lower than that in the non-diabetic group (3.7％ vs.11.4％ ;x2 =5.274,P =0.022).The levels of triglycerides (1.70 ± 0.93 rnmol/L vs.1.45 ± 1.11 mmol/L; t =1.989,P =0.048),fasting glucose (8.46 ± 2.96) mmol/L vs.5.30± 0.96 mmol/L; t=10.706,P=0.000) and glycosylated hemoglobin (8.36％ ± 1.94％ vs.6.07％ ± 0.55％ ; t =10.576,P =0.000) in the diabetic group were significantly higher than those in the non-diabetic group.The proportion of patients with large artery atherosclerosis stroke in the diabetic group was significantly higher than that in the non-diabetic group (73.1％ vs.60.0％; x2=5.457,P=0.019); the proportion of the patients with cardioembolism was significantly lower than that of the non-diabetic group (2.8％ vs.9.1％;x2 =4.428,P =0.035).The proportion of patients with posterior circulation middle segment infarction in the diabetic group was significantly higher than that of the non-diabetic group (49.1％ vs.31.4％ ;x2 =9.726,P =0.002).The proportions of the patients with brainstem infarction (60.2％ vs.48.2％ ;x2 =4.182,P =0.041) and single brainstem infarction (55.6％ vs.30.5％ ;x2 =19.235,P =0.000) in the diabetic group were significantly higher than those in the non-diabetic group.In patients with single brainstem infarction,the proportions of the patients with pontine infarction (43.5％ vs.25.9％ ;x2 =10.374,P =0.001) and medulla oblongata infarction (7.4％ vs.1.8％ ; P =0.023) in the diabetic group were significantly higher than those in the non-diabetic group.Conclusions Diabetes and previous stroke or TIA history are the independent risk factor for posterior circulation stroke.Diabetes is closely associated with brainstem infarction,and it is more likely to result in pontine infarction.
