CAJ | 학술논문

目的探讨后循环重度狭窄或闭塞患者侧支循环代偿情况与神经功能缺损程度以及预后的关系.方法回顾性纳入后循环重度狭窄或闭塞导致的缺血性卒中患者,利用颅脑多普勒和脑血管成像技术评估颅内动脉的侧支循环代偿情况,分为侧支循环代偿充分组与代偿不充分组,对两组性别、年龄、既往病史、血液生化指标、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分以及发病3个月时改良Rankin量表(modified Rankin Scale,mRS)评分进行比较和分析.结果共纳入76例后循环重度狭窄或闭塞导致的缺血性卒中患者,其中侧支循环代偿充分组35例,代偿不充分组41例.侧支循环代偿不充分组超敏C-反应蛋白(high-sensitive C-reactive protein,hs-CRP)[(20.392±31.897) mg/L对(4.172 ±4.268) mg/L;t =2.983,P=0.004]和低密度脂蛋白胆固醇[(1.272±0.835) mmol/L对(1.096±0.301) mmol/L;t =2.520,P =0.014]水平显著性高于代偿充分组.多变量logistic回归分析显示,只有hs-CRP水平增高是后循环重度狭窄或闭塞患者侧支循环建立不充分的独立危险因素(优势比1.513,95％可信区间1.218～1.880;P ＜0.001).侧支循环代偿充分组基线NIHSS评分(Z=3.161,P ＜0.001)以及3个月时mRS评分(Z=3.143,P＜0.001)均显著性低于代偿不充分组.结论 hs-CRP水平增高是后循环重度狭窄或闭塞时侧支循环代偿不充分的独立危险因素.侧支循环建立充分的后循环重度狭窄或闭塞患者神经功能缺损程度较轻,且预后更好.
목적 탐토후순배중도협착혹폐새환자측지순배대상정황여신경공능결손정도이급예후적관계.방법 회고성납입후순배중도협착혹폐새도치적결혈성졸중환자,이용로뇌다보륵화뇌혈관성상기술평고로내동맥적측지순배대상정황,분위측지순배대상충분조여대상불충분조,대량조성별、년령、기왕병사、혈액생화지표、기선미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale,NIHSS)평분이급발병3개월시개량Rankin량표(modified Rankin Scale,mRS)평분진행비교화분석.결과 공납입76례후순배중도협착혹폐새도치적결혈성졸중환자,기중측지순배대상충분조35례,대상불충분조41례.측지순배대상불충분조초민C-반응단백(high-sensitive C-reactive protein,hs-CRP)[(20.392±31.897) mg/L대(4.172 ±4.268) mg/L;t =2.983,P=0.004]화저밀도지단백담고순[(1.272±0.835) mmol/L대(1.096±0.301) mmol/L;t =2.520,P =0.014]수평현저성고우대상충분조.다변량logistic회귀분석현시,지유hs-CRP수평증고시후순배중도협착혹폐새환자측지순배건립불충분적독립위험인소(우세비1.513,95％가신구간1.218～1.880;P ＜0.001).측지순배대상충분조기선NIHSS평분(Z=3.161,P ＜0.001)이급3개월시mRS평분(Z=3.143,P＜0.001)균현저성저우대상불충분조.결론 hs-CRP수평증고시후순배중도협착혹폐새시측지순배대상불충분적독립위험인소.측지순배건립충분적후순배중도협착혹폐새환자신경공능결손정도교경,차예후경호.
Objective To investigate the relationship between compensatory collateral circulation and the degree of neurological deficit and prognosis in patients with severe posterior circulation stenosis or occlusion.Methods Posterior circulation severe stenosis or occlusion caused ischemic stroke patients were enrolled retrospectively.The compensatory collateral circulation in intracranial artery was assessed by using cranial Doppler and cerebrovascular imaging techniques.The patients were divided into either an adequate compensatory collateral circulation group or an inadequate compensatory collateral circulation group.The gender,age,past medical history,blood biochemical indexes,baseline National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin Scale (mRS) score at 3 months after symptom onset in both groups were compared and analyzed.Results A total of 76 patients with severe posterior circulation stenosis or occlusion caused ischemic stroke were enrolled in the study.There were 35 patients in the adequate compensatory collateral circulation group and 41 in the inadequate compensatory collateral circulation group.The levels of high sensitive C-reactive protein (hs-CRP) (20.92 ± 31.97 mg/L vs.4.172 ± 4.268 rmg/L; t =2.983,P =0.004) and low-density lipoprotein cholesterol (1.272 ± 0.835 mmol/L vs.1.096 ± 0.301 mmol/L; t =2.520,P =0.014) were significantly higher than those in the adequate compensatory collateral circulation group.Multivariate logistic regression analysis showed that only the increased hs-CRP level was the independent risk factor for inadequate collateral circulation in patients with severe posterior circulation stenosis or occlusion (odds ratio 1.513,95％ confidence interval 1.218-1.880; P ＜ 0.001).The baseline NIHSS score (Z =3.161,P ＜ 0.001) in the adequate compensatory collateral circulation group and mRS score (Z =3.143,P ＜ 0.001) at 3 months were significantly lower than that in the inadequate compensatory collateral circulation group.Conelusions The increased CRP levd is an independent risk factor for inadequate compensatory of collateral circulation during the severe posterior circulation stenosis or occlusion.The establishment of adequate collateral circulation in patients with severe stenosis or occlusion has mild neurological deficit and the prognosis is better.