颈动脉易损斑块对缺血性脑卒中预后的影响

Effect of carotid artery vulnerable plaques on prognosis of cerebral ischemic stroke patients

目的探讨颈动脉易损斑块与缺血性脑卒中预后的关系。方法经头颅MRI证实的首发或再发缺血性脑卒中患者152例,根据诊断分为易损斑块组56例,非易损斑块组96例,并进行CT血管成像联合颈动脉超声检查,分析斑块性质、形态,发病后根据美国国立卫生研究院卒中量表(NIHSS)评分对患者的神经功能缺损情况进行评估,采用改良的Rankin残障量表(mRS)评估预后,评估各项危险因素,动态观察其入院后7、14、30d时NIHSS评分、mRS评分、梗死灶体积,观察分析患者的脑血管事件。结果与非易损斑块组比较,易损斑块组7、14、30d NIHSS评分及mRS评分所占比例明显增高,大面积脑梗死体积明显增多,差异有统计学意义(P<0.05,P<0.01)。logistic回归分析显示,颈动脉易损斑块与缺血性脑卒中预后密切相关;NIHSS评分、高敏C反应蛋白、年龄与缺血性脑卒中预后相关。结论缺血性脑卒中易损斑块患者病情重、预后不良,动态观察易损斑块与缺血性脑卒中预后的病情变化程度能够更充分的预测脑卒中的预后。

Objective To study the relation between carotid artery vulnerable plaques and prognosis of cerebral ischemic stroke （CIS） patients. Methods One hundred and fifty-two brain MRI- confirmed CIS patients were divided into vulnerable plaque group （n = 56） and non-vulnerable plaque group （n=96）. Their carotid artery plaques were detected by CT angiography and ultrasonograpby, respectively. The nature and morphology of carotid artery plaques were analyzed. The neurological function impairment was scored according to the national institutes of health strok scale （NIHSS）. The prognosis of and risk factors for CIS were assessed according to the mRS. The NIHSS and mRS score,infarction volume and cerebrovascular events were dynamically observed in the patients on clays 7,14 and 30 after admission. Results The NIHSS and mRS scores and infarction volume were significantly higher in vulnerable plaque group than in non-vulnerable plaque group on days 7,14 and 30 after admission （P〈0.05 ,P〈0.01）. Logistic regression analysis showed that the carotid artery vulnerable plaques were closely related with the prognosis of CIS patients. The NIHSS score,hs-CRP and age were related with the prognosis of CIS patients. Conclusion The prognosis of severe CIS patients with carotid artery vulnerable plaques is poor. Dynamic observation of carotid artery vulnerable plaques can effectively predict the prognosis of CIS patients.