| Objective: To investigate the influencing factors of the formation of collateral circulation in patients with middle cerebral artery(MCA)stenosis or occlusion and the predictive effect of independent risk factors on the adverse formation of collateral circulation,and to analyze the correlation between the degree of MCA stenosis and the formation of collateral circulation,as well as the influence of collateral circulation on the prognosis of patients.Methods: Retrospectively analysis was performed on petients with acute cerebral infarction who met the admission and exclusion criteria in Department of Neurology,the First Hospital of Handan City from September 2018-September 2020.Remove 13 cases for incomplete information,included 106 cases,and collect patients admitted to hospital general information(gender,age,body mass index,history of smoking,history of drinking,systolic blood pressure,diastolic blood pressure),past medical history(stroke,hypertension,diabetes,coronary heart disease),laboratory indexes(glycated hemoglobin(Glycated Hemoglobin A,Hb A1c),hypersensitivity-CRP,total cholesterol,triglycerides,high-density lipoprotein cholesterol,low density lipoprotein cholesterol,uric acid,homocysteine),m RS(Modified Rankin Scale)score at 90 days;Divided the patients into good group and poor group according to the farmation of collateral circulation by DSA(Digital subtraction angiography),Divided the patients into mild-to-moderate stenosis,severe stenosis and occlusion group according to the degree of MCA stenosis in patients with DSA results.Analyse the distribution of the above indexes in different collateral circulation formation conditions,and analyse the related factors affecting the formation of collateral circulation in patients with MCA stenosis or occlusion.Draw the ROC curve of the independent risk factors which can be changed to analyze its predictive value for the formation of collateral circulation after MCA stenosis or occlusion.Analyse the correlation between the degree of MCA stenosis and the formation of collateral circulation,and analyse the influence of collateral circulation on the prognosis of patients with severe MCA stenosis or occlusion at 90 days.Results:(1)A total of 106 patients were included,including 57(53.8%)with good collateral circulation,49(46.2%)with poor collateral circulation,38(35.8%)with mild and moderate stenosis of the MCA,47(44.3%)with severe stenosis,and 21(19.9%)with occlusion.The comparison between the poor collateral circulation group and the good collateral group showed statistically significant differences in age,Hb A1 c,hypersensitive CRP,high-density lipoprotein and uric acid(P < 0.05).Multivariate logistic regression analysis showed that age(OR 1.085,95%CI1.038-1.135,P=0.000),Hb A1c(OR 1.696,95%CI 1.237-2.325,P=0.001)and high-density lipoprotein(OR 0.077,95%CI 0.009-0.684,P=0.021)were Independent influencing factors for the formation of collateral circulation of MCA stenosis or occlusion.(2)The ROC curve of the serum Hb A1 c and the formation of collateral circulation was drawn.The area under the curve was 0.757,the critical value was8.85%,the sensitivity was 69.4%,and the specificity was 78.9%.(3)Spearman rank correlation analysis was used to analyze the degree of MCA stenosis and the formation of collateral.The correlation coefficient was 0.381,P < 0.05.(4)After 90 days of follow-up,35 patients(76.1%)in the good collateral circulation group and 9patients(40.1%)in the poor collateral circulation group had good prognosis(chi-square value 8.064,P< 0.05).Conclusion:(1)higher age and Hb A1 c are independent risk factors for the formation of collateral circulation of MCA stenosis or occlusion,while high-density lipoprotein is a protective factor.(2)The area under the ROC curve of Hb A1 c that can be changed predicting poor formation of collateral circulation after MCA stenosis or occlusion is 0.757,the cut-off value is 8.85%,the sensitivity is 69.4%,and the specificity is 78.9%.We believe that higher Hb A1 c has a good application value in predicting poor formation of collateral circulation after MCA stenosis and then for intervention or it may provide reference for the assessment of collateral circulation status and clinical decision making after onset.(3)The degree of MCA stenosis is positively correlated with the status of collateral formation,the more severe the degree of MCA stenosis is,the more likely the collateral circulation is observed to be in good condition.(4)The 90-day prognosis of the well-formed collateral group was better than that of the poorly formed group in MCA severe stenosis or occlusion. |
PDF Full Text Request