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急性心肌梗死后再发脑梗死的危险因素分析

作者 / Author:袁书刚 黄晓远 郭英选

摘要 / Abstract:

目的 分析急性心肌梗死(AMI)再发脑梗死的危险因素。方法 从2009-02—2016-08许昌市中心医院南区医院AMI病例中选取AMI后6个月内再发脑梗死40例为观察组,另筛选同期收治的280例单纯AMI患者为对照组,对比2组临床资料,筛选单因素分析有差异指标行多因素Logistic回归分析,探讨AMI后再发脑梗死的危险因素。结果 年龄、吸烟、心房颤动、高脂血症、高血压、糖尿病、HDL-C、收缩压均为引发AMI后再发脑梗死的独立危险因素(P<0.05),以高脂血症相关性最强。结论 在AMI治疗过程中应严密关注高龄、长期吸烟、心房颤动、高脂血症、高血压、糖尿病、HDL-C异常、收缩压异常患者病情变化,做到早预防、早治疗,最大限度降低AMI患者再发脑梗死风险。

关键词 / KeyWords:

脑梗死,急性心肌梗死,高脂血症,心房颤动,危险因素
急性心肌梗死后再发脑梗死的危险因素分析
袁书刚 黄晓远 郭英选
许昌市中心医院南区医院,河南许昌 461000
作者简介:袁书刚,Email:13949833173@163.com
 
摘要 目的 分析急性心肌梗死(AMI)再发脑梗死的危险因素。方法 从2009-02—2016-08许昌市中心医院南区医院AMI病例中选取AMI后6个月内再发脑梗死40例为观察组,另筛选同期收治的280例单纯AMI患者为对照组,对比2组临床资料,筛选单因素分析有差异指标行多因素Logistic回归分析,探讨AMI后再发脑梗死的危险因素。结果 年龄、吸烟、心房颤动、高脂血症、高血压、糖尿病、HDL-C、收缩压均为引发AMI后再发脑梗死的独立危险因素(P<0.05),以高脂血症相关性最强。结论 在AMI治疗过程中应严密关注高龄、长期吸烟、心房颤动、高脂血症、高血压、糖尿病、HDL-C异常、收缩压异常患者病情变化,做到早预防、早治疗,最大限度降低AMI患者再发脑梗死风险。
关键词】 脑梗死;急性心肌梗死;高脂血症;心房颤动;危险因素
中图分类号】  R743.33    【文献标识码】  A    【文章编号】  1673-5110(2019)03-0303-06
 
Risk factors of recurrent cerebral infarction after acute myocardial infarction
YUAN ShugangHUANG XiaoyuanGUO Yingxuan
Xuchang Central HospitalXuchang 461000,China
Abstract  Objective  To analyze the risk factors of recurrent cerebral infarction after acute myocardial infarction (AMI).Methods  40 patients with recurrent cerebral infarction within 6 months after AMI were selected from patients with AMI who were admitted to the hospital from February 2009 to August 2016 and they were included in the observation group.Another 280 patients with simple AMI were selected as the control group.The general clinical data and pathological data were compared between the two groups.Indexes with differences afterunivariate analysis were analyzed by Logistic regression analysis to identify the risk factors of recurrent cerebral infarction after AMI.Results  Age,smoking,atrial fibrillation,hyperlipidemia,hypertension,diabetes,HDL-C and systolic blood pressure were independent risk factors for recurrent cerebral infarction after AMI (P<0.05),and the correlation with hyperlipidemia was the strongest.Conclusion  Close attention should be paid to the elderly,long-term smoking patients,patients with atrial fibrillation,hyperlipidemia,hypertension,diabetes,abnormal HDL-C or systolic blood pressure disorders in the clinical treatment of AMI.Strengthening the control of the disease in such patients,early prevention and treatment,can minimize the risk of recurrent cerebral infarction in patients with AMI.
Key words】  Cerebral infarction;Acute myocardial infarction;Hyperlipidemia;Atrial fibrillation;Risk factor
 
        急性心肌梗死(AMI)和脑梗死均为致死、致残率较高的心脑血管疾病,两者发病机制具有较强的关联性,临床治疗难度极大,AMI后再发脑梗死更对患者病情造成双重恶化作用,致死、致残率也较单纯AMI更高[1-8]。研究报道,对AMI患者进行早期干预可有效降低再发脑梗死的风险,提高患者生存率[9-13]。本次研究通过对2009-02—2016-08的40例AMI后再发脑梗死患者进行回顾性分析,进一步明确AMI后再发脑梗死的危险因素,以便对AMI患者进行早期干预,减少再发脑梗死风险。
 
1  资料与方法
1.1  一般资料 从2009-02—2016-08在许昌市中心医院确诊为AMI患者中筛选AMI后6个月内再发脑梗死患者40例为观察组,选取同期收治的280例单纯AMI患者为对照组。分析2组患者年龄、性别、高血压史、糖尿病史、吸烟史、饮酒史以及血糖(FBG)、尿酸(UA)、胆总固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、收缩压、舒张压等资料。
1.2  诊断标准  急性心肌梗死诊断标准:依据2012年心肌梗死与心电图诊断新标准中制定的急性心肌梗死诊断标准[14]。脑梗死诊断标准:《2013年AHA/ASA卒中新定义》中制定的脑梗死诊断标准[15]。高血压诊断标准:依据中国高血压防治指南修订委员会修订的2004年中国高血压防治指南(实用本)中制定的高血压诊断标准[16]。糖尿病诊断:依据糖尿病医学诊治标准-2011(概要)[17]制定的糖尿病诊断标准。高脂血症诊断标准:依据2016年修订的中国成人血脂异常防治指南中的高脂血症诊断标准[18]。吸烟史判定标准:每日吸烟10或以上支,持续12个月以上。饮酒史判定标准:每日饮酒150 mL,持续12个月以上。其他:采用分光光度法、比浊法分别测定UA、TC、TG、LDL-C、HDL-C、FBG水平;采用超声心动图诊断收缩压、舒张压及心房颤动等指标。
1.3  统计学方法 采用SPSS 19.0统计软件,数据用均数±标准差(x±s)或百分比表示,组间比较行t检验或卡方检验;筛选单因素有差异的选项进行多因素Logistic回归分析,P<0.05为差异有统计学意义。
 
2  结果
2.1  AMI后再发脑梗死的危险因素单因素分析  2组性别、饮酒史、UA、TC、TG、LDL-C、舒张压、血糖对比差异无统计学意义(P>0.05);观察组平均年龄高于对照组,吸烟、心房颤动、高脂血症、高血压、糖尿病患者占比高于对照组,HDL-C、收缩压较对照组均有明显差异(P<0.05)。见表1。
2.2  AMI后再发脑梗死危险因素的Logistic回归性分析 多因素Logistic回归性分析显示,年龄、吸烟、心房颤动、高脂血症、高血压、糖尿病、HDL-C、收缩压均为AMI后再发脑梗死的独立危险因素(P<0.05),其中高脂血症相关性最高,其次为心房颤动。见表2。
表1  AMI后再发脑梗死的危险因素单因素分析  (x±s)
Table 1  Univariate analysis of risk factors for recurrent cerebral infarction after AMI  (x±s)
因素 观察组(n40) 对照组(n280) 统计值 P
年龄/ 67.18±4.98 56.13±4.61 27.247 0
性别(n)     1.32 0.187
   28 204    
   12 76    
吸烟[n(%)] 36(90.00) 201(71.79) 10.181 0
饮酒[n(%)] 19(47.50) 128(45.71) 0.721 0.471
心房颤动[n(%)] 22(55.00) 28(11.20) 7.555 0
高脂血症[n(%)] 16(40.00) 84(30.00) 6.153 0.013
高血压[n(%)] 16(40.00) 64(22.86) 3.071 0.002
糖尿病[n(%)] 14(35.00) 41(14.64) 3.174 0.001
UA 394.37±141.64 393.51±139.61 0.072 0.942
TC(mmol/L) 4.33±0.77 4.25±0.78 1.221 0.222
TG(mmol/L) 1.39±0.52 1.41±0.49 0.468 0.639
LDL-C(mmol/L) 2.88±0.77 2.81±0.69 1.133 0.258
HDL-C(mmol/L) 0.87±0.13 1.12±0.26 14.391 0
收缩压(mmHg) 156.03±11.03 139.97±9.01 18.869 0
舒张压(mmHg) 94.89±8.12 94.21±8.23 0.984 0.326
血糖(mmol/L) 7.01±2.17 6.98±2.25 0.161 0.872
表2  AMI后再发脑梗死的危险因素分析
Table 2  Analysis of risk factors for recurrent cerebral infarction after AMI
因素 回归系数 标准误 统计值 P OR(95% CI)
年龄 1.536 0.228 4.109 0.05 1.788(1.2372.957)
吸烟 0.523 0.174 8.897 0.05 1.680(1.1892.584)
心房颤动 1.518 0.217 4.178 0.05 1.803(1.3223.012)
高脂血症 1.419 0.184 5.121 0.05 2.131(1.5674.114)
高血压 0.537 0.212 6.449 0.05 1.713(1.1922.659)
糖尿病 0.639 0.228 8.384 0.05 1.197(1.5523.073)
HDL-C 1.509 0.163 4.588 0.05 0.799(0.5181.493)
收缩压 1.368 0.209 4.616 0.05 1.799(1.1314.358)
 3  讨论
        AMI是心脏部位因供血供氧不足导致的缺血性病变,与脑梗死发病机制相似,由动脉循环功能异常引起器官组织缺血缺氧症状后导致的一系列心脑血管并发症[19-26]。AMI及脑梗死不仅发病机制相似,其发病因素也较为相似,过度劳累、不良饮食习惯、吸烟、饮酒、情绪过分紧张或激动、高脂血症、糖尿病等均可诱发AMI或脑梗死[27-32]。该病发病突然,病情发展较快,患者伴不同程度的动脉粥样硬化,易重复性发作恶性心律失常、血栓等。研究报道,AMI和脑梗死患者多伴其他不同程度的心脑血管功能障碍,并直接参与病情发展导致病情加速恶化[33-40]。随着社会的发展,人们日常生活及饮食的日益丰富,吸烟、饮酒、暴饮暴食等不良生活习惯导致高脂血症、糖尿病等日益增加,加大了AMI和脑梗死的发病风险,且患者预后极差,多数患者治疗后均伴不同程度的偏瘫、失语或痴呆,给社会及个人造成严重的经济、生活负担[41-47]
        报道指出,AMI后再发脑梗死的发生率在AMI患者中占2%~3%[48-55],死亡风险极高。心脏与脑部均为机体的重要器官组织,心脏主导整个机体的血液循环,是机体正常工作必备的基础条件。脑部是主导机体行为、心理、运动、语言等的神经中枢系统,两者关系紧密,具有相互作用。AMI患者心肌功能异常,心肌无法维持正常舒张功能,导致血流速度异常,对血管壁造成冲击,导致血液流动性变差从而形成血栓,继而导致脑部组织缺血缺氧诱发脑梗死;同时因心律失常等引起栓子脱落,脱落的栓子随血液循环至脑部血管组织,导致血液流动性变差继而造成再发脑梗死,对AMI患者造成不可逆转的伤害[56-60]。因此,如何区分AMI后再发脑梗死的高危患者,采取积极有效的预防措施,对减少AMI后再发脑梗死风险,降低AMI病死率,改善预后尤为重要。
        本研究显示,年龄、吸烟、心房颤动、高脂血症、高血压、糖尿病、HDL-C、收缩压均为AMI后再发脑梗死的独立危险因素。其中,AMI后再发脑梗死患者年龄较单纯AMI患者更大,这可能是因高龄患者机体免疫力、生理新陈代谢、血管壁韧性、收缩力衰退,与相关研究[61]一致;而长期吸烟患者体内焦油、尼古丁成分日益累积易导致血栓或脑细胞死亡,增加心脑血管事件的发生率[62];高血压、糖尿病患者因血液中糖原沉积导致血管基底膜肥厚、脂肪样变性等引发血管级联反应,紊乱血管细胞的调节功能,导致血管细胞代谢异常继而形成一系列血管微小病变,是动脉血管粥样硬化的催化剂[63];心房颤动是AMI后再发脑梗死的独立危险因素可能与心房颤动患者出现体循环动脉栓塞风险较高有关;HDL-C降低、收缩压增高均为心脑血管事件发生的独立危险因素,可能与AMI患者HDL-C水平较低有关,HDL-C降低则会导致其对LDL-C的抑制效果降低,增加了动脉粥样硬化的风险,继而引起AMI再发脑梗死[64-67];收缩压增高说明患者心率增快,心脏负荷加重,也是脑梗死的诱发因素[65]。高脂血症与AMI后再发脑梗死的相关性最高,可能与高脂血症患者血液内总胆固醇和LDL胆固醇过高有关,血脂水平异常增加了心脑血管事件的发生率[68-71]
 
4  参考文献
[1]  汤庆宾,程岳雷,张宪静,等.急性心肌梗死合并急性脑梗死的临床治疗分析[J].中国急救医学,2015,35(z2):102-103. 
[2]  LI Q Y,ZHAO N M,MA JJ,et al.ALDH2*2 Allele is a Negative Risk Factor for Cerebral Infarction in Chinese Women[J].Biochem Genet,2015,53(9/10):260-267.
[3]  何芸.氯吡格雷与阿司匹林预防缺血性脑梗死再发的效果比较[J].中国实用神经疾病杂志,2016,19(19):45-46. 
[4]  KIM D,PARK J M,KANG K,et al.Dual Versus Mono Antiplatelet Therapy in Large Atherosclerotic Stroke[J].Stroke,2019,1:STROKEAHA119024786.DOI:10.1161/STROKEAHA.119.024786.
[5]  VERDOIA M,KEDHI E,SURYAPRANATA H,et al.Ticagrelor in the prevention of coronary and non-coronary atherothrombotic events:A comprehensive meta-analysis of 10 randomized trials[J].Atherosclerosis,2019,284:136-147.DOI:10.1016/j.atherosclerosis.2019.02.011.
[6]  MOLINA C A,JOHNSTON S C,LADENVALL P,et al.Time to Loading Dose and Risk of Recurrent Events in the SOCRATES Trial[J].Stroke,2019,50(3):675-682.DOI:10.1161/STROKEAHA.118.022675.
[7]  BLAY E JR,BALOGUN Y,NOOROMID M J,et al.Early Carotid Endarterectomy  after Acute Stroke Yields Excellent Outcomes:An Analysis of the Procedure-Targeted ACS-NSQIP[J].Ann Vasc Surg,2019 Jan 26.pii:S0890-5096(19)30045-7.DOI:10.1016/j.avsg.2018.10.023.
[8]  WANG M T,TSAI C K,KUO S H,et al.The Dipyridamole Added to Dual Antiplatelet Therapy in Cerebral Infarction After First Acute Myocardial Infarction:A Nationwide,Case-Control Study[J].Front Neurol,2018,9:1003.DOI:10.3389/fneur.2018.01003.eCollection 2018.
[9]  苏垒鑫,程康,赵志敬.急性心肌梗死并发急性脑梗死危险因素及临床特点[J].心脏杂志,2017,29(4):422-426.
[10]  杨贤,郑萍.临床药师参与1例亚急性心肌梗死合并腔隙性脑梗及深静脉血栓患者的抗栓治疗体会[J].药学实践杂志,2017,35(2):161-164.
[11]  DAI W,YUAN Y,ZUO J,et al.Observation of the efficacy of biological patch in hybrid technique for incisional herniorrhaphy:5-year follow-up results from a single center[J].Zhonghua Wei Chang Wai Ke Za Zhi,2018,21(7):766-771.
[12]  MALHOTRA K,CHANG J J,KHUNGER A,et al.Minocycline for acute stroke treatment:a systematic review and meta-analysis of randomized clinical trials[J].J Neurol,2018,265(8):1871-1879.DOI:10.1007/s00415-018-8935-3.
[13]  KIM J,BUSHNELL C D,LEE H S,et al.Effect of Adherence to Antihypertensive Medication on the Long-Term Outcome After Hemorrhagic Stroke in Korea[J].Hypertension,2018,72(2):391-398.DOI:10.1161/HYPERTENSIONAHA.118.11139.
[14]  刘仁光,陈阳.心肌梗死与心电图诊断新标准[J].临床心电学杂志,2012,21(6):441-442.
[15]  王丽娟,代成波.《2013年AHA/ASA卒中新定义》解读[J].中国循环杂志,2014,29(z2):96-101.
[16]  中国高血压联盟,国家心血管病中心,中华医学会心血管病学分会,中国医师协会高血压专业委员会.2014年中国高血压患者教育指南(简明版)[J].中国循环杂志,2014,29(z2):131-140.
[17]  陆菊明.中国2型糖尿病防治指南(2013年版)更新要点的解读[J].中国糖尿病杂志,2014,22(10):865-869.
[18]  中国成人血脂异常防治指南制订联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35(5):390-419.
[19]  刘浩,武刚,翟雪芹,等.早发冠心病急性心肌梗死的危险因素及临床特点分析[J].中国全科医学,2012,15(11):1 205-1 208.
[20]  王刚,张小瑜,朱惠莉,等.青年患者急性心肌梗死合并急性脑梗死1例[J].西南国防医药,2016,26(11):10-11.
[21]  KIM I,KIM M C,SIM D S,et al.Effect of the Metabolic Syndrome on Outcomes in Patients Aged <50 Years Versus >50 Years With Acute Myocardial Infarction[J].Am J Cardiol,2018,122(2):192-198.DOI:10.1016/j.amjcard.2018.03.366.
[22]  FANG C Y,FANG H Y,CHEN C J,et al.Comparison of clinical outcomes after drug-eluting balloon and drug-eluting stent use for in-stent restenosis related acute myocardial infarction:a retrospective study[J].Peer J,2018,6:e4646.DOI:10.7717/peerj.4646.
[23]  GACO J,BADACZ R,STEPIE E,et al.Diagnostic and prognostic micro-RNAs in ischaemic stroke due  to carotid artery stenosis and in acute coronary syndrome:a four-year prospective study[J].Kardiol Pol,2018,76(2):362-369.DOI:10.5603/KP.a2017.0243.
[24]  DAI Y Y,HUANG Z X,LIU X T,et al.Risk factors for recurrence of large atherosclerotic cerebral infarction[J].Nan Fang Yi Ke Da Xue Xue Bao,2017,37(12):1 678-1 682.
[25]  KARLINSKI M A,BEMBENEK J P,BARANOWSKA A,et al.Noninfectious complications of acute stroke and their impact on hospital mortality in patients admitted to a stroke unit in Warsaw from 1995 to 2015[J].Neurol Neurochir Pol,2018,52(2):168-173.DOI:10.1016/j.pjnns.2017.09.003.
[26]  HE R X,ZHANG L,ZHOU T N,et al.Safety and Necessity of Antiplatelet Therapy on Patients Underwent Endovascular Aortic Repair with Both Stanford Type B Aortic Dissection and Coronary Heart Disease[J].Chin Med J (Engl),2017,130(19):2 321-2 325.doi10.4103/0366-6999.215330.
[27]  TANIZAKI Y,KIYOHARA Y,KATO I,et al.Incidence and risk factors for subtypes of cerebral infarction in a general population:theHisayama study[J].Stroke,2000,31(11):2 616-2 622.
[28]  朱智瑞,楚英杰,徐予.陈旧性脑梗死患者发生急性心肌梗死的冠脉病变特征和临床特点[J].中国心血管病研究,2017,15(11):1 015-1 017.
[29]  AMARENCO P,ALBERS G W,DENISON H,et al.Ticagrelor Versus Aspirin in Acute Embolic Stroke of Undetermined Source[J].Stroke,2017,48(9):2 480-2 487.DOI:10.1161/STROKEAHA.117.017217.
[30]  KOSHIZAKA M,LOPES R D,NEWBY L K,et al.Obesity,Diabetes,and Acute Coronary Syndrome:Differences Between Asians and Whites[J].Am J Med,2017,130(10):1 170-1 176.DOI:10.1016/j.amjmed.2017.03.030.
[31]  YOSHIOKA T,MORI T,TANIGUCHI Y,et al.A Case with Recurrent Free-Floating Ball Thrombi in Left Atrium[J].Am J Case Rep,2017,18:324-328.
[32]  AMARENCO P,ALBERS G W,DENISON H,et al.Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin:a subgroup analysis of SOCRATES,a randomised,double-blind,controlled trial[J].Lancet Neurol,2017,16(4):301-310.DOI:10.1016/S1474-4422(17)30038-8.
[33]  于立鹏,杨志明.急性心肌梗死后缺血再灌注性心律失常发病机制及预防的研究进展[J].实用医学杂志,2016,32(9):1 536-1 537.
[34]  ZHANG S,WANG S,WAN X,et al.Clinical evaluation of post-operative cerebral infarction in traumatic epiduralhaematoma[J].Brain Inj,2017,31(2):215-220.
[35]  LI S J,HU H Q,WANG X L,et al.Correlation between post-stroke pneumonia and outcome in patients with acute brain infarction[J].Zhonghua Yi Xue Za Zhi,2016,96(35):2 796-2 801.DOI:10.3760/cma.j.issn.0376-2491.2016.35.007.Chinese.
[36]  CHEN K C,YIN W H,YOUNG M S,et al.In-Hospital Tele-ECG Triage and Interventional Cardiologist Activation of the Infarct Team for STEMI Patients is Associated with Improved Late Clinical Outcomes[J].Acta Cardiol Sin,2016,32(4):428-438.
[37]  LEE W C,WU B J,FANG  C Y,et al.Timing of Staged Percutaneous Coronary Intervention for a Non-Culprit Lesion in Patients With Anterior Wall ST Segment Elevation Myocardial Infarction With Multiple Vessel Disease[J].Int Heart J,2016,57(4):417-423.DOI:10.1536/ihj.15-402.
[38]  JOHNSTON S C,AMARENCO P,ALBERS G W,et al.Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack[J].N Engl J Med,2016,375(1):35-43.DOI:10.1056/NEJMoa1603060.
[39]  CHA J K,PARK H S,NAH H W,et al.High residual platelet reactivity (HRPR) for adenosine diphosphate (ADP) stimuli is a  determinant factor for long-term outcomes in acute ischemic stroke with anti-platelet agents:The meaning of HRPR after ADP might be more prominent in large atherosclerotic infarction than other subtypes of AIS[J].J Thromb Thrombolysis,2016,42(1):107-117.DOI:10.1007/s11239-015-1304-5.
[40]  GALLUZZO A,GALLO C,BATTAGLIA A,et al.Prolonged QT interval in ST-elevation myocardial infarction:predictors and prognostic value in medium-term follow-up[J].J Cardiovasc Med (Hagerstown),2016,17(6):440-445.DOI:10.2459/JCM.0000000000000317. 
[41]  CHEN Y F,WANG D N,CHEN Z T,et al.Risk factors associated with acute/subacute cerebral infarction in HIV-negative patients with cryptococcal meningitis[J].J Neurol Sci,2016,364:19-23.
[42]  刘瑜,赵玉生,刘光华,等.急性心肌梗死并发心源性休克的危险因素分析[J].中华危重病急救医学,2013,25(7):399-402.
[43]  SATO Y,SATOKAWA H,TAKASE S,et al.Efficacy of Early Surgical Strategy for Active Infective Endocarditis[J].Kyobu Geka,2015,68(11):930-935.
[44]  JOHNSTON S C,AMARENCO P,ALBERS G W,Denison H,Easton JD,Held P,Jonasson J,Minematsu K,Molina CA,Wong LK.Acute Stroke or Transient Ischemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes (SOCRATES) trial:rationale and design[J].Int J Stroke,2015,10(8):1 304-1 308.DOI:10.1111/ijs.12610.
[45]  SHIBATA T,KAWAKAMI S,NOGUCHI T,et al.Prevalence,Clinical Features,and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism[J].Circulation,2015,132(4):241-250.DOI:10.1161/CIRCULATIONAHA.114.015134.
[46]  VUORIO A,KASTE M,KOVANEN P T.Combina-tion of intracerebral haemorrhage and familial hypercholesterolemia in the acute hospital setting--a challenge for statin treatment?[J].Int J Stroke,2015,10(4):467-468.DOI:10.1111/ijs.12492.
[47]  肖华,彭智欣,林朴卿,等.高血压并发急性心肌梗死与急性缺血性脑卒中患者血压变异性的差异[J].广东医学,2013,34(10):1 522-1 525.
[48]  沈珠,施爱明,曹国文,等.急性心肌梗死双抗血小板治疗基础上再发脑梗死一例[J].中国医学科学院学报,2014,36(5):575-576.
[49]  TSAI M L,MAO C T,CHEN D Y,et al.Short-and long-term major cardiovascular adverse events in carotid artery interventions:a nationwide population-based cohort study in Taiwan[J].PLoS One,2015,10(3):e0121016.DOI:10.1371/journal.pone.0121016.
[50]  NOMURA E,SUZUKI A,INOUE I,et al.Subsequent vascular events after ischemic stroke:the Japan Statin Treatment Against Recurrent Stroke-Longitudinal[J].J Stroke Cerebrovasc Dis,2015,24(2):473-479.DOI:10.1016/j.jstrokecerebrovasdis.2014.09.023.
[51]  PENNLERT J,ERIKSSON M,CARLBERG B,et al.Long-term risk and predictors of recurrent stroke beyond the acute phase[J].Stroke,2014,45(6):1 839-1 841.DOI:10.1161/STROKEAHA.114.005060.
[52]  SMOL'NIKOV A V,KOZLOV K L,KACHESOV  I U,et al.Endovascular revascularization of the carotid area in elderly patients in acute ishemic stroke:the current view of the problem (review of literature)[J].Adv Gerontol,2014,27(3):503-509.
[53]  BAZAN H A,CATON G,TALEBINEJAD S,et al.A stroke/vascular neurology service increases the volume of urgent carotid endarterectomies performed in a tertiary referral center[J].Ann Vasc Surg,2014,28(5):1 172-1 177.DOI:10.1016/j.avsg.2013.10.002.
[54]  FERRERO E,FERRI M,VIAZZO A,et al.A retrospective study on early carotid endarterectomy within 48 hours after transient ischemic attack and stroke in evolution[J].Ann Vasc Surg,2014,28(1):227-238.DOI:10.1016/j.avsg.2013.02.015.
[55]  王冬颖,解亚楠,何彦芳,等.1例急性心肌梗死合并脑梗死继发急性左心衰竭病例报道[J].中国循证心血管医学杂志,2017,9(5):624.
[56]  云霞,武力勇,吴明正,等.急性心肌梗死患者PCI术后并发急性脑梗死的发生率及其危险因素[J].心脏杂志,2015,27(2):186-189.
[57]  KOWOLL C M,MOELLER-HARTMANN W,FINK G R,et al.Acute interventional recanalisation of vertebrobasilar stenoses by angioplasty:complications and 12 months follow up[J].Neuroradiology,2013,55(9):1 135-1 141.DOI:1007/s00234-013-1214-1.
[58]  RUTTEN-JACOBS L C,MAAIJWEE N A,ARNTZ R M,et al.Long-term risk of recurrent vascular events after young stroke:The FUTURE study[J].Ann Neurol,2013,74(4):592-601.DOI:10.1002/ana.23953.
[59]  ZHU Y,GUO W,LIU X,et al.The single-centre experience of  the supra-arch chimney technique in endovascular repair of type B aortic dissections[J].Eur J Vasc Endovasc Surg,2013,45(6):633-638.DOI:10.1016/j.ejvs.2013.02.016.
[60]  ZHUO Y,YU H,YANG Z,et al.Prediction Factors of Recurrent Stroke among Chinese Adults Using Retinal Vasculature Characteristics[J].J Stroke Cerebrovasc Dis,2017,26(4):679-685.
[61]  PARK W,AHN J S,LEE H S,et al.Risk Factors for Newly Developed Cerebral Infarction After Surgical Revascularization for Adults withMoyamoya Disease[J].World Neurosurg,2016,92:65-73.
[62]  ZHETISHEV R R,PETRENKO N V,KAMCHATNOV P R,et al.Pathomorphological characteristics and risk factors of asymptomatic cerebral infarction based on the results of a cross-sectional hospital-based study[J].Zh Nevrol Psikhiatr Im S S Korsakova,2016,116(3 Pt 2):18-22.
[63]  LI M,WU J,CHEN X,et al.Symptomatic and silent cerebral infarction following surgical clipping ofunruptured intracranial aneurysms:incidence,risk factors,and clinical outcome[J].Neurosurg Rev,2018,41(2):675-682. 
[64]  刘悦,毕齐,刘向荣.高血压、糖尿病、高脂血症对老年脑梗死患者颈动脉粥样硬化的作用[J].实用老年医学,2016,30(1):58-60.
[65]  DONG M X,HU L,HUANG Y J,et al.Cerebrovas-cular risk factors for patients with cerebral watershed infarction:A case-control study based on computed tomography angiography in a population from Southwest China[J].Medicine (Baltimore),2017,96(28):e7505. 
[66]  DONG Z,GUO Q,SUN L,et al.Serum lipoprotein and RBC rigidity index to predict cerebral infarction in patients with carotid arterystenosis[J].J Clin Lab Anal,2018,32(4):e22356.
[67]  李明春,初少莉,左君丽,等.LDL-C/HDL-C与冠状动脉病变程度的相关性研究[J].第二军医大学学报,2014,35(3):270-273.
[68]  MURAOKA S,ARAKI Y,KONDO G,et al.Postoperative Cerebral Infarction Risk Factors and Postopera-tive Management of Pediatric Patients withMoyamoya Disease[J].World Neurosurg,2018,113:e190-e199.
[69]  HORI Y S,KODERA S,SATO Y,et al.Eosinopenia as a Predictive Factor of the Short-Term Risk of Mortality and Infection after Acute Cerebral Infarction[J].J Stroke Cerebrovasc Dis,2016,25(6):1 307-1 312.
[70]  IJS P,NUOTIO K,VIKATMAA P,et al.Carotid arterystenosis as predictor of the risk of cerebral and cardiac infarction[J].Duodecim,2014,130(21):2 193-2 200.
[71]  GJERDE G,NAESS H.Risk factor burden predicts long-term mortality after cerebral infarction[J].Acta Neurol Scand,2014,129(3):173-177.
(收稿 2018-08-15)
本文责编:夏保军
本文引用信息:袁书刚,黄晓远,郭英选.急性心肌梗死后再发脑梗死的危险因素分析[J].中国实用神经疾病杂志,2019,22(3):303-308.DOI:10.12083/SYSJ.2019.03.056

Reference informationYUAN ShugangHUANG XiaoyuanGUO Yingxuan.Risk factors of recurrent cerebral infarction after acute myocardial infarction[J]Chinese Journal of Practical Nervous Diseases201922(3)303-308.DOI10.12083/SYSJ.2019.03.056

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