急性脑梗死与颈动脉硬化斑块的临床相关性分析

Relation between acute cerebral infarction and carotid atherosclerotic plaque

目的探讨急性脑梗死与颈动脉硬化斑块的临床相关性。方法回顾性收集行彩色多普勒超声检查的急性脑梗死患者和同期住院的非急性脑梗死患者,对两组颈动脉硬化斑块大小及分布情况、高血压及糖尿病发生情况以及血液生化指标进行比较。结果①共入组102例急性脑梗死患者(急性脑梗死组)和92例非急性脑梗死患者(对照组)。急性脑梗死组与对照组颈动脉粥样硬化斑块检出率比较,差异无统计学意义(90.2%vs 83.6%,P>0.05),但面积大于20 mm2斑块的检出率急性脑梗死组显著高于对照组(44.1%vs 4.3%,P<0.01)。②两组颈动脉硬化斑块的分布部位均以颈总动脉分叉处为主,两组间差异无统计学意义(60.5%vs 65.9%,P>0.05)。③伴有颈动脉硬化斑块患者中,急性脑梗死组糖尿病患者高于对照组(P<0.05),空腹血糖(FBG)>6.1 mmol/L、低密度脂蛋白胆固醇(LDL-C)>3.1 mmol/L、LDL-C/高密度脂蛋白胆固醇(HDL-C)值>3.0,载脂蛋白A(ApoA)<1.0 g/L、载脂蛋白B(ApoB)>1.0 g/L发生率显著高于对照组(P<0.05)。结论几乎所有的急性脑梗死患者均存在较大的颈动脉粥样硬化斑块,颈动脉粥样硬化斑块及糖脂代谢紊乱与急性脑梗死的发生密切相关。

Objective To investigate the clinical relations between acute cerebral infarction and carotid atherosclerotic plaque. Meth- ods The patients with acute cerebral infarction detected by color Doppler uhrasonography and the hospitalized patients without acute cerebral infarction in the same period were collected. The size and distribution of the carotid plaques, the incidences of hypertension and diabetes and blood biochemical markers were compared between two groups. Results （!）A total of 102 patients with acute cerebral infarction（ ACI group） and 92 patients without acute cerebral infarction（ control group） were included in the study. The detection rate of carotid plaques was not different between two groups（90.2% vs 83.6%,P 〉0.05） ,but the detection rate of carotid plaques more than 20 mm2 was significantly higher in ACI group than in control group（44.1% vs 4.3% ,P 〈0.01 ）.（1）There was no significant difference in the distribution of carotid plaque between two groups. Most of the plaques located in the carotid artery bifurcation in ACI group and control group（60.5% vs 65.9% ,P 〉 0.05 ）. （2） Among the patients with carotid plaque, the incidence of diabetes in ACI group was higher than in control group（P 〈 0.05）. The incidences of fasting blood-glucose 〉 6.1 mmol/L and/or low-density lipoprotein choles- terol（LDL-C） 〉 3.1 mmol/L,the ration of LDL-C/high-density lipoprotein cholesterol（HDL-C） 〉 3.0, apolipoprotein A（ApoA） 〈 1.0 g/L and apolipoprotein B（ApoB） 〉 1.0 g/L in ACI group were higher than those in control group（P 〈 O. 05）. Conclusion At- most all patients with acute cerebral infarction have greater carotid atherosclerotic plaques. Carotid atherosclerotic plaques, blood glucose and lipid disorders are closely related with the occurrence of acute cerebral infarction.