颈动脉斑块在脑梗死亚型间分布差异及相关性分析

Formations of carotid artery plaque and cerebral infarction subtypes

目的研究不同临床和影像学亚型脑梗死发生颈动脉斑块的差异。方法选取2008年2月至2011年2月在南京大学医学院附属鼓楼医院神经内科住院治疗的251例缺血性脑血管病患者根据头颅磁共振结果分为脑梗死和非脑梗死组并以后者作为对照,根据超声检查颈动脉内膜-中膜厚度以确定颈动脉斑块的有无。比较脑梗死组和对照组颈动脉斑块的阳性率,并进一步分析其在各临床和影像学分型中的差异。Logistic回归分析颈动脉斑块与脑梗死临床和影像学亚型间的相关性。结果脑梗死组斑块阳性率为74.2%(135/182),对照组为56.5%(39/69),差异有统计学意义(P<0.05)。脑梗死组内,按临床分型斑块发生率由高向低的次序为部分前循环梗死(PA-CI)、腔隙性脑梗死、后循环梗死、完全前循环梗死,其中PACI(83.8%)较对照组明显升高(P<0.05)。按影像学分型斑块发生率由高向低的次序是放射冠梗死、前循环皮质梗死、基底节区梗死、后循环梗死,其中放射冠梗死(85.2%)、皮质梗死(75.4%)明显高于对照组。颈动脉斑块与PACI的P值和OR(95%CI)分别为0.01,2.576(1.251～5.307)。结论临床和影像学亚型对于脑梗死患者颈动脉斑块的发生具有一定的预测作用。

Objective To investigate the differences of carotid artery plaque in all clinical and image subtypes of cerebral infarction and analyze their possible association. Methods 251 patients who had been hospitalized in our department from February 2008 through February 2011 with ischemic cerebral vascular disease were included in the present investigation. They were divided into a cerebral infarction group and a non-infarction group （control） according to their MR[ findings. The intima-media thickness （IMT） of carotid artery was measured by B-mode ultrasound to determine the presence of carotid ar- tery plaque. The positive rates of carotid artery plaque were compared between the two group to analyze differences among the clinical and image subtypes of ischemic stroke. The level-risk relationships between different formations of carotid artery plaque and clinical and image subtypes of ischemic stroke were explored through logistic regression. Results The positive rate of carotid artery plaque was significantly higher in the infarction group than in the control group （74. 2% versus 56. 5% ）. In the cerebral infarction group, the positive rates of carotid artery plaque for the clinical subtypes followed an or- der of PACI 〉 LACI 〉 POCI 〉 TACL The positive rate for PACI （ 83.8% ） was significantly higher than that in the control （ P 〈 0. 05 ）. For the image subtypes, the positive rates of carotid artery plaque ranked in an order of corona radiata infarc- tion 〉 cortex infarction 〉 basal ganglia infarction 〉 partial anterior circulation infarction. The positive rates for corona ra- diata infarction （85.2%） and cortex infarction （75.4%） were significantly higher than those in the control （P 〈 0. 05 ）. The OR （95% CI） and P value were respectively 2. 576 （ 1. 251 to 5. 307） and 0. 01 between carotid artery plaque and PACI. Conclusion Clinical and image subtypes of isehemic Stroke can have a role in prediction of formation of carotid artery plaque in patients with cerebral infarction.