Analysis Of The Factors Affecting The Formation Of Leptomeningeal Collaterals In Patients With Middle Cerebral Artery Occlusion

Objective:At present,many studies have confirmed that collateral circulation（Leptomeningeal Collaterals,LMC）is an important factor affecting the clinical prognosis of patients with acute ischemic stroke.Higher level of LMC can not only significantly improve the effect of ischemia-reperfusion treatment.It can also reduce various complications such as secondary intracranial hemorrhage after reperfusion treatment.However,in clinical work,we often find that even in patients with the same diseased blood vessels,the formation patterns and compensation levels of LMC are different.Metabolic syndrome（MetS）is a group of complex symptoms characterized by the disorder of glucose and lipid metabolism,which is an independent risk factor for the occurrence of ischemic cerebrovascular disease.This study is a retrospective clinical analysis.The purpose of this study is to explore the effect of MetS on the formation and development of LMC in patients with unilateral middle cerebral artery occlusion,that is,to promote the formation of LMC in patients with ischemic cerebrovascular disease by various methods.Improve the prognosis of stroke patients.Methods:Collect the patients with middle cerebral artery occlusion in Yijishan Hospital of Wannan Medical College,and collect baseline clinical data,blood biochemical results,waistline,etc.The collateral circulation grading system ASITN/SIR blood flow classification system was evaluated by cerebral angiography.The collateral circulation was divided into 5 grades:grade 0 to Grade4.Grade 0-2 was included in the poor group of LMC,and grade 3-4 was included in the good group of LMC.The difference of MetS and MetS components between the two groups was compared.Results:In the study,one hundred and thirty patients participated in the study,nineteen of whom were found to have severe ipsilateral internal carotid artery stenosis and 9 were diagnosed with moyamoya disease.A total of one hundred and two patients with unilateral middle cerebral artery occlusion were enrolled.Fifty-four patients with metabolic syndrome,fifty patients with good LMC.Data were analyzed by SPSS software（22）.Univariate analysis showed that there was no significant difference in sex test(^?2=0.323,P=0.57),but there was significant difference in age test（Z=3.012,P=0.003）.There was no significant difference in smoking use and drinking history between the two groups（P>0.05）.Diagnosis of metabolic syndrome and satisfaction metabolic syndrome in patients.There was significant difference in the MetS and components of the metabolic syndrome（P<0.001）.There was statistical significance in the analysis of hypertension,diabetes and hyperlipidemia（P<0.05）,but there was no significant difference in the use of antihypertensive drugs and hypoglycemic drugs in univariate chi-square test（P>0.05）,but there was significant different in the previous use of statins in chi-square laboratory(^?2=14.197,P<0.001).It was found that systolic and diastolic blood pressure were not statistically significant when nonparametric tests were performed on biological indicators.There was significant difference in waist circumference（P<0.001）.Creatinine level was found to be statistically significant in nonparametric test results（Z=2.567,P=0.004）.Independent sample T test of HDL,LDL and TG levels in two groups of patients found that there was no significant difference in LDL and TG between the two groups.Bringing the positive value of univariate analysis into multivariate regression analysis showed that age was a risk factor for LMC（OR=1.109,95%CI=（1.034,1.191）,P=0.004）,and a risk factor for LMC in history of diabetes（OR=4.673,95%CI=（1.277,17.099）,P=0.020）,hyperlipidemia was a risk factor for poor LMC（OR=4.828,95%CI=（1.166,19.989）,P=0.030）,and metabolic syndrome is a risk factor for LMC（OR=8.688,95%CI=（1.501,32.465）,P=0.005）.Components of MetS were risk factors for side branch compensation（OR=5.801,95%CI=（2.082,16.166）,P=0.001）.The history of statins was a protective factor for the formation of lateral compensation（OR=0.264,95%CI=（0.076,0.917）,P=0.036）.Conclusion:Our results show that age,history of diabetes,waist circumference,metabolic syndrome and MetS components can affect the formation and development of collateral circulation.Statins are the factors that promote the formation of LMC.