Facteurs de risque vasculaire predisposant aux lacunes cerebrales au CHU de Lome (Togo)

Buts: Determiner les facteurs de risque predisposant aux lacunes. Methode: Le diagnostic de lacunes a ete fait sur des arguments cliniques et tomodensitometriques. Nous avons dose la cholesterolemie, la triglyceridemie, la creatininemie et l’homocysteinemie plasmatique. Resultats: Deux cent cinquante-cinq (255) patients repondaient a nos criteres d’inclusion. La sex-ratio etait de 1,3 avec un âge moyen de 61,3 ans. La prevalence de l’hypertension arterielle etait de 85,6%; le diabete 15,7% et l’ethylisme chronique 18,4%. Les principaux facteurs de risque biologique etaient l’hyperhomocysteinemie 60,2%; l’hypercholesterolemie 48,6%, l’hypertriglyceridemie 20%. L’homocysteinemie moyenne etait de 21,2μmol/l. L’homocysteineme etait inferieure a 15μmol/l chez 39,7% des patients, entre 15 et 30 μmol/l chez 47,7% et superieure a 30μmol/l dans 12,6%. La cholesterolemie moyenne etait de 2,7mmol/l ; la triglyceridemie moyenne etait de 1,3mmol/l. La prevalence des lacunes etait de 46,4%. Les lacunes etaient significativement associees a l’hypertension arterielle (p=0,001), au diabete (p=0,001), a l’âge (p= 0,005), au sexe masculin (p =0,026), a l’ethylisme chronique (p = 0,006), a la cholesterolemie (p = 0,04) et a l’homocysteineme (p= 0,001). Conclusion: Les facteurs de risque des lacunes sont multiples. En dehors de l’âge et du sexe, ils sont modifiables. Mots cles: Lacunes, facteurs de risque English Abstract Objective: To determine the hospital prevalence of brain small infarct risk factors. Patients and methods: The small infarct diagnosis was made on brain CT scan. The diagnosis of hypertension, diabetes and chronic alcoholism was made by the diseases history. The dosage of the plasmatic homocysteinemia was made by the "Fluorescence Polarizing Immunoenzymatic Assay" (FPIA) method. Results: The sex-ratio was of 1.3. The hypertension prevalence was of 85.6%; the diabetes, 15.7% and 18.4% for the chronic alcoholism. The main biologic risk factors were the hyperhomocysteinemia at 60.2%; the hypercholesterolemia 48.6%, the hypertriglyceridemia 20%. The average homocysteinemia was of 21.2μmol/l. The homocysteinemia was moderate in 47.7% and intermediate in 12.6%. The prevalence of the small infarcts associated to large ischemic stroke was of 25.4%; small infarcts were associated to brain haemorrhage in 13% and the exclusive prevalence of small infarcts was 8%. The small infarcts were significantly associated to arterial hypertension (p = 0.001), to diabetes (p = 0.001), to chronic alcoholism (p = 0.006), to male sex (p = 0.026), to age (p = 0.005), to cholesterolemia (p = 0.04) and homocysteinemia (p = 0.001). Conclusion: Small infarcts risk factors are multiple and most of them are modifiable. Keywords: small infarcts; Risk factors