广西汉族与壮族症状性颅内动脉粥样硬化性狭窄(3)

心血管卒中预防存在一个“东亚悖论”[17]，即欧美国家使用替格瑞洛进行心血管二级预防时获益较多，但东亚人群却无明显获益，除基因差异外，人种、生活背景的差异也不能忽视。本研究结果显示，壮族与汉族sICAS患者的侧支循环不良的影响因素存在差异，其中VEGF水平升高是壮族患者侧支循环不良的保护因素(P<0.05)。但本研究没有进行样本量估算，因此这不排除存在样本量过少而引起的结果差异。然而已有研究表明VEGF基因多态性与颈内动脉颅外段狭窄相关[18]，近年也有研究提示VEGF基因多态性与壮族妇女复发性流产相关[19]。因此，不能忽视壮族sICAS患者存在基因多态性而导致侧支循环差异的可能性，壮族患者VEGF水平对颅内侧支循环的影响需要进一步探索。

综上所述，汉族和壮族sICAS患者侧支循环不良的影响因素存在差异，高年龄、高LDL水平是汉族sICAS患者侧支循环不良的危险因素，高年龄、高LDL、低VEGF水平是壮族sICAS患者侧支循环不良的危险因素。今后针对不同卒中的二级预防及早期治疗，以及各少数民族侧支循环的相关研究，需重视不同民族患者间影响因素的差异。此外，有学者提出，在急性缺血性卒中的治疗中侧支循环窗比时间窗更重要[20]，这将颅内侧支循环的重要性提升到一个新的高度，今后可进一步研究探索。

[1]Wang Y,Zhao X,Liu L,et and outcomes of symptomatic intracranial large artery stenoses and occlusions in China:the Chinese Intracranial Atherosclerosis(CICAS) Study[J].Stroke,2014,45(3):663-669.

[2]皮成慧,王 君,张荣举,等.前循环慢性闭塞患者颅内侧支循环形成的影响因素[J].中国脑血管病杂志,2018,15(11):567-571.

[3]Samuels OB,Joseph GJ,Lynn MJ,et al.A standardized method for measuring intracranial arterial stenosis[J].AJNR Am J Neuroradiol,2000,21(4):643-646.

[4]Higashida RT,Furlan AJ,Roberts H,et al.Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke[J].Stroke,2003,34(8):e109-e137.

[5]Maas MB,Lev MH,Ay H,et vessels on CT angiography predict outcome in acute ischemic stroke[J].Stroke,2009,40(9):3 001-3 005.

[6]Sundaram S,Kannoth S,Thomas B,et assessment by CT angiography as a predictor of outcome in symptomatic cervical internal carotid artery occlusion[J].AJNR Am J Neuroradiol,2017,38(1):52-57.

[7]Nambiar V,Sohn SI,Almekhlafi MA,et al.CTA collateral status and response to recanalization in patients with acute ischemic stroke[J].AJNR Am J Neuroradiol,2014,35(5):884-890.

[8]Bang OY,Saver JL,Kim SJ,et flow averts hemorrhagic transformation after endovascular therapy for acute ischemic stroke[J].Stroke,2011,42(8):2 235-2 239.

[9]李吕力,李晓峰,陈 渊,等.广西壮族与汉族脑梗死患者脑血管狭窄分布特征及影响因素[J].中华老年心脑血管病杂志,2011,13(8):727-729.

[10]Malik N,Hou Q,Vagal A,et and clinical predictors of leptomeningeal collaterals in stroke patients[J].J Stroke Cerebrovasc Dis,2014,23(8):2 018-2 022.

[11]Nannoni S,Sirimarco G,Cereda CW,et factors of better leptomeningeal collaterals:a study of 857 consecutive acute ischemic stroke patients[J].J Neurol,2019,266(3):582-588.

[12]Lucitti JL,Mackey JK,Morrison JC,et of the collateral circulation is regulated by vascular endothelial growth factor-A and a disintegrin and metalloprotease family members 10 and 17[J].Circ Res,2012,111(12):1 539-1 550.

[13]Lucitti JL,Tarte NJ,Faber intracellular channel 4 is required for maturation of the cerebral collateral circulation[J].Am J Physiol Heart Circ Physiol,2015,309(7):H1 141-H1 150.

[14]Hong L,Cheng X,Lin L,et al.The blood pressure paradox in acute ischemic stroke[J].Ann Neurol,2019,85(3):331-339.

[15]Akamatsu Y,Nishijima Y,Lee CC,et leptomeningeal collateral flow contributes to the poor outcome following experimental stroke in the type 2 diabetic mice[J].J Neurosci,2015,35(9):3 851-3 864.

[16]Siasos G,Tsigkou V,Kokkou E,et and atherosclerosis:mechanisms of disease and new therapeutic approaches[J].Curr Med Chem,2014,21(34):3 936-3 948.

[17]Jeong YH."East asian paradox":challenge for the current antiplatelet strategy of "one-guideline-fits-all races" in acute coronary syndrome[J].Curr Cardiol Rep,2014,16(5):485.

[18]Yadav BK,Yadav R,Chang H,et polymorphismsrs,rs,andrson the VEGF gene are correlated with extracranial internal carotid artery stenosis and ischemic stroke[J].Ann Clin Lab Sci,2017,47(2):144-155.

[19]黄如甸,庞丽红,黎欧阳,等.VEGF基因多态性与广西壮族妇女复发性流产的相关性研究[J].生殖与避孕,2013,33(10):652-657,671.

[20]Vagal A,Aviv R,Sucharew H,et clock is more important than time clock for tissue fate[J].Stroke,2018,49(9):2 102-2 107.

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