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目的以有症状的腔隙性脑梗死患者为对象,分析伴有和不伴有脑白质疏松(LA)患者危险因素的差异,探讨LA发生的机制。方法经头颅MRI证实有症状的腔隙性脑梗死患者268例,分为单纯腔隙性梗死组(LI组)和伴有脑白质疏松组(LA组)。对患者的性别、年龄、高血压病史、脑梗死病史等多种危险因素进行单因素分析及Logistic回归分析。结果LI组138例(51.5%),平均年龄(63.4±11.4)岁;LA组130例(48.5%),平均年龄(71.3±8.9)岁,两组比较有显著性差异(P﹤0.01)。两组年龄、冠心病史、高血压病史、既往脑梗死病史、叶酸浓度[(16.1±8.4)ng/ml,(13.1±5.9)ng/ml]和纤维蛋白原水平[(3.0±0.9)g/L,(3.4±0.8)g/L]均有显著性差异。多因素回归分析最终入选模型的变量是年龄、既往脑梗死史、叶酸和高血压病史。结论高龄、高血压病史、脑梗死病史和低血浆叶酸浓度对于有症状的腔隙性脑梗死患者是否伴发LA有独立的提示作用,纤维蛋白原可能通过与其他因素一起在LA的形成中发挥作用。
Objective To analyze the difference of risk factors in patients with symptomatic lacunar infarction and with or without leukoaraiosis (LA), and to explore the mechanism of LA. Methods A total of 268 patients with symptomatic lacunar infarction confirmed by cranial MRI were divided into lacunar infarction group (LI group) and leucoaraiosis group (LA group). The risk factors such as gender, age, history of hypertension and history of cerebral infarction were analyzed by univariate analysis and Logistic regression analysis. Results There were 138 cases (51.5%) in LI group and 63.4 ± 11.4 years old in LI group, 130 cases (48.5%) in LA group, with an average age of (71.3 ± 8.9) years. There were significant differences between the two groups (P <0.01). The age, history of coronary heart disease, history of hypertension, history of previous cerebral infarction, folic acid concentration [(16.1 ± 8.4) ng / ml, (13.1 ± 5.9) ng / ml and fibrinogen level (3.0 ± 0.9) g /L,(3.4 ± 0.8) g / L] were significantly different. Multivariable regression analysis of the final enrolled model variables were age, previous history of cerebral infarction, history of folic acid and hypertension. Conclusions Age, history of hypertension, history of cerebral infarction and low plasma folate concentration are independent prognostic factors for patients with symptomatic lacunar infarction. Fibrinogen may play an important role in the formation of LA together with other factors effect.