| Objective:With the development of medicine,the understanding of the disease of cerebral infarction has undergone tremendous changes.In recent years,the study found that posterior circulation lacunar infarction as a type of ischemic stroke in a variety of ischemic stroke is particularly prominent in inducing injury and death.So far,the main risk factors for acute posterior circulation lacunar infarction have been controversial.In order to further explore the main factors that aggravate the condition of acute posterior circulation lacunar infarction,the clinical features and prognosis of 195 patients with acute posterior circulation lacunar infarction were retrospectively observed,risk factors for the progression of the acute posterior circulation lacunar were analyzed,in order to make predictions on the progression of the patient's condition and take effective measures in time to improve the prognosis to reduce morbidity and mortality and improve the quality of life of the patients.Methods:A total of 635 patients with cerebral infarction were enrolled in the Department of Neurology from August 2014 to July 2015.Patients included in the study with acute posterior circulation lacunar infarction are selected by Magnetic resonance imaging(MRI)and diffuse weighted imaging(DWI)Scan with the inclusion criteria and exclusion criteria.Factors may aggravate the condition of acute posterior circulation lacunar infarction were collected,such as: age,gender,hospital blood pressure(Including history of hypertension,history of diabetes mellitus,history of cerebral infarction,history of transient ischemic attack,history of cerebral hemorrhage,history of cerebral hemorrhage).Chronic cholesterol,low blood pressure,Density lipoprotein,homocysteine,glycosylated hemoglobin,hemoglobin,average erythrocyte volume,erythrocyte distribution width and other laboratory test results were recorded.the patient circulation of arterial plaque and intimal thickening were observed by neck arterial ultrasonography.Whether the presence of white matter and clear the patient's lesions bit were determined by the use of skull MRI examination.A standardized procedure was used to examine the patient and to record whether the patient had swallowing dysfunction,assess the patient's admission and the 7-day NIHSS score to determine if the condition of the cerebral infarction was progressing.Patients who were enrolled in the 7-day NIHSS score of 2 or more were included in the progression group and others were included in the non-progressive group.All patients received the same treatment,that is,anti-platelet and blood lipid,blood sugar,blood pressure,improve heart and brain circulation.The use of SPSS software to analyze the factors that may cause acute posterior circulation lacunar infarction increased the severity of the factors and the critical value of each factor.Results: A total of 195 patients with acute posterior circulation lacunar infarction were included in this study,including 124 males and 71 females.The youngest was 27 years old and the oldest was 91 years old,with an average age of(64.8±11.2)years;39 cases(20%)in the progress group and 156 cases(80%)in the non-progressive group.Univariate analysis showed that there was no statistically significant difference between the two groups(?2=3.189,P=0.074).The age of all patients was divided into 6 age groups,namely <50 years old,50-59 years old,60-69 years old,70-74 years old,75-80 years old,> 80 years old,the two groups of patients were no significant Differences(?2=1.865,P=0.868),were the largest in the 60-year group.The time of treatment was 16(12,24)h in the progress group and 16(8,24)h in the non-progression group,and the patients were divided into two groups at the time of treatment statistically significant difference(Z=0.053,P=0.615).There was no significant difference in the history of hypertension,history of diabetes mellitus,history of coronary heart disease,history of cerebral infarction,history of TIA and history of cerebral hemorrhage in the two groups of patients with chronic history(P>0.05).There were no significant differences in swallowing dysfunction,systolic blood pressure and diastolic blood pressure between the two groups(P>0.05).The NIHSS score was 4(2,7)in the progress group and 3(1.25,5.00)in the non-progression group.The NIHSS scores of the two groups were statistically significant(P=0.023,P<0.05)Total cholesterol,low density lipoprotein,homocysteine,glycosylated hemoglobin,hemoglobin,average erythrocyte volume and erythrocyte distribution were not statistically significant(P>0.05).There were 20 cases(51.28%)of non-progress group and 33 cases(33.97%)in the progress group.The rate of white matter in the progress group was significantly higher than that in the non-progression group(P=0.046).There were 24 cases(61.54%)of the arterial plaques and 66 cases(42.31%)in the non-progression group.There was significant difference between the two groups(P=0.031).Intimal thickening two groups showed no significant difference.There was no significant difference in the brainstem,thalamus,occipital lobe,cerebellum and site of the two groups(P>0.05).The values of the single factor P <0.1 were included in the multivariate analysis.The assignment was as follows: sex1=male,2=female;NIHSS score at admission admission;white matter loose 0=no,1=yes;arterial plaque 0=no,1=yes.(P<0.1),"NIHSS score at admission","white matter loose" and "arterial plaque" were used as independent variables,and all the entry method was used to classify the multivariate logistic Regression analysis,the final entry into the equation of "admission NIHSS score" and "arterial plaque",suggesting that admission NIHSS score is acute progressive lacunar infarction risk factors,arterial plaque acute posterior circulation lacunar.The risk of progression in patients with cerebral infarction was 2.311 times higher than that in patients without arterial plaque.The receiver operating characteristic curve(ROC curve)analysis found that the area under the receiver operating characteristic curve was calculated.The NIHSS score at admission was calculated to be 0.617 with an error of 0.051,95% CI of 0.518 to 0.716,a critical value of 7.5.Conclusion: NIHSS score and posterior circulation arterial plaque in patients with acute posterior circulation lacunar infarction are risk factors for progression of disease.The risk of progression of posterior circulation arterial plaque is 2.311 times of patients without posterior circulation artery plaque.Patients with circulating arterial plaques and NIHSS score> 7.5 were required to pay close attention to the changes in their condition and give timely and effective treatment to the patient's etiology to maximize the prognosis. |
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