急性缺血性卒中患者颈动脉斑块超声观察

摘要

目的 观察急性缺血性卒中患者的颈动脉斑块分布、管腔狭窄程度及不稳定斑块的危险因素.方法 经头颅MRI证实的急性缺血性卒中患者909例为AIS组,选取同期非脑卒中住院患者885例为对照组,比较2组颈动脉斑块的分布及管腔狭窄程度.根据狭窄程度将AIS组分为狭窄率≥50％亚组及＜50％亚组,比较2亚组稳定性斑块与不稳定性斑块的检出率.比较AIS组不稳定斑块和非不稳定斑块患者的临床资料,以有统计学意义的指标为自变量,行多因素Logistic回归分析.结果 AIS组颈动脉多发斑块和不稳定斑块的检出率及管腔狭窄程度均显著高于对照组(P均＜0.001).颈动脉狭窄率≥50％亚组的不稳定斑块检出率显著高于狭窄率＜50％亚组(P＜0.001).单因素分析显示年龄、男性、糖尿病、血脂异常、吸烟及饮酒是AIS颈动脉不稳定斑块的危险因素(P均＜0.05);多因素分析显示年龄、糖尿病、血脂异常及吸烟是AIS颈动脉不稳定性斑块的独立危险因素(P均＜0.05).结论 颈动脉不稳定斑块、狭窄程度与AIS发生密切相关;年龄、糖尿病、血脂异常和吸烟是颈动脉不稳定斑块的独立危险因素.%Objective To investigate distribution of carotid plaques,degree of stenosis and risk factors of unstable plaques in patients with acute ischemic stroke.Methods Totally 909 patients with acute ischemic stroke (AIS group) confirmed with head MRI were enrolled,while 885 patients without stroke in the same period hospitalization were selected as controls (control group).The distribution of carotid plaques and the degree of stenosis were compared between the 2 groups.Patients in AIS group were divided into stenosis rate ≥50％ subgroup and ＜50％ subgroup according to the degree of carotid artery stenosis,and the detectable rate of stable plaques and unstable plaques were compared between the 2 groups.Clinical data of patients with unstable plaques and non-unstable plaques in AIS group were compared.Logistic regression models were established with parameters with significantly differences among those features.Results The detectable rates of multiple plaques and unstable plaques of carotid artery and the degree of stenosis in AIS group were statistically higher than those in control group (all P＜0.001).The detectable rate of unstable plaque in carotid artery stenosis rate ≥50％ group was statistically higher than that in stenosis rate ＜50％ group (P＜0.001).Age,male,diabetes,dyslipidemia,smoking and drinking were significantly risk factors (all P＜0.05).Age,diabetes,dyslipidemia and smoking were independent risk factors (all P＜0.05).Conclusion Carotid unstable plaque and stenosis are closely related to the occurrence of AIS.Age,diabetes,dyslipidemia and smoking are independent risk factors for carotid artery plaque.