Zhongguo cuzhong zazhi (May 2018)
颅内外动脉粥样硬化相关因素的差异 Differences in Related Factors of Intracranial and Extracranial Atherosclerosis
Abstract
目的 探讨颅内外动脉粥样硬化的相关因素是否存在差异。 方法 在中国颅内动脉粥样硬化研究的数据库中，将患者分为4组：无显著颅内外动脉狭窄或闭塞组、 单纯颅内动脉病变组、单纯颅外动脉病变组及颅内合并颅外动脉病变组。以无显著颅内外动脉狭窄 或闭塞组作为参考，应用多元Logistic回归分析，评估颅内外动脉病变的相关因素。 结果 共入组2864例缺血性脑血管病患者，其中无显著颅内外动脉狭窄或闭塞组1388例（48.5%）、 单纯颅内动脉病变组1074例（37.5%）、单纯颅外动脉病变组141例（4.9%）、颅内合并颅外动脉 病变组261例（9.1%）。多因素分析显示，单纯颅内动脉病变的独立相关因素包括：白质病变[比值比 （odds ratio，OR）1.359，95%（confidence interval，CI）1.109～1.666，P =0.0031] 、白细胞计数（OR 1.045， 95%CI 1.007～1.084，P =0.0210）、空腹血糖（OR 1.054，95%CI 1.009～1.101，P =0.0182）、高密度脂 蛋白（OR 0.644，95%CI 0.480～0.864，P =0.0034）；单纯颅外动脉病变的独立相关因素包括：高龄 （OR 1.047，95%CI 1.026～1.069，P <0.0001）、吸烟（OR 1.887，95%CI 1.212～2.937，P =0.0050）、既 往缺血性脑血管病史（OR 2.260，95%CI 1.352～3.778，P =0.0019）和白质病变（OR 0.603，95%CI 0.394～0.922，P =0.0196）。颅内合并颅外动脉病变组独立相关因素包括：高龄（OR 1.022，95%CI 1.006～1.039，P =0.0064）、糖尿病（OR 1.494，95%CI 1.053～2.118，P =0.0244）和卒中家族史（OR 1.964，95%CI 1.302～2.961，P =0.013）。高同型半胱氨酸血症是3组共同的独立相关因素。 结论 颅内外动脉粥样硬化病变的相关因素可能存在差异。白细胞计数、空腹血糖、高密度脂蛋白 水平低与颅内动脉粥样硬化病变相关；高龄、吸烟、既往缺血性脑血管病史与颅外动脉粥样硬化相 关。高同型半胱氨酸血症是颅内外动脉病变的共同相关因素。 Abstract: Objective To explore the differences in Related factors between intracranial and extracranial atherosclerosis. Methods From the Chinese Intracranial Atherosclerosis Study (CICAS), all the enrolled patients were divided into four groups: no significant intracranial or extracranial atherosclerosis group, only intracranial atherosclerosis group, only extracranial atherosclerosis group, and intracranial and extracranial atherosclerosis group. With no significant intracranial or extracranial atherosclerosis group as control, the logistic regression analysis was used to assess the possible factors associated with intracranial or extracranial atherosclerosis. Results Of 2864 patients, 1388 (48.5%) had no significant intracranial or extracranial atherosclerosis, 1074 (37.5%) had only intracranial atherosclerosis, 141 (4.9%) had only extracranial atherosclerosis, and 261 (9.1%) had intracranial and extracranial atherosclerosis. Multi-factors analysis showed that independent factors associated with intracranial atherosclerosis were white matter lesions [odds ratio (OR) 1.359, 95% confidence interval (CI) 1.109-1.666, P =0.0031], leukocyte count (OR 1.045, 95%CI 1.007-1.084, P =0.0210), fasting blood glucose (OR 1.054, 95%CI 1.009-1.101, P =0.0182), and high density lipoprotein (OR 0.644, 95%CI 0.480-0.864, P =0.0034); Independent factors associated with extracranial atherosclerosis were senior age (OR 1.047, 95%CI 1.026-1.069, P <0.0001), smoking (OR 1.887, 95%CI 1.212-2.937, P =0.0050), previous history of ischemic cerebrovascular disease (OR 2.260, 95%CI 1.352-3.778, P =0.0019), and leukoaraiosis (OR 0.603, 95%CI 0.394-0.922, P =0.0196). Senior age (OR 1.022, 95%CI 1.006-1.039, P =0.0064), diabetes mellitus (OR 1.494, 95%CI 1.053- 2.118, P =0.0244) and family history of stroke (OR 1.964, 95%CI 1.302-2.961, P =0.013) were the independent factors of intracranial and extracranial atherosclerosis. Hyperhomocysteinemia was a common independent factor in the three groups. Conclusion The related factors may have differences between intracranial and extracranial atherosclerotic lesions. Leucocyte count, fasting blood glucose, and high-density lipoprotein are associated with intracranial atherosclerotic lesions; while age, smoking and history of ischemic cerebrovascular disease are associated with extracranial atherosclerosis. Hyperhomocysteinemia is the common independent factor of intra-and extracranial lesions.
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