You R, McNeil J J, O'Malley H M, Davis S M, Donnan G A
Department of Neurology, Austin Hospital, University of Melbourne, Heidelberg, VIC, Australia.
Neurology. 1995 Aug;45(8):1483-7. doi: 10.1212/wnl.45.8.1483.
Lacunar infarction is an important stroke subgroup with unique clinical and pathologic features, but its relative risks for associated risk factors have been rarely documented. To address this matter, we studied 203 consecutive patients with first-ever stroke due to lacunar infarction admitted to four general hospitals during the period 1985 to 1992.
We obtained information concerning risk factor exposure status among the patients by interview using a structured questionnaire and by comparison with age- and sex-matched neighborhood controls. Odds ratios were estimated with adjustment for confounding variables by using multivariate logistic regression.
Significantly increasing the risk of lacunar stroke were hypertension (with an odds ratio of 8.9 [95% confidence intervals 4.2, 18.8]), current smoking (6.6 [2.9, 14.8]), and diabetes (2.3 [1.0, 5.5]), whereas frequent physical exercise was associated with a significantly decreased risk (0.3 [0.1, 0.7]). There was no risk of lacunar stroke associated with heart disease (odds ratio 1.0 [0.5, 1.9]).
Patients with hypertension or diabetes, and those who currently smoke, are at a higher risk of lacunar stroke, whereas those who undertake regular physical exercise may be at lower risk. The high risk associated with hypertension but absent risk with heart disease supports the "lacunar hypothesis" of a unique pathophysiologic mechanism for lacunar stroke.
腔隙性脑梗死是具有独特临床和病理特征的重要卒中亚组，但其相关危险因素的相对风险鲜有记录。为解决这一问题，我们研究了1985年至1992年期间入住四家综合医院的203例首次因腔隙性脑梗死发生卒中的连续患者。
我们通过使用结构化问卷进行访谈，并与年龄和性别匹配的社区对照进行比较，获取了患者危险因素暴露状况的信息。通过多变量逻辑回归对混杂变量进行调整后估计比值比。
高血压（比值比为8.9[95%置信区间4.2,18.8]）、当前吸烟（6.6[2.9,14.8]）和糖尿病（2.3[1.0,5.5]）显著增加腔隙性卒中风险，而经常进行体育锻炼与风险显著降低相关（0.3[0.1,0.7]）。心脏病与腔隙性卒中风险无关（比值比1.0[0.5,1.9]）。
高血压或糖尿病患者以及当前吸烟者发生腔隙性卒中的风险较高，而经常进行体育锻炼的人风险可能较低。高血压相关的高风险但心脏病无风险支持了腔隙性卒中独特病理生理机制的“腔隙假说”。
