作者：汤群英，徐红，于建刚

单位：

214500 江苏省靖江市人民医院神经内科

Units：

Department of Neurology，Jingjiang People's Hospital，Jingjiang 214500，China

关键词：

腔隙性脑梗死；腔隙形成；影响因素分析

Keywords：

Infarction，lacunar；Lacunar formation；Root cause analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.027

Funds：

江苏省卫生计生委 2016 年度面上科研课题（H201651）

摘要：

背景　急性腔隙性脑梗死是临床常见的脑血管疾病类型，起病隐匿，一旦病变部位进展为腔隙则会导致患者认知障碍甚至死亡，故早期识别、预防急性腔隙性脑梗死患者病变部位腔隙形成具有重要临床意义。目的　探讨急性症状性腔隙性脑梗死患者病变部位腔隙形成的影响因素。方法　选取 2016 年 9 月—2019 年 10 月靖江市人民医院收治的急性症状性腔隙性脑梗死患者 106 例，根据门诊随访时磁共振成像（MRI）检查结果分为腔隙形成组（n=14）和非腔隙形成组（n=92）。收集患者一般资料及实验室检查指标，采用多因素 Logistic 回归分析急性症状性腔隙性脑梗死患者病变部位腔隙形成的影响因素。结果　腔隙形成组患者年龄≥ 65 岁、有吸烟史、有糖尿病病史、有高血压病史者所占比例高于非腔隙形成组，病变直径变化值大于非腔隙形成组（P＜0.05）。多因素Logistic回归分析结果显示，糖尿病病史〔OR=2.016，95%CI（1.397，2.908）〕、高血压病史〔OR=2.479，95%CI（1.669，3.684）〕及血管病变直径变化值≥ 3.0 mm〔OR=2.457，95%CI（1.462，4.131）〕是急性症状性腔隙性脑梗死患者病变部位腔隙形成的独立影响因素（P ＜ 0.05）。结论　糖尿病病史、高血压病史与血管病变直径变化值≥ 3.0 mm 可能是急性症状性腔隙性脑梗死患者病变部位腔隙形成的独立影响因素，因此需监督患者控制血压、血糖，定期复查，以降低腔隙形成发生风险。

Abstract：

Background　Acute lacunar infarction was a common cerebrovascular disease with insidious onset. Once the lesions progress to lacunar，it would cause cognitive impairment and even death.Therefore，early identification and prevention of lacunar formation in patients with acute lacunar infarction have an important clinical significance.Objective　To investigate the influencing factors of lacunar formation at the lesion site in patients with acute symptomatic lacunar infarction. Methods　From September 2016 to October 2019，106 patients with acute symptomatic lacunar infarction were admitted to Jingjiang People's Hospital，and they were divided into lacunar formation group（n=14） and non lacunar formation group（n=92） according to the results of magnetic resonance imaging（MRI）during outpatient follow-up. The general data and laboratory examination indexes were collected，and the influencing factors of lacunar formation at the lesion site of patients with acute symptomatic lacunar infarction were analyzed by multivariate Logistic regression. Results　The proportion of patients in the lacunar formation group who were ≥ 65 years old，had a history of smoking，diabetes，and hypertension were higher than those in the non-lacunform group，and the change value of vascular lesion diameter was higher than that in non lacunar formation group（P ＜ 0.05）.The results of multivariate Logistic regression analysis showed that history of diabetes〔OR=2.016，95%CI（1.397，2.908）〕，history of hypertension〔OR=2.479，95%CI（1.669，3.684）〕and change value of vascularlesion diameter ≥ 3.0 mm〔OR=2.457，95%CI（1.462，4.131）〕were independent influencing factors for lacunar formation at the lesion site in patients with acute symptomatic lacunar infarction（P ＜ 0.05）.Conclusion　The history of diabetes，hypertension and the change value of vascular lesion diameter ≥ 3.0 mm may be the independent influencing factors of lacunar formation at the lesion site in patients with acute symptomatic lacunar infarction.Therefore，it is necessary to supervise patients to control blood pressure and blood glucose，and regularly review，so as to reduce the risk of lacunar formation.

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