Analysis Of Related Factors Leading To Stroke And Influencing Prognosis After Stroke In Patients With Moyamoya Disease

Objective:To analyze the related factors leading to stroke and influencing prognosis after stroke in patients with moyamoya disease,in order to take active interventions for the controllable factors among them,so as to reduce the risk of stroke and improve the clinical prognosis of patients.Methods:The clinical data of patients with idiopathic moyamoya disease who were hospitalized in our hospital from April 2014 to March 2022 were collected.According to the results of brain CT and MRI examinations and clinical symptoms of the patients,the corresponding responsible cerebral hemisphere was divided into infarction hemisphere,hemorrhage hemisphere,and simple blood insufficiency hemisphere.The univariate and multivariate analysis was carried out on the Suzuki stage,collateral circulation score,posterior cerebral artery involvement and other cerebrovascular examination data in the responsible cerebral hemispheres of the three groups,as well as the general clinical data of patients in hypertension,diabetes,laboratory examination and other general clinical data,to study the related factors of patients with stroke(cerebral infarction and cerebral hemorrhage);The patients with unilateral stroke were followed up by telephone,and their neurological function recovery were evaluated using the modified Rankin scale(mRs).According to the mRs score of the patients during follow-up,the patients with unilateral cerebral infarction and unilateral cerebral hemorrhage were divided into a good prognosis group(mRs≤2 points)and a poor prognosis group(mRs≥3 points)respectively,and the prognosis of the patients were analyzed using univariate and multivariate analysis,to study the related factors that affect the prognosis of patients after stroke.Results:1.A total of 260 patients with moyamoya disease(363 responsible hemispheres)were selected as the study population and subjects,including 100 males and 160 females.Of the 363 responsible cerebral hemispheres,148 were in the infarction group,110 were in the hemorrhage group,and 105 were in the simple blood insufficiency group.Among the 260 patients with moyamoya disease,136 patients had unilateral stroke,including 78 patients with unilateral cerebral infarction and 58 patients with unilateral cerebral hemorrhage.Of the 78 patients with unilateral cerebral infarction,48 had a good prognosis and 30 had a poor prognosis;Among 58 patients with unilateral cerebral hemorrhage,28 had a good prognosis and 30 had a poor prognosis.2.Univariate analysis showed that there were differences in sex、age、hypertension grade、blood pressure control level grade、Suzuki stage、collateral circulation score、mean corpuscular volume、mean corpuscular hemoglobin、triglyceride、total cholesterol and low density lipoprotein cholesterol between the infarction group and the simple blood insufficiency group(P<0.05);Further multivariate binary logistic regression analysis showed that poor blood pressure control level(OR=1.893,95%CI=1.146-3.126)and higher Suzuki stage(OR=1.332,95%CI=1.024-1.731)were independent risk factors for cerebral infarction in patients with moyamoya disease,female sex(OR=0.356,95%CI=0.181-0.699)and higher age(OR=0.970,95%CI=0.942-1.000)were protective factors for cerebral infarction in patients with moyamoya disease(P<0.05).3.Univariate analysis showed that there were differences in blood pressure control level grade、frequent transient ischemic attacks、Suzuki stage、hemoglobin、mean corpuscular hemoglobin,mean corpuscular hemoglobin concentration、red blood cell count、triglyceride、low density lipoprotein cholesterol、high density lipoprotein cholesterol and homocysteine in the hemorrhage group compared with the simple blood insufficiency group(P<0.05);Further multivariate binary logistic regression analysis showed that poor blood pressure control level(OR=2.211,95%CI=1.404-3.483)and higher high density lipoprotein cholesterol level(OR=5.422,95%CI=1.425-20.640)were independent risk factors for cerebral hemorrhage in patients with moyamoya disease,and frequent transient ischemic attacks(OR=0.418,95%CI=0.177-0.991)was protective factor for cerebral hemorrhage in patients with moyamoya disease(P<0.05).4.Univariate Cox regression analysis of patients with unilateral cerebral infarction showed that there were differences in hypertension、hypertension grade、blood pressure control level grade、blood glucose control level、posterior cerebral artery involvement and recurrence between the group with good prognosis and the group with poor prognosis(P<0.05);Further multivariate Cox regression analysis showed that the poor blood pressure control level(HR=2.073,95%CI=1.215-3.537)、poor blood glucose control level(HR=3.925,95%CI=1.501-10.269)and posterior cerebral artery involvement(HR=2.573,95%CI=1.147-5.771)were independent risk factors for poor prognosis in patients with moyamoya disease after cerebral infarction(P<0.05).5.Univariate Cox regression analysis of patients with unilateral cerebral hemorrhage showed that there were differences in blood glucose control level and posterior cerebral artery involvement between the group with good prognosis and the group with poor prognosis(P<0.05);Further multivariate Cox regression analysis showed that the poor blood glucose control level(HR=3.023,95%CI=1.168-7.823)and posterior cerebral artery involvement(HR=2.729,95%CI=1.111-6.703)were independent risk factors for poor prognosis in patients with moyamoya disease after cerebral hemorrhage(P<0.05).Conclusions:1.Poor blood pressure control level and higher Suzuki stage will increase the risk of cerebral infarction in patients with moyamoya disease,female sex and higher age will reduce the risk of cerebral infarction in patients with moyamoya disease.2.Poor blood pressure control and higher high density lipoprotein cholesterol level will increase the risk of cerebral hemorrhage in patients with moyamoya disease,and frequent transient ischemic attacks will reduce the risk of cerebral hemorrhage in patients with moyamoya disease.3.Poor blood pressure control,poor blood glucose control and posterior cerebral artery involvement will lead to poor prognosis in patients with moyamoya disease after cerebral infarction.4.Poor blood glucose control and posterior cerebral artery involvement will lead to poor prognosis in patients with moyamoya disease after cerebral hemorrhage.