Zhongguo cuzhong zazhi (Jun 2019)

多发颅内动脉粥样硬化性狭窄对轻型卒中和短暂性脑缺血发作早期卒中复发风险影响研究 Effect of Multiple Intracranial Atherosclerotic Stenosis on the Risk of Recurrent Stroke in Patients with Transient Ischemic Attack and Minor Stroke

  • 荆京，孟霞，王安心，赵性泉，王伊龙，刘丽萍，王拥军

DOI
https://doi.org/10.3969/j.issn.1673-5765.2019.06.007
Journal volume & issue
Vol. 14, no. 6
pp. 555 – 560

Abstract

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【摘要】 目的 探讨多发颅内动脉狭窄对轻型缺血性卒中和TIA早期卒中复发的影响。 方法 纳入氯吡格雷用于急性非致残性脑血管事件高危人群的疗效（Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events，CHANCE）研究影像亚组1089例非心源性高危TIA和轻型缺血性卒中患者。根据患者入院时MRA序列的检查结果分为无颅内动脉狭窄、单发颅内动脉狭窄和多发颅内动脉狭窄3组。随访患者90 d卒中复发（缺血性和出血性卒中）事件。采用Cox回归分析多发颅内动脉狭窄对轻型缺血性卒中和TIA患者90 d卒中复发风险的影响。 结果 无颅内动脉狭窄、单发颅内动脉狭窄和多发颅内动脉狭窄组分别有608例、298例和183例患者；90 d卒中发生风险比例分别为5.43%、9.06%和18.03%。与无颅内动脉狭窄患者相比，伴有颅内动脉狭窄（包含单发和多发颅内动脉狭窄）患者卒中复发风险显著高于非颅内动脉狭窄患者（12.50% vs 5.40%，P＜0001）。其中，多发颅内动脉狭窄卒中复发风险最高（18.03%），是无颅内动脉狭窄患者的3.578倍（HR 3.578，95%CI 2.189～5.850）。 结论 多发颅内动脉狭窄是非心源性TIA和轻型卒中患者早期卒中复发的独立危险因素。 【Abstract】 Objective To investigate the effect of multiple intracranial atherosclerotic stenosis (ICAS) on early stroke recurrence in patients with TIA and minor ischemic stroke. Methods 1089 patients with noncardioembolic high-risk TIA and minor ischemic stroke in the imaging subgroup of the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) randomized clinical trial were included in this study. Based on MRA results after admission, ICAS status were grouped into no ICAS, single ICAS and multiple ICAS. The outcomes were recurrent stroke (including ischemic or hemorrhagic stroke) during 90-day follow-up. Cox proportional hazards models were used to assess the association of ICAS status and stroke recurrence. Results 608 patients had no ICAS, 298 patients had single ICAS and 183 patients had multiple ICAS, and theircorresponding risk of recurrent stroke was 5.43%, 9.06% and 18.03%, respectively. Patients with ICAS (including single and multiple ICAS) had a significantly higher risk of recurrent stroke than patients without ICAS (12.50% vs 5.40%, P<0.0001). The risk of recurrent stroke in patients with mutiple ICAS was the highest (18.03%) and was 3.578 times higher than that of patients without ICAS (HR 3.578, 95%CI 2.189-5.850). Conclusions Multiple intracranial arterial stenosis was an independent risk factor of 90-day recurrent stroke in patients with noncardioembolic high-risk TIA and minor ischemic stroke.

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