颈动脉粥样硬化及血流动力学变化与脑梗死的关系

The relationship of cerebral infarction to carotid atherosclerosis and hemodynamic changes

目的应用双功能彩色多普勒超声观察脑梗死患者颈动脉粥样硬化斑块和颈动脉各部位的血流动力学变化及其相互关系。方法经头颅CT和(或)MRI检查确诊的58例脑梗死患者(脑梗死组)及45例健康体检者(对照组),采用多普勒超声检测颈动脉内膜中层厚度(IMT),并同时检测颈总动脉及颈内动脉血流动力学指标。结果脑梗死组颈总动脉、颈内动脉及颈总动脉分叉部IMT均明显高于对照组(P<0.01);脑梗死组颈动脉粥样斑块检出率显著高于对照组(P<0.01);脑梗死组颈总动脉收缩期峰值流速、舒张末期流速及最大剪切率明显低于对照组,搏动指数、阻力指数高于对照组,脑梗死组颈内动脉舒张末期流速及最大剪切率明显低于对照组,阻力指数高于对照组;颈总动脉最大剪切率与颈总动脉IMT及颈总动脉分叉部IMT呈负相关,颈内动脉最大剪切率与颈内动脉IMT呈负相关。结论颈动脉IMT、斑块的部位和性质及血流动力学变化与脑梗死的发生密切相关。

Objectives To examine carotid atherosclerotic plaque and homodynamic changes of the common carotid and internal carotid arteries with color Doppler ultrasound and to study the relationship of carotid artery plaque and hemodynamic changes to cerebral infarction. Methods Intima-medial thickness （IMT）, location, amount and property of the carotid atherosclerotic plaque and hemodynamic changes of the common carotid and internal carotid were examined with color Doppler ultrasound in 58 patients with cerebral infarction confirmed by cranial CT and（or） MRI and 45 subjects as controls. Results IMT of common carotid,internal carotid and bifurcation of common carotid in cerebral infarction patients was obviously higher than that in control group （P 〈 0.01）. The prevalence of carotid artery plaque in cerebral infarction group was obviously higher than that in control group （P 〈0.01）. Peak systolic velocity, end diastolic velocity（EDV） and shear rate（SR） of common carotid artery in cerebral infarction patients were obviously lower than those in control group,while pulse index and resistance index（RI） of common carotid were higher than those in control group. EDV and SR of internal carotid artery in cerebral infarction patients were obviously lower than those in control group,while RI of internal carotid artery was higher than that in control group. SR of common carotid artery was negatively correlated with the IMT of common carotid and bifurcation. SR of internal carotid was negatively correlated with the IMT of internal carotid. Conclusion The development of cerebral infarction is closely correlated with the carotid IMT,location and property of the carotid plaque and change of hemodynamics.