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目的:观察急性脑梗死并发脑白质疏松(LA)的危险因素,以及LA对老年急性脑梗死患者预后的影响。方法:选取急性脑梗死186例,按照是否合并LA分为LA组84例和无LA组102例。收集两组性别、年龄及吸烟、饮酒等基本信息,记录实验室检查结果及影像学检查结果,比较两组高脂血症等脑梗死危险因素存在情况,并分析急性脑梗死并发LA的影响因素;对入组病例随访1年,以复发及死亡为终点事件,比较两组预后情况。结果:LA组高血压病、脑梗死史、颈内动脉狭窄≥50%、腔隙性脑梗死发生率显著或非常显著高于无LA组(P<0.05,P<0.01);两组性别、吸烟史、饮酒史、糖尿病、高脂血症、冠心病等均差异不显著(P>0.05)。多因素Logistic回归分析结果显示,高血压病、脑梗死病史、腔隙性脑梗死、颈内动脉狭窄≥50%进入以急性脑梗死并发LA为因变量的回归方程(P<0.05,P<0.01)。随访1年,LA组病死率22.6%,非常显著高于无LA组的5.9%(P<0.05);两组复发率比较,差异不显著(P>0.05)。结论:高血压病、脑梗死病史、腔隙性脑梗死、颈内动脉狭窄≥50%是急性脑梗死并发LA的危险因素;伴发LA可能增加急性脑梗死患者的病死率,但对急性脑梗死复发无显著影响。
Objective: To observe the risk factors of cerebral infarction (LA) in acute cerebral infarction and the effect of LA on the prognosis of elderly patients with acute cerebral infarction. Methods: A total of 186 acute cerebral infarction patients were selected and divided into LA group (n = 84) and non-LA group (n = 102) according to whether they were combined with LA or not. Two groups of sex, age and smoking, drinking and other basic information were collected, the results of laboratory tests and imaging findings were recorded, the presence of hyperlipidemia and other cerebral infarction risk factors were compared, and the influencing factors of acute cerebral infarction complicated with LA ; The patients were followed up for 1 year, recurrence and death as the end point, the prognosis of the two groups were compared. Results: The incidence of hypertension, cerebral infarction, carotid artery stenosis≥50% and lacunar infarction in LA group were significantly higher than those without LA (P <0.05, P <0.01) Smoking history, drinking history, diabetes, hyperlipidemia, coronary heart disease were not significantly different (P> 0.05). Multivariate logistic regression analysis showed that hypertension, cerebral infarction, lacunar infarction and carotid artery stenosis≥50% entered the regression equation of acute cerebral infarction with LA as the dependent variable (P <0.05, P <0.01) ). The follow-up of 1 year showed that the mortality rate in LA group was 22.6%, which was significantly higher than that in non-LA group (5.9%, P <0.05). There was no significant difference in relapse rate between two groups (P> 0.05). Conclusion: Hypertension, history of cerebral infarction, lacunar infarction and carotid artery stenosis≥50% are risk factors for acute cerebral infarction complicated with LA. Complicated LA may increase the mortality of patients with acute cerebral infarction, No significant effect of infarction recurrence.