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目的探讨腔隙性脑卒中患者的脑血管反应性及影响因素。方法连续选取自2014年1月—2015年1月新疆医科大学第五附属医院神经内科入院的急性腔隙性脑卒中患者75例,性别、年龄相匹配的健康对照60例患者,详细记录腔隙性脑卒中患者的一般临床资料及影像学特点,Fazekas量表对脑白质病变进行分级;并利用脑多普勒(transcranial doppler,TCD)屏气试验,计算腔隙性脑卒中患者及对照组患者基础脑血流速度(MFV)及屏气指数(BHI),进一步多因素分析影响腔隙性脑卒中患者BHI的相关临床因素。结果腔隙性脑卒中患者基础MFV[(56.5±8.9)cm/s]及BHI(1.09±0.18)分均低于对照组[MFV:(59.9±6.6)cm/s;BHI:(1.39±0.14)分],差异有统计学意义(P<0.05);在腔隙性脑卒中患者中,白质疏松等级与BHI评分呈负相关(r=-0.869,P<0.01),白质疏松等级越高,BHI评分越低;进一步多因素线性回归方程分析,将BHI为应变量,将吸烟、糖尿病、高血压、及白质疏松等级纳入方程,年龄(OR=-0.333,P<0.01)、白质疏松等级(OR=-0.583,P<0.01)是影响腔隙性脑卒中患者BHI的相关危险因素。结论腔隙性脑卒中患者脑血管反应性发生了严重的破坏,脑血流调节功能严重受损,白质病变越严重,损伤越重,年龄及白质疏松等级是影响腔隙性脑卒中脑血管反应性的相关危险因素。
Objective To investigate the cerebrovascular reactivity and its influencing factors in lacunar stroke patients. Methods Seventy-five patients with acute lacunar stroke who were hospitalized in Department of Neurology, the Fifth Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2015 were selected. Sixty patients with matched sex and age were selected and recorded. The general clinical data and imaging features of patients with stroke and stroke were assessed by Fazekas scale, and the patients with lacunar stroke and control group were calculated by breath-hold test with transcranial doppler (TCD) Baseline cerebral blood flow velocity (MFV) and breath holding index (BHI), and further multivariate analysis of the impact of lacunar stroke in patients with BHI related clinical factors. Results The median MFV [(56.5 ± 8.9) cm / s] and BHI (1.09 ± 0.18) in lacunar stroke patients were lower than those in control group [MFV: (59.9 ± 6.6) cm / ), The difference was statistically significant (P <0.05). In patients with lacunar stroke, the level of leukoaraiosis was negatively correlated with BHI (r = -0.869, P <0.01), the level of leukoaraiosis was higher, BHI as the dependent variable, age, age (OR = -0.333, P <0.01), level of leukoaraiosis (P <0.01) OR = -0.583, P <0.01) were the risk factors influencing BHI in lacunar stroke patients. Conclusions The cerebrovascular reactivity of patients with lacunar stroke is severely damaged. The function of cerebral blood flow regulation is severely impaired. The more severe the white matter lesions are, the heavier the lesions are. The age and the level of leukopenia are the factors that influence the cerebrovascular responses to lacunar stroke Sex-related risk factors.