急性脑梗死患者颅内与颅外动脉粥样硬化的相关性分析

摘要

目的 探讨急性脑梗死患者颅内与颅外动脉粥样硬化的相关性.方法 选择2011年长治医学院附属和平医院神经内科收治的108例急性脑梗死患者,应用颅脑血管造影(CTA)和颈部血管彩色超声检查,根据检查结果以规定标准对颅内外动脉硬化进行分级,均分为0~3级,应用Spearman相关分析及一致性检验分析两组之间是否存在相关性.结果 (1)颅脑CTA检查结果:108例患者中,81例(75%)患者显示有颅内动脉硬化,0级:正常32例(29.6%);1级:管壁僵硬及大血管远端分支细小、减少14例(13%);2级:大血管起始或中段狭窄40例(37%);3级:大血管主干及主要分支闭塞22例(20.4%).(2)颈部血管彩色超声检查结果:0级:正常5例(4.6%);1级:颈动脉内中膜增厚,椎动脉流速下降29例(26.9%);2级:存在颈动脉1~2个斑块,最大斑块直径≤10 mm 45例(41.7%);3级:存在颈动脉多个斑块,最大斑块直径>10 mm 29例(26.9%).(3)颅内外动脉血管粥样硬化的关系:Spearman相关分析结果显示相关系数r=0.27,P＜0.05;而一致性检验结果显示Kappa值为0.216,P＜0.05.结论 急性脑梗死患者颅内与颅外动脉粥样硬化的程度有相似性,但差异更多,颈部血管彩色超声不能取代颅脑CTA检查.%Objective To discuss the correlation between extracranial and intracranial arterial scleroses in patients with acute cerebral infarction.Methods 108 patients with acute cerebral infarction admitted to Heping Hospital affiliated to Changzhi Medical University in 2011 were selected.Head CTA and neck vascular ultrasound were performed and according to the results, extracranial and intracranial arterial scleroses were classified from grades 0 to 3 respectively.Spearman correlation analysis and consistency check were used to analyze the correlation between the two groups.Results (1) The results of head CTA showed that among the 108 patients, 81 cases (75%) had intracranial arterial sclerosis.Grade 0: 32 cases (29.6%) were within normal range; Grade 1: 14 cases (13%) had rigid arterial wall and small branches of aorta distal end; Grade 2: 40 cases (37%) had stenosis at the beginning or middle of aorta; Grade 3: 22 cases (20.4%) had blocking in aorta trunk and major branches.(2) The results of neck vascular ultrasound showed that: Grade 0: 5 cases were within normal range (4.6%); Grade 1: 29 cases had thickened IMT and reduced vertebral artery velocity; Grade 2: 45 cases (41.7%) had one or two carotid atherosclerotic plaques with the largest diameter≤10 mm; Grade 3: 29 cases (26.9%) had multiple carotid atherosclerotic plaques with the largest diameter > 10 mm.(3) The correlation between extracranial and intracranial arterial sclerosis: according to Spearman correlation analysis, the correlation coefficient r = 0.27, P < 0.05 ; consistency check showed that Kappa was 0.216 and P <0.05.Conclusion The degree of extracranial and intracranial arterial sclerosis was similar in patients with acute cerebral infarction, but with more differences.The head CTA cannot be totally replaced by neck vascular ultrasound.