老年急性缺血性卒中患者伴颅内动脉多发狭窄的脑小血管病特征及影响因素分析

Analysis of characteristics and influence factors of cerebral small vessel disease in elderly patients with AIS complicated with multiple intracranial arterial stenosis

中文关键词: 老年  缺血性卒中  动脉狭窄  脑小血管病  白质高信号

英文关键词: elderly  ischemic stroke  arterial stenosis  cerebral small vessel disease  white matter hyperintensity

中文摘要:

      目的 探讨老年急性缺血性卒中(AIS)患者伴颅内动脉多发狭窄的脑小血管病特征及危险因素.方法 回顾性选取2024年1月—2024年12月复旦大学附属华东医院神经内科诊治的162例老年AIS伴颅内动脉多发狭窄患者的临床资料,根据颅内动脉狭窄程度分为轻中度狭窄组(n=73)和重度狭窄组(n=89).运用t检验、U检验或x2检验方法,分析2组患者实验室指标及脑小血管病(CSVD)特征差异,采用多因素Logistic回归分析老年AIS患者伴颅内动脉重度狭窄的危险因素.结果 重度狭窄组的红细胞沉降率、美国国立卫生研究院卒中量表评分(NIHSS)、CSVD特征中白质高信号和CSVD负荷占比均高于轻中度狭窄组,估算肾小球滤过率(eGFR)低于轻中度狭窄组,差异均具有统计学意义(P＜0.05).多因素 Logistic 回归分析显示,eGFR(OR=0.984,95％CI:0.969～0.999,P=0.043)是老年AIS 患者伴重度动脉狭窄的危险因素.结论 CSVD中的白质高信号与老年AIS患者伴颅内动脉多发狭窄的动脉狭窄程度相关,且eGFR可作为评估此类患者重度狭窄的危险因素.

英文摘要:

      Objective To investigate the characteristics of cerebral small vessel disease(CSVD)and its risk factors in elderly patients with acute ischemic stroke(AIS)complicated with multiple intracranial arterial stenoses.Methods The clini-cal data of 162 elderly AIS patients with multiple intracranial arterial stenoses diagnosed and treated in Department of Neurology of Huadong Hospital Affiliated to Fudan University from January 2024 to December 2024 were retrospectively selected.Patients were divided into mild-to-moderate stenosis group(n=73)and severe stenosis group(n=89)based on the degree of intracra-nial arterial stenosis.T-tests,Mann-Whitney U tests and Chi-square tests were used to analyze differences in laboratory indica-tors and CSVD features between the two groups.Multivariate logistic regression was employed to identify risk factors for severe intracranial arterial stenosis in elderly AIS patients.Results Compared with the mild-to-moderate stenosis group,the severe stenosis group had significantly higher level of erythrocyte sedimentation rate,score of National Institutes of Health Stroke Scale(NIHSS),and proportions of white matter hyperintensities and increased CSVD burden.The estimated glomerular filtration rate(eGFR)in the severe stenosis group was significantly lower than that in the mild-to-moderate stenosis group(P＜0.05).Multivariate logistic regression analysis indicated that eGFR was an independent risk factor for severe arterial stenosis in elderly AIS patients(OR=0.984,95％CI:0.969-0.999,P=0.043).Conclusion White matter hyperintensities in CSVD are asso-ciated with the degree of arterial stenosis in elderly AIS patients with multiple intracranial arterial stenoses.Furthermore,eGFR can serve as a risk factor for assessing severe stenosis in such patients.