Clinical Study Of New Symptomatic Cerebral Infarction In Silent Brain Infarction Patients

Objective: We studied the characteristic of TOAST type,risk factors,image and severity of newly symptomatic cerebral infarction in patients with silent brain infarction,explored the difference of new cerebral infarction between patients with SBI and without SBI,investigated the related factors of new cerebral infarction with serious neurological impairment and the related factors of new Large artery atherosclerosis type cerebral infarction in SBI patients,explored the indicators that can predict the occurrence and development of cerebral infarction,provided reference for early stroke prevention and intervention in patients with silent brain infarction.Methods: We used a retrospective cross-sectional study,we collected 578 newly acute cerebral infarction(ACI)patients who were hospitalized in the department of neurology of West coast branch of Qingdao university hospital from April 2017 to March 2019 and met the inclusion criteria,we divided acute cerebral infarction patients into SBI group(214 cases)and non-sbi group(364 cases)according to the medical history and relevant examinations such as craniocerebral magnetic resonance imaging.We compared the differences of risk factors between the two groups;we observed the distribution characteristics of different subtypes of TOAST classification in the two groups;we compared the difference in the degree of neurological impairment(NIHSS score)between the two groups(NIHSS score ≤5 was divided into light group and NIHSS score ≥6 was divided into severe group).We compared the differences of the related factors of new cerebral infarction between the light group and the severe group in SBI group,study the factors associated with severe neurological impairment in new cerebral infarction patients with SBI.we compared the differences of the related factors of new LAA cerebral infarction and non-laa cerebral infarction in SBI group.We collected controls with old SBI lesions found on health examination(106 cases)during the same period,studied the differences of inflammatory factors C-Reactive Protein and Platelet lymphocyte ratio in SBI group,non-sbi group and control group.Results: 1.Comparison between the SBI group and the non-SBI group: There was no significant difference in the distribution of TOAST classification between the two groups,and both groups had a large proportion of large artery atherosclerosis type;The proportion of diabetes mellitus and vascular white matter lesions was higher in the SBI group,and the difference between the two groups was statistically significant.Patients in the SBI group had more severe neurological impairments than those in the non-sbi group.2.Comparison of severe and mild cerebral infarction in SBI patients: The proportion of patients with diabetes and vascular white matter lesions in the severe group was higher than that in the mild group,and the difference was statistically significant.3.Comparison of patients with new cerebral infarction in the LAA group and the non-LAA group: Only diabetes and coronary heart disease had a high proportion in the LAA group,and the difference was statistically significant.4.In the SBI group with white matter lesions of different parts of the brain,there was no significant difference in the degree of neurological impairments of newly diagnosed cerebral infarction.The degree of neurological impairments of new cerebral infarction was related to the severity of white matter lesion.The more severe the white matter lesion was,the more severe the neurological impairments were in the new cerebral infarction patients with SBI.5.Inflammatory indicators:C-reactive protein and platelet lymphocyte ratio were higher in the group of new cerebral infarction patients with SBI than those in the group of old silent brain infarction,and were also higher in the group of new cerebral infarction patients without silent brain infarction than those in the group of old cerebral infarction,and were higher in SBI group than in non-sbi group.Conclusion: 1.There was no significant difference in the proportion of different TOAST subtypes in patients with new cerebral infarction with or without silent brain infarction,and both of them showed a large proportion of large atherosclerotic type(LAA).The new cerebral infarction with silent brain infarction had more severe the neurological impairments.Cerebral infarction patients with diabetes mellitus or vascular white matter lesions were more likely to be associated with SBI.2.SBI patients with diabetes mellitus or vascular white matter lesions had severe neurological impairments when they had new cerebral infarction.Recurrent cerebral infarction in SBI patients with diabetes mellitus or coronary heart disease were prone to large atherosclerotic cerebral infarction.In the SBI group with white matter lesions of different parts of the brain,there was no significant difference in the degree of neurological impairments of newly diagnosed cerebral infarction.The degree of neurological impairments of new cerebral infarction was related to the severity of white matter lesion.The more severe the white matter lesion was,the more severe the neurological impairments were in the new cerebral infarction patients with SBI.3.Inflammatory played an important role in the pathogenesis of new cerebral infarction in SBI patients.Increased c-reactive protein and platelet lymphocyte ratio may predict new cerebral infarction in SBI patients.