目的：对45周岁以下高血压合并动脉粥样硬化患者进行10年观察，发现与缺血性脑血管疾病相关的早期因素。方法选择2001年1月-2003年12月我院健康体检45周岁以下高血压合并动脉粥样硬化患者118例进行10年跟踪观察，61例完成随访，终点发生缺血性脑血管疾病33例（ A组）与未发生28例（ B组）。比较两组血生化指标、血压、体脂肪含量（ Fat%）、斑块形态、血管血流速度、阻力指数（ RI）、颈动脉内-中膜厚度（ IMT）等，采用多因素Logistic逐步回归分析缺血性脑血管疾病发生的影响因素。结果基线时两组患者性别、病程、吸烟史、舒张压、Fat%、三酰甘油、低密度脂蛋白胆固醇水平比较，差异均有统计学意义（ P<0.05）。基线时A组粥样硬化斑块发生率高于B组〔24例（73%）与8例（29%），χ2=11.84，P<0.01〕。终点时A组粥样硬化斑块发生率高于 B组〔32例（97%）与15例（54%），χ2=16.13，P<0.01〕。基线时两组颈总动脉（ CCA）、颈内动脉（ ICA）搏动指数（PI）、RI比较，差异均有统计学意义（P <0.05）。基线时 A 组颈动脉 IMT 为（1.12±0.05）mm，B 组为（1.11±0.08）mm，差异无统计学意义（t=0.56，P>0.05）；终点时A组颈动脉IMT为（1.77±0.06）mm，高于B组的（1.49±0.08）mm（t=15.60，P<0.01）。多因素Logistic回归分析结果显示，早期软斑、Fat%超标、ICA RI增高与缺血性脑血管疾病的发生有回归关系（ P <0.05）。结论男性中青年高血压合并动脉粥样硬化患者，早期软斑、IFat%超标、CA RI增高与远期发生缺血性脑血管意外密切相关。%Objective Thepatientsbelow45yearsoldwithhypertensioncombinedwithatherosclerosiswerefollowed upfor10years,thustheearlystagefactorsassociatedwithischemiccerebrovasculardiseasescouldbefound.Methods 118pa-tients below 45 years old with hypertension combined with atherosclerosis who received physical examination from January of 2001 to December of 2003,were selected and followed up for 10 years. 61 patients completed the follow-up. At the end of observa-tion,33 cases with ischemic cerebrovascular diseases were included in group A,and 28 cases without ischemic cerebrovascular diseases were included in group B. The blood biochemical parameters,blood pressure,body fat content( Fat%),the formation of the plaques,systemic vascular blood flow velocity and resistance index,dynamic changes of IMT at baseline were compared between two groups,the influencing factors for the occurrence of ischemic cerebrovascular diseases were identified by multivariate stepwiseLogisticregressionanalysis.Results Gender,diseaseduration,DBP,Fat%,TG,LDL-Candsmokinghistorywere compared between two groups at baseline and the differences were statistically significant(P<0. 05). The incidence of athero-sclerotic plaque in group A was significantly higher than that in group B at baseline〔24 cases(73%)and 8 cases(29%),χ2=11. 84,P<0. 01〕. At the end of observation,the incidence of atherosclerotic plaque in group A was significantly higher than that in group B〔32 cases(97%)and 15 cases(54%),χ2 =16. 13,P<0. 01〕. At baseline the PI and RI of CCA and ICA between two groups were compared, and the differences were statistically significant ( P <0. 05 ) . There was no significant difference in carotid IMT at baseline between group A(1. 12 ±0. 05)mm and group B(1. 11 ±0. 08)mm(t=0. 56,P<0. 05). At the end of observation,carotid IMT in group A(1. 77 ±0. 06)mm was significantly higher than that in group B (1. 49±0. 08)mm(t=15. 60,P<0. 01). Multivariate Logistic regression analysis results showed that early presence of soft spots,the exceeding Fat% and elevatory ICA RI are the independent risk factors for the occurrence of ischemic cerebrovascular disease(P<0.05).℅onclusion Foryoungandmiddle-agedmalepatientswithhypertensioncombinedwithatherosclerosis, the early presence of soft plaques,exceeding Fat% and elevatory ICA RI are closely related to long-term ischemic cerebrovascu-lar accidents.
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