CAJ | 학술논문

目的：研究粥样硬化性大脑中动脉狭窄（ MCAS）合并内分水岭梗死（ IBZ）的独立预测因素。方法选取2008年1月至2014年3月福建医科大学附属协和医院和福建省立临床学院的粥样硬化性MCAS患者167例，收集人口学、粥样硬化危险因素、MCA狭窄程度、前向血流评分和侧支循环评分等临床和影像资料，并将患者分为“IBZ组”（55例）和“无IBZ组”（112例）；单变量分析比较两组的临床资料，将P＜0．1变量纳入多变量分析，分别建立包含前向血流评分或MCAS狭窄程度的两个Logistic回归模型。结果 MCAS患者共167例（ IBZ组55例，无IBZ组112例），平均年龄（54±12）岁。单变量分析显示血压偏低（P＝0．006）、MCA狭窄程度（P＝0．012）和前向血流评分（P＝0．003）差异有统计学意义，其他P＜0．1的变量有高血压病史（P＝0．055）和侧支循环评分（P＝0．067）。 Logistic回归模型Ⅰ包含前向血流评分（ OR 4．310，95％CI 1．698～10．869），高血压病史（OR 0．458，95％CI 0．224～0．936）和血压偏低（ OR 3．848，95％CI 1．345～7．983）；模型Ⅱ包含MCA狭窄程度（P＝0．006；重度比中度狭窄： OR 4．796，95％CI 1．676～13．729；闭塞比中度狭窄： OR 5．537，95％CI 1．846～16．603），高血压病史（ OR 0．444，95％CI 0．215～0．914）和血压偏低（OR 5．747，95％CI 1．500～9．425）。结论 MCA重度狭窄或闭塞、前向血流受损以及血压偏低是MCAS发生IBZ的独立危险因素，MCAS患者有高血压病史则为IBZ的保护性因素。
목적：연구죽양경화성대뇌중동맥협착（ MCAS）합병내분수령경사（ IBZ）적독립예측인소。방법선취2008년1월지2014년3월복건의과대학부속협화의원화복건성립림상학원적죽양경화성MCAS환자167례，수집인구학、죽양경화위험인소、MCA협착정도、전향혈류평분화측지순배평분등림상화영상자료，병장환자분위“IBZ조”（55례）화“무IBZ조”（112례）；단변량분석비교량조적림상자료，장P＜0．1변량납입다변량분석，분별건립포함전향혈류평분혹MCAS협착정도적량개Logistic회귀모형。결과 MCAS환자공167례（ IBZ조55례，무IBZ조112례），평균년령（54±12）세。단변량분석현시혈압편저（P＝0．006）、MCA협착정도（P＝0．012）화전향혈류평분（P＝0．003）차이유통계학의의，기타P＜0．1적변량유고혈압병사（P＝0．055）화측지순배평분（P＝0．067）。 Logistic회귀모형Ⅰ포함전향혈류평분（ OR 4．310，95％CI 1．698～10．869），고혈압병사（OR 0．458，95％CI 0．224～0．936）화혈압편저（ OR 3．848，95％CI 1．345～7．983）；모형Ⅱ포함MCA협착정도（P＝0．006；중도비중도협착： OR 4．796，95％CI 1．676～13．729；폐새비중도협착： OR 5．537，95％CI 1．846～16．603），고혈압병사（ OR 0．444，95％CI 0．215～0．914）화혈압편저（OR 5．747，95％CI 1．500～9．425）。결론 MCA중도협착혹폐새、전향혈류수손이급혈압편저시MCAS발생IBZ적독립위험인소，MCAS환자유고혈압병사칙위IBZ적보호성인소。
Objective To explore the independent predictors of internal borderzone ( IBZ) infarcts in patients with atherosclerotic middle cerebral artery stenosis/occlusion ( MCAS) .Methods A total of 167 hospitalized patients with atherosclerotic MCAS during January 2008 and March 2014 were retrospectively analyzed.They were divided into“with IBZ group” (n=55) and“without IBZ group” (n=112) according to the findings of magnetic resonance images ( MRI ) . Their clinical data were collected including demographics, traditional vascular risk factors, stenotic degree of MCA and other cerebral supply arteries, TICI grading for antegrade blood flow, ASITN/SIR grading for collateral circulation and other variables.The intra-group data were compared by univariate analysis. Variables with P <0.1 were included into multivariate Logistic regression model for obtaining the independent predictors of IBZ.Two models were established including either TICI-grading or stenotic degree of MCAS due to close correlations between two variables.Results There were 45 females and 122 males with a mean age of 54 ±12 years.Variables with a P value <0.1 in univariate analysis included relatively low blood pressure (P=0.006), stenotic degree of MCAS (P=0.012), TICI-grading (P=0.003), history of hypertension (P =0.055) and ASITN-grading (P=0.067).In multivariate model Ⅰ, independent predictors of IBZ included TICI-grading (OR 4.310, 95%CI 1.698-10.869, P=0.002), history of hypertension (OR 0.458, 95%CI 0.224-0.936, P=0.032), relatively low blood pressure (OR 3.848; 95%CI 1.345 -7.983, P =0.039).In multivariate modelⅡ, independent predictors of IBZ included stenotic degree of MCAS (P=0.006;severe vs moderate:OR 4.796, 95%CI 1.676-13.729, P=0.003;occlusion vs moderate:OR 5.537, 95%CI 1.846-16.603, P=0.002).The two models had a similar area under the curve (AUC) of receiver operating curve (ROC) of 0.702 (95%CI 0.618 ~0.787, P<0.001) and 0.709 (95%CI 0.626 -0.792, P<0.001).Conclusion Severe stenosis or total occlusion of MCA, impairment of antegrade blood flow and relatively low blood pressure are the independent risk factors of IBZ.And history of hypertension is a protective fact or of IBZ in patients with MCAS.