高血压患者前循环脑梗死发作与颈动脉斑块的性质之间的关系

Relationship between the clinical onset of cerebral infarction in anterior cycle and the properties of carotid plaque in hypertensive patients *

目的:探讨高血压患者前循环脑梗死发作与颈动脉斑块的性质之间的关系。方法:收集2008年1月至2010年5月因头颅DWI诊断为前循环新发脑梗死并患高血压的患者181例,其中同时查颈彩超及头颅MRA共98例(CI组),与同期住院并接受过相同检查的高血压性非脑梗死69例(nCI组)相比较。通过χ2检验及均数比较分析两组组内及组间颈动脉的IMT,斑块的类型、Crouse评分和指数的差异。结果:组内比较发现:CI组病灶侧颈动脉扁平斑块比例减少,溃疡斑块和混合斑块比例增多(P=0.012);和非病灶侧相比,病灶侧颈动脉斑块的Crouse评分降低,IMT增高(均P<0.05);nCI组左右两侧颈动脉的IMT、斑块类型、Crouse积分和指数均无统计学意义;组间比较:CI组的SBP(P=0.002)及DBP(P=0.003)、颈动脉斑块的Crouse评分(P=0.002)及指数(P=0.019)均明显高于nCI组。结论:高血压患者前循环发生脑梗死与颈动脉的粥样硬化程度,更与其斑块的脱落有关,溃疡斑块和混合斑块的稳定性相对较差。

Objective To investigate the relationship between the clinical onset of cerebral infarction in anterior cycle and the properties of carotid plaque in hypertensive patients.Methods From Jun 2008 to May 2010,one hundred and eighty-one inpatients with hypertension were diagnosed as new onset of cerebral infarction（CI） in anterior cycle by head DWI scan.Among them,ninety-eight patients underwent carotid color ultrasound and head MRA scan simultaneously,compared with 69 hypertensive patients without cerebral infarction（nCI） who accepted the same examinations in the same period of hospitalization.χ2 test and mean comparison were used to analyze the difference of inteima-media thickness（IMT）,plaque types,Crouse score and index of carotid artery within and between the 2 groups.Results Comparison within group indicated that in CI group,less flat plaques and more ulcer plux mixed plaques were detected in lesion side than in non-lesion side carotid artery（P = 0.012）,and comparing with non-lesion side carotid artery,there were less Crouse score and thicker IMT in lesion side carotid artery（P 0.05）;in nCI group,there were no significant difference of IMT,plaque types,Crouse score and index of carotid artery between the right and left sides.Comparison betweem groups demonstrated that there were significant higher SBP（P = 0.002）,DBP（P = 0.003）,Crouse score（P = 0.002） and index（P = 0.019） of carotid plaque in CI group than those in nCI group.Conclusions The clinical onset of cerebral infarction in anterior cycle in hypertensive patients was correlated with the carotid sclerosis degree,and especially with the drop of carotid plaque,the ulcer and mixed plaques have less stability.