缺血性脑卒中颈动脉杂音与颈动脉狭窄相关性研究

Association study between carotid artery bruit and carotid stenosis in cerebral arterial thrombosis

目的探讨缺血性脑卒中患者颈动脉杂音对颈动脉狭窄的预测价值。方法根据颈动脉听诊结果，将200例缺血性脑卒中患者分为有杂音组（100例）和无杂音组（100例）。排除心脏杂音、静脉杂音及甲状腺杂音的患者。200例患者均行颈部血管超声及经颅多普勒（TCD）检查，必要时行主动脉弓＋全脑数字减影血管造影（DSA）。比较两组颈动脉狭窄率、狭窄部位和狭窄程度，并对颈动脉杂音分级与颈动脉狭窄程度的关系进行分析。结果有杂音组颈动脉狭窄率[67％（67／100）]高于无杂音组[29％（29，100）]（P〈0．01）。两组狭窄部位及狭窄程度比较差异均有统计学意义（P〈0．05），颈总动脉分叉部狭窄及重度狭窄者易于听到颈动脉血管杂音（P〈0．05）。颈动脉杂音分级与颈动脉狭窄程度有关（P〈0．05），颈动脉杂音级别越高，重度狭窄的几率越大。结论在缺血性脑卒中患者中，颈动脉杂音与颈动脉狭窄的部位及程度有关，临床上可作为判断颈动脉是否存在狭窄的一个初筛指标。

Objective To evaluate the value of carotid artery bruit in predicting carotid stenosis in patients with cerebral arterial thrombosis. Methods Two hundred cerebral arterial thrombosis patients were divided into bruit group and no bruit group according to carotid artery auscultation,with 100 cases in each group. The patients with cardiac murmur, vein sound and thyroid noise were excluded from bruit group. The examination of carotid artery auscultation （transcranial Doppler sonography ） was managed in all the patients, and digital subtraction angiography （ DSA ） about aortic arch and the whole brain were perfomed. The carotid stenosis rate, site, degree were compared and the relationship between carotid bruit grade and carotid stenosis degree were evaluated. Results The carotid stenosis rate in bruit group [ 67% （67/100） ] was higher than that in no bruit group [29%（29/100） ]（P〈 0.01 ）. There was significant difference in the carotid stenosis site and degree between two groups （P 〈 0.05）. Carotid bruit were significantly associated with stenosis near carotid bifurcation or serious stenosis （P 〈 0.05）. The carotid bruit grade was positively related with the carotid stenosis degree （P 〈 0.05 ）. Conclusions Carotid bruit is associated with site and degree of carotid stenosis. Carotid bruit is valuable in screening for carotid stenosis in patients with cerebral arterial thrombosis.