目的 探讨缺血性卒中患者的颅内外动脉狭窄特点及程度与高血压病、糖尿病的病史及控制水平的关系.方法 回顾性分析住院治疗的存在颅内外动脉狭窄且并发高血压或糖尿病的大动脉粥样硬化性急性缺血性卒中患者资料.将高血压患者分为高年限组(病史>5年)和低年限组(病史≤5年),血压控制良好组和不良组;将糖尿病患者也分为高年限组(病史>5年)和低年限组(病史≤5年),血糖控制良好组和不良组.比较不同组间颅内外动脉狭窄分布情况、血管狭窄程度.结果 共入组216例急性缺血性卒中患者,其中57例颅外动脉狭窄,105例颅内动脉狭窄,54例颅内外动脉均狭窄.轻度狭窄发生73例,中度狭窄发生101例,重度狭窄及闭塞发生42例.高血压病患者共140例,高年限组动脉狭窄最常见于颅内动脉(54.5%),低年限组血管狭窄的部位多见于颅外动脉(51.3%),差异有统计学意义(P<0.001).两组间动脉狭窄程度差异也有统计学意义.糖尿病患者共76例,高年限组发生动脉狭窄最常见于颅内动脉(72.2%),低年限组血管狭窄的部位多见于颅外动脉(65%),差异有统计学意义,两组间动脉狭窄程度差异也有统计学意义.高血压控制不良组发生重度狭窄或闭塞的概率高于血压控制良好组(20.7% vs 8.6%);血糖控制情况不良组发生重度狭窄或闭塞的概率高于血糖控制良好组(40.9% vs 6.3%).结论 随着高血压病年限的增长,急性缺血性卒中患者颅内动脉狭窄的发生率增高,其中以中度狭窄程度多见;血压控制不良的患者发生重度狭窄或闭塞的比率高.随着糖尿病年限的增长,颅内动脉狭窄的发生率增高,其中以中度狭窄程度多见,血糖控制不良者发生重度狭窄或闭塞的比例高.%Objective To investigate the characteristics of intra-and extracranial arteriostenosis in patients with ischemic stroke (IS) and its relationship with course and control levels of hypertension and diabetes. Methods The data of hospitalized patients with atherosclerotic acute ischemic stroke (AIS) who had intracranial and extracranial artery stenosis and concomitant hypertension or diabetes were retrospectively analyzed. Hypertension patients were divided into long-course group (>5 years) and short-course group (≤5 years), blood pressure well controlled and badly controlled groups. Diabetic patients were also divided into long-course group (>5 years) and short-course group (≤5 years), blood glucose well controlled group and badly controlled group. The distribution situation of intracranial and extracranial arteriostenosis and hemadostenosis degree were compared in different groups. Results A total of 216 patients with IS were enrolled into study, including 57 extracranial arteriostenosis patients, 105 intracranial arteriostenosis patients, and 54 intracranial and extracranial arteriostenosis patients. Among which, there were 73 mild arteriostenosis patients, 101 moderate arteriostenosis patients, 42 severe arteriostenosis and occlusion patients. There were 140 hypertensive patients in total. The commonest arterostenosis in long-course group was in intracranial artery (54.5%) and short-course group was in extracranial artery (51.3%), which had statistical significance in difference (P<0.001). Besides, the difference in the degree of arterial stenosis between two groups also had statistical significance. There were 76 diabetic patients in total. The commonest arterostenosis in long-course group was in intracranial artery (72.2%) and short-course group was in extracranial artery (65%), which had statistical significance in difference. The difference in the degree of arterial stenosis between two groups also had statistical significance. The probability of severe stenosis or occlusion in badly controlled hypertension group was higher than that of well controlled group(20.7% vs 8.6%).The probability of severe stenosis or occlusion in blood glucose badly controlled group was higher than that of well controlled group(40.9% vs 6.3%). Conclusion With the course of hypertension lengthening, the incidence of intracranial artery stenosis in IS patients was increasing, and moderate stenosis was the commonest. The proportion of severe stenosis or occlusion in blood pressure badly controlled patients was high. With the course progression of diabetes, the incidence of intracranial artery stenosis was increasing, and moderate stenosis was the commonest. Similarly, the proportion of severe stenosis or occlusion in blood glucose badly controlled group was high.
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