动脉硬化性脑梗死复发的危险因素分析_临床医学论文.docVIP

动脉硬化性脑梗死复发的危险因素分析_临床医学论文 动脉硬化性脑梗死复发的危险因素分析_临床医学论文 作者：池万章，易兴阳，池丽芬，潘继豹，张顺开 【摘要】 目的：探讨脑梗死复发的危险因素。方法 ：随访观察769例脑梗死患者，比较有复发的脑梗死患者和无复发的脑梗死患者首次卒中时的危险因素、血同型半胱氨酸（Hcy）、可溶性黏附分子（SICAM-1）、细胞因子水平、颈动脉粥样硬化的严重程度、狭窄程度及斑块类型、首次卒中后危险因素控制情况。结果 ：769例脑梗死患者在随访期有156例（占20.3%）复发，出院后正规服阿斯匹林的患者复发率低于未正规服阿斯匹林的患者（P lt;0.05）；首次卒中后戒烟者及血压、血糖、血胆固醇控制在正常范围的患者复发率低于控制不好的患者；多变量Logistic回归分析表明，年龄、血清白蛋白/球蛋白比例、血糖、纤溶酶原活性、Hcy、sICAM-1、IL-6水平及颈动脉粥样硬化的严重程度、狭窄程度、斑块类型以及首次卒中后是否戒烟，血压、血糖和血胆固醇是否控制在正常水平，出院后是否正规服用阿斯匹林是脑梗死复发密切相关的危险因素。结论 ：与脑梗死复发相关的危险因素多，首次卒中后戒烟、控制好血压、血糖和血胆固醇以及出院后正规服用阿斯匹林在降低脑梗死复发中起重要作用。 【关键词】 脑梗死；预后；颈动脉粥样硬化；细胞因子；同型半胱氨酸 Abstract: Objective: To explore the risk factors for recurrence of cerebral infarction. Methods: 769 patients with cerebral infarction were following-up observed. The risk factor of stroke， the levels of blood homocysteine (Hcy)， soluble intercellular adhesion molecule， cytokine， the grade of carotid atherosclerosis， stenosis， and types of plaque and the situation of controlling the first post-stroke risk factors were compared between patients with recurrent cerebral infarction and non recurrent cerebral infarction of the firstr stroke. Results:Of 769 patients with cerebral infarction， 156 patients (20.3%) relapsed during follow-up periods. The incidence of recurrence was lower in patients of regular use of aspirin than those of no regular use after discharge （P lt;0.05）， The incidence of recurrence was lower in patients of giving up smoking and controlling normal of blood glucose， blood pressure，blood cholesterol than those of continuing smoking and poor control after stroke. The multivariable logistic regression analysis showed that the age， blood glucose， the A/G ratio， and the levels of HCY， sICAM-1， IL-6， plasminogen， the grade of carotid atherosclerosis， stenosis， and types of plaque，and whether or not to give up smoking， whether or not to control normal blood glucose，blood pressure， blood cholesterol， whether or not to regular use of aspirin after first stroke were closely related to cer