颈动脉粥样斑块稳定性与进展性卒中相关因素的研究

Relationship between the stability of carotid artery plaque and progressive cerebral infarction

目的观察颈动脉不稳定粥样斑块与进展性脑卒中的相关性,探讨进展性脑卒中的预测因素。方法选取2009-09～2010-05我院神经内科住院的发病24h内急性脑梗死患者107例,依据病情变化分为进展组和非进展组,并选取健康体检者30例作为对照组,比较3组患者不稳定颈动脉粥样斑块的特征。结果进展组颈动脉斑块发生率(89.8%)远高于非进展组(58.7%),进展组以不稳定斑块为主(85.8%),发生率也远高于非进展组(25.9%);在进展组中,同侧颈动脉不稳定粥样斑块合并重度颈动脉狭窄中多发病灶发生率为80.7%(DWI成像);进展组、非进展组与对照组血浆同型半胱氨酸分别为(19.4±5.1)μmol/L、(13.7±4.1)μmol/L、(8.3±1.7)μmol/L,3组间差异有统计学意义(P<0.05)。结论颈动脉粥样斑块不稳定性与进展性脑卒中的发生密切相关,而血浆同型半胱氨酸水平升高能预测脑卒中的发生发展。

Objective To observe the relation between carotid artery instable plaque and progressive cerebral infarction. Methods One hundred and seven patients with stroke onset less than 24 hours admitted to the department of neurology of our hospital from September 2009 to May 2010 were divided into progressing group and non-progressing group, The examiners without cerebrovaseular and cardiovascular disease to be selected as control group in the same time. We compared the characteristics of carotid artery instable plaque of the three groups. Results Instable plaque was the main type of plaque in the progressing group, and the incidence was higher in the progressing group than the non-progressing group. In the progressing group, 25 （80.7%） patients of the same side of instable plaque combined with carotid high-grade stenosis were higher than low-grade stenosis （DWI）. There were signifieant differences in the levels of Hcy among the progressing group[-（19.4±5.1）μmol/L, the non-progressing group[-（13.7±4. 1）μmol/L, and normal control group [-（8.3 ± 1.7）μmol/L. The level of Hcy was significantly different in instable plaque group and stable plaque grasp. Conclusion Instable carotid plaque may be closed related to ischemic stroke in progressive, the levels of Hey is a predicting of progressive cerebral infarction.