颈动脉超声检查评价原发性高血压合并非瓣膜性心房颤动患者缺血性卒中

Evaluation on ischemic stroke in older hypertension patients with nonvalvular atrial fibrillation using carotid ultrasound

目的评价颈动脉超声检查预测原发性高血压合并非瓣膜性心房颤动(简称房颤)患者缺血性卒中的价值。方法对原发性高血压患者(高血压组,77例)、原发性高血压合并非瓣膜性房颤患者(高血压合并房颤组,74例)和健康对照者(健康对照组,70例)进行颈动脉彩色多普勒超声检查,测量、计算并比较各组受试者粥样斑块总面积(TPA)、颈动脉内径(CAD)、颈动脉内中膜厚度(IMT)、颈动脉最大剪切率(SR-max)、颈动脉最小剪切率(SR-min)、搏动指数(PI)、阻力指数(RI),并对各组受试者缺血性卒中发生率和斑块类型进行比较。结果高血压组患者TPA、CAD、IMT、SR-max、SR-min分别为(20.59±5.43)mm2、(7.08±0.95)mm、(1.38±0.32)mm、(365.5±129.5)s-1、(132.3±46.2)s-1;高血压合并房颤组患者上述参数分别为(40.46±8.18)mm2、(7.21±0.83)mm、(1.61±0.57)mm、(313.7±101.5)s-1、(105.3±51.1)s-1;健康对照组上述参数分别为(9.14±4.12)mm2、(6.49±0.87)mm、(0.67±0.12)mm、(419.0±138.9)s-1、(145.7±49.3)s-1。与健康对照组比较,高血压组及高血压合并房颤组患者TPA、CAD、IMT均增加,而SR-max、SR-min均下降,且差异均有统计学意义(高血压组与健康对照组比较,q值分别为5.92、16.14、15.90、4.61、3.44;高血压合并房颤组与健康对照组比较,q值分别为7.23、20.91、43.54、8.99、3.44;P均<0.05)。与高血压组患者比较,高血压合并房颤组患者TPA、IMT均增加,而SR-max、SR-min均下降,且差异均有统计学意义(q值分别为5.22、27.99、4.53、8.16,P均<0.05)。高血压合并房颤组患者缺血性卒中发生率为37.8%(28/74),高于健康对照组受试者[5.7%(4/70)]和高血压组患者[19.5%(15/77)],且差异均有统计学意义(χ2值分别为21.9、6.9,P均<0.05)。健康对照组受试者低回声斑块、混合回声斑块检出率为11.4%(8/70)、4.3%(3/70),高血压组及高血压合并房颤组患者对应的值为25.9%(20/77)、25.9%(20/77)和45.9%(31/74)、21.6%(16/74)。与健康对照组比较,高血压组及高血压合并房颤组患者低回声斑块、混合回声斑块检出率均增高,且差异均有统计学意义(高血压组与健康对照组比较,χ2值分别为5.8、12.1;高血压合并房颤组与健康对照组比较,χ2值分别为16.9、9.5;P均<0.05);而与高血压组患者比较,高血压合并房颤组患者仅低回声斑块检出率增加(χ2=4.2,P<0.05)。结论颈动脉超声检查可作为评价缺血性卒中颈动脉硬化的重要方法;高血压、非瓣膜性房颤是颈动脉硬化斑块形成的主要危险因素,并增加缺血性卒中发生率。

Objective To assess the ischemic stroke in older hypertension patients with nonvalvular atrial fibrillation by carotid ultrasound.Methods Seventy-seven patients with hypertension,74 patients with hypertension and nonvalvular atrial fibrillation and 70 controls were studied by carotid ultrasound examination.The parameters of total plaque area(TPA),carotid artery diameter(CAD),intima-media thickness(IMT),carotid artery maximum shear rate(SR-max),minimum shear rate(SR-min),pulsatility index(PI),resistance index(RI) were measured and calculated.And the type of plaque and incidence of ischemic stroke were compared between the three groups.Results TPA,CAD,IMT,SR-max and SR-min were(20.59±5.43)mm2,(7.08±0.95)mm,(1.38±0.32)mm,(365.5±129.5)s-1,and(132.3±46.2)s-1 in hypertension group;(40.46±8.18)mm2,(7.21±0.83)mm,(1.61±0.57)mm,(313.7±101.5)s-1,and(105.3±51.1)s-1 in hypertension and nonvalvular atrial fibrillation group;(9.14±4.12)mm2,(6.49±0.87)mm,(0.67±0.12)mm,(419.0±138.9)s-1,and(145.7±49.3)s-1 in control group respectively.Compared with control group,obvious increase in TPA,CAD,IMT and significant decrease in SR-max,SR-min were shown in hypertension group,and hypertension and nonvalvular atrial fibrillation group(hypertension group vs control group,q=5.92,16.14,15.90,4.61,3.44;hypertension and nonvalvular atrial fibrillation group vs control group,q=7.23,20.91,43.54,8.99,3.44;all P<0.05).Compared with hypertension group,TPA and IMT significantly increased in hypertension and nonvalvular atrial fibrillation group,while SR-max and SR-min significantly decreased(q=5.22,27.99,4.53,8.16,all P<0.05).The incidence of ischemic stroke in hypertension and nonvalvular atrial fibrillation group was significantly higher[37.8%(28/74)]than that in control group[5.7%(4/70)] and hypertension group[19.5%(15/77)](χ2=21.9,6.9,both P<0.05).Compared with control group[11.4%(8/70),4.3%(3/70)],the incidence of hypoechoic plaque and mixed echo plaque were significantly higher in hypertension group[25.9%(20/77),25.9%(20/77)],and hypertension and nonvalvular atrial fibrillation group[45.9%(31/74),21.6%(16/74)](hypertension group vs control group,χ2=5.8,12.1;hypertension and nonvalvular atrial fibrillation group vs control group,χ2=16.9,9.5;all P<0.05).However compared with hypertension group,only hypoechoic plaque incidence significantly increased in nonvalvular atrial fibrillation group(χ2=4.2,P<0.05).Conclusions Carotid ultrasound is one of the important methods of evaluating carotid atherosclerosis in ischemic stroke.Hypertension and nonvalvular atrial fibrillation are the major risk factors of carotid atherosclerosis,and increase the incidence of ischemic stroke.