老年人颈动脉粥样硬化与缺血性脑梗死关系的初步分析

Relationship Between Carotid Artery Athorosclerosis and lschemic Cerebral Infarction in the Eldedy

目的：研究60岁以上老年人不同程度颈动脉粥样硬化与缺血性脑梗死的关系。方法：对222例老年患者行颈动脉彩色多普勒超声检查，并测量血糖、血脂、血压水平以及进行头颅CT或MRI扫描。将患者分为有斑块组（158例）和无斑块组（64例）。观察不同年龄段颈动脉粥样硬化的发生率，分析脑梗死与不同颈动脉斑块分级的关系。结果：70岁以上患者颈动脉斑块检出率及2级以上斑块的检出率显著增高（P〈0．01），脑梗死和多次脑梗死的发生率也高于70岁以下患者（P〈0．05）。2级和3级斑块组患者的颈总动脉内径增大，血流速度增快，血管阻力增大（P〈0．05）。有斑块组患者的脑梗死发生率显著高于无斑块组（P〈0．01）。结论：颈动脉硬化斑块与脑梗死密切相关，斑块级别越高，颈动脉血流动力学参数异常越明显，脑梗死发生率也越高。70岁以上高龄是颈动脉粥样硬化程度加重的重要危险因素。

Objective： To study the relationship between varying degrees of carotid artery atherosclerosis and ischemic cerebral infaction in the elderly over 60. Methods： Carotid artery color Doppler ultrasonography was performed in 222 old patients, their blood glucose, lipids, and blood pressure were measured, and their cranial CT or MRI was performed. The patients were divided into either plaque （n = 158） or non-plaque （n =64） groups. The incidence of carotid athorosclerosis was observed in different ages. The relashionship between cerebral infaction and carotid atherosclerotic plaques with different grades was analyzed. Results： The detection rates of carotid plaque and carotid plaque grade 2 or more in patients over 70 years of age were sig- nificantly increased （P 〈0.01 ）, and the incidences of cerebral infaction and repeated cerebral infarctions were higher than those in patients under 70 years old （P 〈0.05）. The inner diameter of common carotid artery extended in patients with grades 2 and 3 in the plaque group, the blood flow velocity increased, and the vascular resistance was increased （P 〈 0.05 ）. The incidence of cerebral infaction in the plaque group was significantly higher than that in the nonplaque group （P 〈 0.01 ）. Conclusions： Carotid atherosclerotic plaque is closely correlated with cerebral infaction. The higher of the plaque grade is, the more significant of the abnormality of carotid hemodyrnamic parameters, and the higher of the incidence of cerebral infaction. The advanced age （above 70 years old） is an important risk factor for the aggravating degree of carotid artery atherosclerosis.