头颈部动脉夹层致青年缺血性卒中影响因素及影像学特点分析

doi:10.3969/j.issn.1672-6731.2021.04.011

摘要/Abstract

摘要：

目的总结头颈部动脉夹层致青年缺血性卒中的发生率、相关影响因素及其临床和影像学特点。方法纳入2016年10月至2020年9月首都医科大学附属北京朝阳医院治疗的首发青年急性缺血性卒中患者共242例，根据病因分为头颈部动脉夹层组（CAD组，32例）和非头颈部动脉夹层组（对照组，210例），收集临床和影像学资料，采用单因素和多因素前进法Logistic回归分析筛查头颈部动脉夹层致青年缺血性卒中的影响因素，并归纳总结不同部位头颈部动脉夹层的影像学特点。结果头颈部动脉夹层占青年首发缺血性卒中的13.22%（32/242）。与对照组相比，CAD组患者年龄更小（t=-3.480，P=0.001），发病前多存在感染和颈部运动等诱因（t=8.796，P=0.003），存在头颈部疼痛比例更高（t=17.466，P=0.000），梗死部位位于前循环比例更低（t=22.705，P=0.000）。Logistic回归分析显示，年龄大（OR=0.920，95% CI：0.853~0.992；P=0.030）、梗死部位位于前循环（OR=0.145，95% CI：0.059~0.356；P=0.000）是头颈部动脉夹层致青年缺血性卒中的保护因素，而头颈部疼痛（OR=5.428，95% CI：1.653~17.824；P=0.005）是其危险因素。影像学检查显示夹层病变位于前循环11例（34.37%），包括颈动脉颅外段9例、大脑前动脉1例、大脑中动脉1例；位于后循环21例（65.63%），包括椎动脉颅外段10例（2例为双侧病变）、颅内段6例、颅内外均累及4例、小脑后下动脉1例。结论头颈部动脉夹层是青年缺血性卒中的常见病因，椎动脉夹层及后循环梗死更常见，年龄小、梗死部位位于后循环、头颈部疼痛是头颈部动脉夹层致青年缺血性卒中的危险因素。

关键词: 卒中, 脑缺血, 颅内动脉疾病, 颈动脉疾病, Logistic模型, 磁共振成像, 青年人

Abstract:

Objective To explore the prevalence, influencing factors, and clinical and imaging features of cervicocerebral artery dissection (CAD) in young patients with ischemic stroke. Methods A total of 242 young patients with first ever ischemic stroke were included in this study from October 2016 to September 2020. Thirty-two patients with CAD were included in the CAD group, and 210 patients without CAD were included as controls. We collected the clinical and imaging data of all the patients. Univariate and multivariate Logistic regression analysis were used to screen the influencing factors of young ischemic stroke patients caused by CAD. And we analyzed imaging characteristics of CAD in different locations. Results Among the 242 young patients with ischemic stroke, 32 (13.22%) patients were due to CAD. Compared with the control group, the CAD group had younger onset age (t=-3.480, P=0.001), more inducible events (infection and neck movement) before the onset of cerebral infarction (t=8.796, P=0.003), and higher incidence of headache or neck pain (t=17.466, P=0.000) and posterior circulation infarction (t=22.705, P=0.000). Multivariate Logistic regression analysis showed that older age (OR=0.920, 95%CI: 0.853-0.992; P=0.030), the infarction located in the anterior circulation (OR=0.145, 95%CI: 0.059-0.356; P=0.000) were protective factors for ischemic stroke due to CAD, while head and neck pain (OR=5.428, 95%CI: 1.653-17.824; P=0.005) was risk factor for ischemic stroke due to CAD. The artery dissection lesions were located in anterior circulation in 11 (34.37%) patients with CAD, including 9 cases of extracranial carotid artery, one case of anterior cerebral artery, and one case of middle cerebral artery, while 21 (65.63%) patients' artery dissection lesions were located in the posterior circulation, including 10 cases of extracranial vertebral artery dissection (2 patients with bilateral lesions), 6 cases of intracranial segment, 4 cases with both intracranial and extracranial segment involvement, and one case with posterior inferior cerebellar artery dissection. After discharge, the follow-up imaging examination of 9 CAD patients showed that 6 patients had varying degrees of recovery of the arterial lumen and the rest 3 patients had no change. Conclusions CAD is a common cause of cerebral infarction in young people, and younger age, posterior circulation infarction and head and neck pain are risk factors for CAD.

Key words: Stroke, Brain ischemia, Intracranial arterial diseases, Carotid artery diseases, Logistic models, Magnetic resonance imaging, Young adult

秦伟, 杨磊, 杨淑娜, 李譞婷, 李悦, 蒋涛, 胡文立. 头颈部动脉夹层致青年缺血性卒中影响因素及影像学特点分析[J]. 中国现代神经疾病杂志, 2021, 21(4): 296-303.

QIN Wei, YANG Lei, YANG Shu-na, LI Xuan-ting, LI Yue, JIANG Tao, HU Wen-li. Influencing factors and imaging features of young patients with ischemic stroke caused by cervicocerebral artery dissection[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(4): 296-303.

http://journal11.magtechjournal.com/cjcnn/CN/Y2021/V21/I4/296

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2 头颈部动脉夹层致青年缺血性卒中影响因素及影像学特点分析

Influencing factors and imaging features of young patients with ischemic stroke caused by cervicocerebral artery dissection

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2 头颈部动脉夹层致青年缺血性卒中影响因素及影像学特点分析

Influencing factors and imaging features of young patients with ischemic stroke caused by cervicocerebral artery dissection

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