颈内动脉闭塞患者临床表现与侧支循环的关系及其影响因素

摘要

Objective To investigate the relationship between clinical manifestations and collateral circulation and its related factors in patients with internal carotid artery occlusion (ICAO).Methods 63 patients with ICAO were analyzed retrospectively.According to the clinical manifestations,all patients were divided into three groups:asymptomatic group(n =14),TIA group (n =4) and cerebral infarction group (n =45).According to the building of collateral circulation,all patients were divided into two groups:the better compensation group (n =42) and the poorer compensation group (n =21).According to cerebral infarction,all patients were divided into two groups:the cerebral infarction group (n =45) and no cerebral infarction group (n =18).CT angiography (CTA) and Transcranial Doppler (TCD) were used to evaluate collateral circulation and the risk factors.The relationship between clinical manifestations and collateral circulation and its related factors were discussed Results ①The opening of primary collateral pathways (AComA and PComA) had the most frequency of the three groups,the secondary collateral pathways(OA) was the second.No statistically significance was found among three groups.②The hyperlipidemia percentage and the high-sensitivity C-reactive protein(hs-CRP) level of the poorer compensation group were higher than those of the better compensation group(P ＜ 0.05).③For coronary heart disease,cerebral infarction group was significantly lower than that of no cerebral infarction group (P ＜ 0.05),but for hs-CRP,cerebral infarction group was significantly higher than that of no cerebral infarction group (P ＜ 0.01).Conclusions There is no significant relativity between clinical manifestations and collateral circulation in patients with ICAO.Hyperlipidemia and inflammatory factor influence the establishment of collateral circulation and formation of cerebral infarction,which participate in the pathophysiological process of ICAO,so we should strengthen the control of risk factors and inflammation of ICAO patients.%目的 探讨颈内动脉闭塞(ICAO)患者临床表现和侧支循环的关系及其影响因素.方法 ICAO患者63例,按临床表现分为:无症状组14例、短暂性脑缺血发作(TIA)组4例和脑梗死组45例；按侧支循环建立情况分为:代偿良好组(侧支循环开放数目≥2)42例和代偿不良组(侧支循环开放数目＜2)21例；按有无脑梗死分为:脑梗死组45例和无脑梗死组(无症状和TIA)18例.用CT血管成像和经颅多普勒超声评价其侧支循环的建立情况,分析其危险因素.结果 ①不同临床表现三组两两比较侧支循环开放情况均无统计学差异(P均＞0.05).②代偿不良组高敏C-反应蛋白(hs-CRP)水平明显高于代偿良好组(P＜0.05).③脑梗死组冠心病发生率明显低于无脑梗死组(P＜0.05)；但其hs-CRP水平明显高于无脑梗死组(P＜0.01).结论 ICAO患者临床表现和侧支循环的建立无关,高血脂和炎症影响ICAO患者侧支循环的建立和脑梗死形成.