颈动脉粥样硬化与进展性缺血性脑卒中的关系

The relationship between carotid atherosclerosis and progressive ischemic stroke

目的探讨颈动脉粥样硬化与进展性缺血性脑卒中的关系。方法采用彩色多普勒超声仪对564例缺血性脑卒中患者的颈动脉进行评估,比较进展性缺血性脑卒中和非进展性缺血性脑卒中患者的颈动脉粥样硬化特征和程度。结果564例缺血性脑卒中患者有135例为进展性缺血性脑卒中(23.8%);在重度颈动脉粥样硬化110例中,有49例(44.5%)发展为进展性卒中;在重度颈动脉狭窄95例中,有48例(50.5%)发展为进展性卒中;在病理表现为溃疡斑86例中,有47例(54.7%)发展为进展性卒中:无颈动脉粥样硬化或伴轻度颈动脉粥样硬化的缺血性脑卒中患者,仅9%～10%发生进展性卒中。经Logistic回归分析发现,颈动脉粥样硬化程度、狭窄程度以及溃疡斑与进展性缺血性卒中的发生成正相关。结论颈动脉粥样硬化与进展性缺血性脑卒中的发生密切相关,颈动脉粥样硬化的严重程度可作为进展性缺血性脑卒中的预测指标。

Objective To study the relationship between carotid atherosclerosis and progressive ischemic stroke. Methods Doppler ultrasonography in 564 patients with acute ischemic stroke, and the characteristics of carotid atherosclerosis was compared to patients with or without progressive ischemia stroke. Results Of all the 564 patients with ischemic stroke, 135 patients （23.8%）were progressive during acute period. 49 （44. 5% ） of 110 patients with severe carotid atherosclerosis, 48 （ 50. 5% ） of 95 patients with carotid high-grade stenosis and 47（54. 7% ） of 86 patients with carotid ulcerated plaque. The frequency of progressive ischemic stroke in these patients was significantly higher than those patients without or with mild carotid atherosclerosis. The logistic regression analysis showed that the severity of carotid atherosclerosis, stenosis, ulcerated plaque were positively related to the progressive ischemic stroke. Conclusion There is a positive relationship between carotid atherosclerosis and ischemic stroke in evolution. The severity of carotid atherosclerosis may be a risk predictor in stroke evolution.