目的 探讨老年首发缺血性脑卒中合并无症状性冠心病(ACAD)患者的影像学预测指标.方法 连续纳入2019年9月至2021年11月首都医科大学宣武医院神经内科收治的14 d内首次发病的非心源性缺血性脑卒中患者241例,根据诊断分为ACAD组103例,非ACAD组138例.同时接受常规头颅MRI和心脑一体化CT血管造影检查.采用logistic回归分析首发缺血性脑卒中患者合并ACAD的影响因素.结果 ACAD组男性、吸烟、隐匿性脑梗死(SBI)患病率(单个SBI及多个SBI)、颅内动脉阳性狭窄、颅内动脉阳性狭窄节段数、颅外动脉阳性狭窄节段数及头颈动脉阳性狭窄总节段数明显高于非ACAD组,差异有统计学意义(P<0.05,P<0.01).多因素logistic回归分析显示,单个SBI及多个SBI均为合并ACAD患者的独立危险因素(OR=4.474,95%CI:2.057~9.731,P=0.001;OR=8.071,95%CI:3.945~16.513,P=0.001).结论 SBI是老年首发缺血性脑卒中合并ACAD患者的独立预测因素,较脑白质高信号、颅内外动脉狭窄有更好的预测价值.
Objective To explore imaging predictors in elderly patients with first-ever ischemic stroke combined with asymptomatic coronary artery disease(ACAD).Methods A total of 241 non-cardioembolic ischemic stroke patients within 14 d of symptom onset admitted to the neuro-logical department of our hospital from September 2019 to November 2021 were consecutively en-rolled.Based on the diagnosis,they were divided into an ACAD group(103 cases)and a non-ACAD group(138 cases).All patients underwent routine brain MRI and hybrid coronary and cer-vicocephalic CT angiography.Logistic regression analysis was used to identify factors influencing the presence of ACAD in these patients.Results The ACAD group had significantly larger ratios of males,smoking,silent brain infarcts(SBI,both single and multiple),positive stenosis in in-tracranial arteries,numbers of positive stenotic segments in intracranial and extracranial arteries,and total number of positive stenotic segments in head and neck arteries when compared with the non-ACAD group(P<0.05,P<0.01).Multivariate logistic regression analysis revealed that both single and multiple SBI were independent risk factors for ACAD(OR=4.474,95%CI:2.057-9.731,P=0.001;OR=8.071,95%CI:3.945-16.513,P=0.001).Conclusion SBI is an independ-ent predictive factor for ACAD in elderly patients with first-ever ischemic stroke,and it has better predictive value than cerebral white matter hyperintensities and intracranial/extracranial arterial stenosis for ACAD.