摘要
目的探讨后循环脑梗死的危险因素及可能影响后循环脑梗死患者预后的相关因素。方法选择自2010年6月至2012年6月福建医科大学附属第一医院收治的1536例脑梗死患者，根据排除标准去除218例，然后收集患者发病时间、入院时收缩压、舒张压、糖化血红蛋白、空腹血糖、餐后2h血糖、既往使用降糖药、既往使用胰岛素、冠心病、房颤、吸烟、既往有脑梗死或短暂性脑缺血发作史、脑梗死家族史、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、载脂蛋白A1、纤维蛋白原、梗死类型等20项因素的资料，再次剔除410例数据资料不全病例，最终人组的908例患者依据颅脑MRI检查结果分为后循环脑梗死组431例和前循环脑梗死组477例，并对相关资料进行Logistic回归分析；根据人院时Barthel指数将后循环脑梗死组分成可能预后良好组140例与可能预后不良组291例，同样对相关资料进行Logistic回归分析。结果Logistic回归分析显示：糖化血红蛋白≥8．5％（OR=1．919，P=0．004，95％CI：1．230～2．993）、既往使用胰岛素（OR=2．108，p=0．089，95％CI：0．892～4．982）为后循环脑梗死的独立危险因素，房颤（OR=0．655，P=0．028，95％CI：0．449～0．955）为前循环脑梗死的独立危险因素。糖化血红蛋白≥8．5％（OR=2．502，P=0．013，95％CI：1．217-5．147）、纤维蛋白原（OR=2．318，P=0．001，95％CI：1．381-3．891）、发病时间（OR=2．120，P=0．011，95％CI：1．191～3．7721、年龄（OR=I．022，P=0．015，95％CI：1．004～1．039）为可能影响后循环脑梗死预后的因素。结论在脑卒中预防中可将糖化血红蛋白作为判断脑卒中风险和干预效果的临床生物学标志之一。
Objective To probe into the risk factors associated with posterior circulation cerebral infarction, and to evaluate the factors affecting the prognosis of posterior circulation cerebral infarction. Methods One thousand and five hundred thirty-six patients with cerebral infarction, admitted to our hospital from June 2010 to June2012, were chosen in our study; 218 patients were excluded according to the exclusion criteria; 410 patients were eliminated for incomplete information （time of onset, admission systolic blood pressure, diastolic blood pressure, glycated hemoglobin, fasting glucose, 2 h postprandial glucose, previous use of hypoglycemic agents, previous use of insulin, coronary heart disease, atrial fibrillation [AF], smoking, previous infarction or transient ischemic history of seizures, cerebral family history, triglycerides, total cholesterol, high density lipoprotein, low density lipoprotein, apolipoprotein A1, fibrinogen [FIB], and infarct type）. The 908 eligible patients were divided into posterior circulation cerebral infarction group （n=431） and anterior circulation cerebral infarction group （n=477） according to their MRI features. Then the 431 patients with posterior circulation cerebral infarction were divided into possible good prognosis group （n=140） and possible poor prognosis group （n=291） according to their Barthel indexes on admission. All data were analyzed with Logistic regression analysis. Results Occurrence of posterior circulation cerebral infarction were mainly related to HbAlc≥8.5% （OR=1.919, P=0.004, 95%CI： 1.230-2.993） and history of using insulin （OR=2.108, P=0. 089, 95%CI： 0.892-4.982）. And that of anterior circulation cerebral infarction was mainly related to AF （OR=0.655, P=0.028, 95%CI： 0.449-0.955）. The possible prognostic factors of posterior circulation cerebral infarction were HbAlc≥8.5% （OR=2.502, P=0.013, 95%CI： 1.217-5.147）, FIB （OR=2.318, P= 0.001, 95%CI： 1.381-3.891）, time of onset （OR=2.120, P=-0.011, 95%CI： 1.191-3.772）, and age （OR=I. 022, P=0.015, 95%CI： 1.004-1.039）. Conclusion In the prevention of stroke, HbAlc can be one of the clinical biomarkers in judging stroke risk and intervention effect.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2015年第1期37-42,共6页
Chinese Journal of Neuromedicine
基金
国家临床重点建设专科资助项目
福建省临床重点建设专科资助项目
关键词
后循环脑梗死
危险因素
预后
糖化血红蛋白
Posterior circulation cerebral infarction
Risk factor
Prognosis
Glycosylated hemoglobin
作者简介
通信作者：吴钢．Email：gangwu44@vip．sina．com
