颈动脉不稳定斑块与狭窄在缺血性脑卒中发病机制中的作用

The Role of Carotid Unstable Plaques and Stenosis Play in Ischemic Stroke

目的探讨颈动脉不稳定斑块与狭窄在缺血性脑卒中发病机制中的作用。方法采用回顾性队列研究,试验组37例为我院神经内科治疗的缺血性脑卒中患者,对照组43例为同期在我科治疗的非缺血性脑卒中患者。所有患者均采用CTA进行颈部血管评价。对比两组患者颈动脉斑块性质、部位、狭窄程度,并采用logistic回归模型对缺血性卒中患者颈动脉斑块性质、部位、狭窄程度进行分析。结果两组患者人口学资料差异无统计学意义(P>0.05)。缺血性卒中患者与非缺血性卒中患者颈动脉斑块性质有显著性差异(χ2=10.72;P=0.001);颈动脉狭窄程度尤其是重度狭窄有显著性差异(χ2=7.42;P=0.007);斑块分布部位无差异,均以颈动脉起始处多见。logistic回归结果显示,颈动脉狭窄、不稳定斑块均是缺血性脑卒中的重要危险因素(P<0.05),对于轻、中度狭窄的患者,颈动脉不稳定斑块的优势比最大(OR=11.840;P<0.001)。结论颈动脉不稳定斑块与狭窄共同作用于缺血性卒中的发生,对于颈动脉轻、中度狭窄的患者,不稳定斑块是导致其发生缺血性卒中的最重要危险因素。

Objective To explore the role of the characterization of carotid plaque and stenosis in CTA play in is- chemic stroke. Methods We carried out a retrospective cohort study. Ischemic stroke patients treated in the Department of Neurology in our hospital from January 1,2011 to February 1,2013 were enrolled in experimental group. Patients without ischemic stroke treated in our department at the same period were in the control group. All patients were evaluated by CT angiography for their neck vessels. Comparisons were made between the two groups based on the characterization of carotid plaque, location, degree of stenosis. The logistic regression model were made to analysis features of carotid atherosclerosis. Results A total of 80 cases were collected, 37 cases of ischemie stroke group,43 cases of non-ischemic stroke group. There are not statistically significant in the risk factors of patients in the two groups, （ P 〉 0.05 ） ; but the nature of the ca- rotid artery plaque（x2 = 10.72;P = 0. 001 ;and the degree of stenosis specifically in patients with severe stenosis （X2 = 7.42 ;P = O. 007. There was no difference in position of the plaque, the most common position is the beginning of the carotid artery. Logistic analysis shows, carotid stenosis, unstable plaque are important risk factors leading to ischemic （ P 〈 0.05 ）. For the patients with mild or moderate stenosis, carotid artery unstable plaque was the most important risk factor that lead to ischemic stroke. Conclusions The carotid artery unstable plaque and stenosis interact in ischemic stroke, for patients with light or moderate stenosis,unstable plaque is the most important risk factor of ischemic stroke.