摘要
目的探讨单发性腔隙性梗死（single lacunar infarct，SLI）和同侧多发性腔隙性梗死（multiple lacunar infarct，MLI）的特征以及二者危险因素和病因学的差异。方法回顾性分析2008年8月1日至2014年12月13日期间所有急性颈内动脉供血区脑梗死患者的临床资料，根据临床表现和影像学结果筛选腔隙性梗死，根据弥散加权成像显示的病灶数量和部位分为SLI组、单侧同一血管供血区MLI组（MLI1组）和单侧不同血管供血区MLI组（MLI2组）。应用多变量logistic回归分析确定潜在的独立危险因素。结果MLI1组同侧颈动脉斑块（73．33％对48．67％；X^2=5．801，P=0．016）、同侧不稳定颈动脉斑块（70．0％对42．5％；X^2=7．192，P=0．007）及同侧颈动脉狭窄≥50％（16．67％对1．77％;X^2=8．327，P=0．004）发生率均显著高于SLI组；MLI2组心房颤动发生率显著高于SLI组（40．0％对0．88％;X^2=15．887，P〈0．001）；其余危险因素在各组之间均无显著统计学差异。多变量logistic回归分析显示，心房颤动[优势比（odds ratio，OR）14．452，95％可信区间（confidence interval，CI）1．558～134．011；P=0．019]和同侧颈动脉狭窄≥50％（OR 11．483，95％CI 2．202～59．891；P=0．011）为MLI的独立危险因素。结论MLI可能具有与SLI不同的危险因素和发病机制。动脉粥样硬化病变和栓塞为MLI的重要发病机制，而SLI则不然。
Objective To investigate the characteristics of single lacunar infarct （SLI） and ipsiiateral multiple lacunar infarction （MLI）, and the differences of risk factors and and pathologies between them. Methods The clinical data of all patients with cerebral infarction in acute internal carotid artery territory from August 1, 2008 to December 13, 2014 were analyzed retrospectively. Lacunar infarctions were screened according to the clinical manifestations and imaging findings. The patients were divided into a SLI, a unilateral MLI in the same blood supply area （MLI 1） and a unilateral MLI in the different blood supply area （MLI 2） group according to the number and location of the lesions showed on diffusion weighted imaging. Multivariate logistic regression analysis was used to identify potential independent risk factors. Results The incidences of ipsilateral carotid plaque （73.33% vs. 48.67% ; X^2 = 5. 801, P = 0. 016）, ipsilateral unstable carotid plaque （70. 0% vs. 42. 5% ; X^2 = 7. 192, P = 0. 007 ）, and ipsilateral carotid stenosis ≥ 50% （16.67% vs. 1.77% ;X^2 =8. 327, P=0. 004） of the MLI 1 group were significantly higher than those of the SLI group; the incidence of atrial fibrillation of the MLI 2 group was significantly higher than that of the SLI group （40.0% vs. 0.88%;X^2 =15.887, P〈0.001）; there were no significant differences in the remaining risk factors among each group. Multivariate logistic regression analysis showed that atrial fibrillation （odds ratio [OR] 14.452, 95% confidence interval [CI] 1.558-134.011; P=0.019） and ipsilateral carotid stenosis 350% （OR 11. 483, 95% CI 2. 202 - 59. 891 ; P = 0. 011） were the independent risk factors for MLI. Conclusions MLI may have different risk factors and pathogeneses with SLI. Atherosclerotic lesions and embolism are the important pathogeneses of MLI, while SLI is not.
出处
《国际脑血管病杂志》
2015年第6期444-448,共5页
International Journal of Cerebrovascular Diseases
关键词
卒中
腔隙
颈动脉狭窄
动脉粥样硬化
心房颤动
磁共振成像
危险因素
Stroke, Lacunar
Carotid Stenosis
Atherosclerosis
Atrial Fibrillation
Magnetic Resonance Imaging
Risk Factors
