Studying Of Risk Factors For Progressive Ischemic Stroke In The Middle Cerebral Artery Region

Objective:To investigate the risk factors associated with progressive ischemic stroke in the middle cerebral artery region.Methods:Retrospective analysis of patients with acute middle cerebral artery cerebral infarction hospitalized in the Department of Neurology of our hospital from January2018 to December 2018.According to the enrollment and exclusion criteria of this study,344 patients were collected.The National Institute of Health Stroke Scale(NIHSS)score was used for hospitalization,hospitalization for 72 hours,and hospitalization for one week.The NIHSS scores at 72 hours of hospitalization and 1week of hospitalization were compared with the NIHSS scores at hospitalization.Those who are equal or greater than 2 scores are judged as progress,classified as the progressive group(PIS group)and the rest are classified as non-progressive group(non-PIS group).Data collection: All patients are collected for gender,age,smoking history,drinking history,history of hypertension,history of diabetes,history of hyperlipidemia,fasting blood glucose,triglycerides,total cholesterol,high-density lipoprotein,low-density lipoprotein,Hemocysteine,NIHSS score,Body Mass Index(BMI),thyroid function indicators(FT3,FT4,TSH,TG-Ab,TPO-Ab),cranial CT,head magnetic resonance imaging and Magnetic Resonance Angiography(MRA).Vascular conditions are assessed based on the head MRA.The degree of arterial stenosis is classified according to the Samuels criteria: 1)normal or mild stenosis:arterial stenosis <50%;2)moderate stenosis: arterial stenosis 50%-70%;3)severe stenosis: arterial stenosis ? 70 %.The type of infarction was classified into vascular complete infarction,pial infarction,perforating artery infarction,border-zone infarct,and multiple infarction according to the imaging of the DWI sequence of theMRI.According to the CT situation of the head,it is evaluated whether the hyperdense middle cerebral artery sign(HMCAS)is combined.Univariate analysis of the data collected from all patients in the two groups is performed to identify risk factors for progressive ischemic stroke.Then,the index of P<0.1 in the univariate analysis was included in the binary logistic regression model to identify independent risk factors for progressive ischemic stroke.Result:1.Risk factors for progressive ischemic stroke: There were significant differences between the two groups in hyperhomocysteinemia(c2=12.201,P<0.01),hyperdense middle cerebral artery sign(c2=9.205,P=0.002),NIHSS score(Z=-2.198,P=0.028),FT3(c 2=6.282,P=0.043),TPO-Ab(c 2=9.7,P=0.002),arterial stenosis(c2=18.855,P<0.001)and infarction type(c2=24.098,P<0.001).There were no significant differences in gender(c 2=0.317,P=0.573),age(Z=-0.617,P=0.537),history of hypertension(c2=0.582,P=0.446),history of diabetes(c2=0.121,P=0.728),coronary heart disease(c2=1.329,P=0.249),hyperlipidemia(c2=0.362,P=0.548),smoking history(c2=0.752,P=0.386),alcohol history(c2=0.323,P=0.57),BMI(c 2=0.409,P=0.523),TG(Z=-0.096,P=0.923),TC(Z=-0.344,P=0.731),HDL(Z=-1.078,P=0.281),LDL(Z=-0.913,P=0.361),fasting blood glucose(c2=0.247,P=0.619),FT4(c2=0.758,P=0.685),TSH(c2=1.899,P=0.387)and TG-Ab(c2=1.259,P=0.262).(P ? 0.05).Hyperhomocysteinemia,hyperdense middle cerebral artery sign,high NIHSS score,low FT3,TPO-Ab positive,arterial stenosis,and different infarct types are risk factors of progressive ischemic stroke.2.The results of binary logistic regression analysis:1).Patients with hyper-homocysteinemia have an increased risk of stroke progression compared with patients of normal homocysteine(OR 2.65,95% CI 1.38-5.12).2).Patients with high-density MCA are more likely to have stroke progression risk than those patients without high-density MCA(OR 3.02,95% CI 1.04-8.82).3).Stroke patients with arterial stenosis,have high risk of stroke progression with the increase of vascular stenosis(50%-70% stenosis group,OR 2.78,95% CI 1.04-8.82;>70% stenosis group,OR6.93,95% CI 3.39-14.18).4).Among those patients with different infarct types,patients with perforating artery infarction and border-zone infarction have an increased risk of stroke progression(PAI group OR 3.37,95% CI 1.68-6.75;BZ group OR 7.59,95% CI 2.47-23.37).5).TPO-Ab positive patients have an increased risk of stroke progression relative to negative stroke patients(OR 2.35,95% CI1.36-4.07).For FT3,FT3 <2.0 pg/ml is an independent risk factor for stroke progression(OR 2.36,95% CI 1.14-4.89).Namely: Hyperhomocysteinemia,HMCAS,FT3 <2.0 pg/ml,TPO-Ab positive,moderate or severe arterial stenosis,perforating artery infarction,border-zone infarction are independently associated with progressive ischemic strok.Conclusion:1.Risk factors for progressive ischemic stroke include hyperhomocysteinemia,hyperdense middle cerebral artery sign,high NIHSS score,low FT3,TPO-Ab positive,arterial stenosis,and different infarct types.2.Hyperhomocysteinemia,HMCAS,FT3<2.0 pg/ml,TPO-Ab positive,moderate and severe arterial stenosis,perforating artery infarction,border-zone infarction were independently associated with progressive ischemic stroke.3.Stroke patients with arterial stenosis,will have the high risk of stroke progression as the degree of vascular stenosis increases.