Zeng Quantao, Tao Wendan, Lei Chunyan, Dong Wei, Liu Ming
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
J Stroke Cerebrovasc Dis. 2015 Jul;24(7):1614-20. doi: 10.1016/j.jstrokecerebrovasdis.2015.03.033. Epub 2015 Apr 17.
Many clinicians regard posterior circulation infarction (PCI) as different from anterior circulation infarction (ACI), leading them to apply different treatments. Few studies have validated this practice by directly comparing the etiology and risk factors of PCI and ACI.
We compared the etiology and risk factors of 2245 consecutive patients with a diagnosis of PCI or ACI confirmed by magnetic resonance imaging in the Chengdu Stroke Registry. Stroke etiology in each patient was classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.
Our sample included 482 patients (21.5%) with PCI and 1763 (78.5%) with ACI. The most frequent etiology for both infarction types was small-artery occlusion, occurring in 37.6% of patients with PCI and 37.1% of those with ACI. Cardioembolism caused infarction in a significantly smaller proportion of patients with PCI (5.4%) than in patients with ACI (13.3%; odds ratio [OR] = .373; 95% confidence interval [CI], .245-.566). Frequencies of other stroke etiologies were similar between the 2 patient groups. Analysis of risk factor frequencies in the 2 groups showed hypertension to be the most common, occurring in 47.9% of patients in either group. Multivariable analysis identified 2 factors as conferring greater risk of PCI than ACI: male gender (OR = 1.392; 95% CI, 1.085-1.786) and diabetes mellitus (OR = 1.667; 95% CI, 1.275-2.180). The same analysis identified 2 factors as conferring greater risk of ACI: atrial fibrillation (OR = .530; 95% CI, .295-.951) and heart valve disease (OR = .433; 95% CI, .203-.922). Frequencies of other possible risk factors were similar between the 2 groups.
These findings suggest that PCI and ACI are more similar than different in their etiology and risk factors and that the 2 types of infarction should be treated based more on etiology and risk factors than on their posterior or anterior localization.
许多临床医生认为后循环梗死（PCI）与前循环梗死（ACI）不同，从而采用不同的治疗方法。很少有研究通过直接比较PCI和ACI的病因及危险因素来验证这种做法。
我们比较了成都卒中登记处连续2245例经磁共振成像确诊为PCI或ACI患者的病因及危险因素。根据急性卒中治疗中组织纤溶酶原激活物10172试验（TOAST）标准对每位患者的卒中病因进行分类。
我们的样本包括482例PCI患者（21.5%）和1763例ACI患者（78.5%）。两种梗死类型最常见的病因均为小动脉闭塞，分别发生在37.6%的PCI患者和37.1%的ACI患者中。心源性栓塞导致梗死的PCI患者比例（5.4%）显著低于ACI患者（13.3%；优势比[OR]=0.373；95%置信区间[CI]，0.245 - 0.566）。两组患者其他卒中病因的发生率相似。对两组危险因素频率的分析表明，高血压最为常见，在两组患者中发生率均为47.9%。多变量分析确定了2个因素使PCI风险高于ACI：男性（OR = 1.392；95% CI，1.085 - 1.786）和糖尿病（OR = 1.667；95% CI，1.275 - 2.180）。同样的分析确定了2个因素使ACI风险更高：心房颤动（OR = 0.530；95% CI，0.295 - 0.951）和心脏瓣膜病（OR = 0.433；95% CI，0.203 - 0.922）。两组其他可能危险因素的频率相似。
这些发现表明，PCI和ACI在病因及危险因素方面的相似性大于差异性，两种梗死类型的治疗应更多地基于病因和危险因素，而非梗死部位在前循环还是后循环。
