颈动脉钙化与缺血性卒中：回顾性病例系列研究

Carotid artery calcification and ischemic stroke： a retrospective case series study

目的 探讨颈动脉钙化与缺血性卒中的关系.方法 回顾性收集急性缺血性卒中患者和同期住院的非急性卒中患者的人口统计学资料、血管危险因素和临床特征.所有患者均行64排螺旋CT检查,平扫数据被传入GE工作站,应用Smart积分软件评价颈动脉钙化情况.采用多变量logistic回归分析确定缺血性卒中的独立危险因素.采用受试者工作特征（receiver operator characteristic,ROC）曲线分析判断颈动脉钙化对急性缺血性卒中的预测价值.结果 共纳入86例急性缺血性卒中和89例非缺血性卒中患者（对照组）.缺血性卒中组与对照组比较,除既往卒中史外,年龄、性别和血管危险因素均无显著性差异.缺血性卒中组钙化积分[（338.57＆#177;77.35）分对（147.79＆#177;64.52）分；t=4.065,P=0.045]、总钙化体积[（372.22＆#177;78.73） mm3对（197.27＆#177;61.12）mm3；t =4.740,P=0.031]和钙化质量[（70.33＆#177;13.83）mg对（32.44＆#177;12.27） mg;t =6.673,P=0.011]均显著性高于对照组.在缺血性卒中患者中,症状侧颈动脉的钙化积分[（335.50＆#177;85.95）分对（312.73＆#177;90.61）分；t=0.052,P=0.820]、总钙化体积[（357.91＆#177;88.93）mm3对（311.71＆#177;81.43）mm3;t =0.071,P=0.791]和钙化质量[（59.68＆#177;17.36）mg对（51.29＆#177;18.69）mg;t=1.716,P=0.192]与非症状侧无显著性差异.多变量logistic回归分析显示,颈动脉钙化积分[优势比（odds ratio,OR）4.963,95％可信区间（confidence interval,CI）5.932 ～ 18.994；P=0.019]、总钙化体积（OR 5.967,95％ CI3.940 ～ 14.993；P=0.015）和钙化质量（OR 6.815,95％ CI4.703 ～21.946；P=0.007）是缺血性卒中的独立危险因素.对颈动脉钙化积分进行ROC曲线分析显示,当颈动脉钙化积分为231.25分时对急性缺血性卒中具有预测价值,敏感性为85.4％,特异性为89.9％,阳性预测值87.1％,阴性预测值为89.1％,ROC曲线下面积为0.891（95％ CI 0.808 ～0.913,P=0.027）.结论 颈动脉钙化为缺血性卒中的独立危险因素之一,颈动脉钙化积分对急性缺血性卒中有一定的预测价值.

Objective To investigate the relationship between carotid artery calcification and ischemic stroke.Methods The demographic data,vascular risk factors and clinical features of patients with acute ischemic stroke and non-acute stroke patients admitted in the same period were collected retrospectively.All the patients received 64-slice spiral CT examination,and the scan data were transmitted to a GE workstation.A smart score software was used to evaluate carotid artery calcification.Multivariate logistic regression analysis was used to identify the independent risk factors for ischemic stroke.Receiver operator characteristic （ROC） curve was used to analyze and determine the predictive value of carotid artery calcification in acute ischemic stroke.Results A total of 86 patients with acute ischemic stroke and 89 with non-acute stroke （control group） were enrolled.In addition to the previous stroke history,there were no significant differences in age,gender,and vascular risk factors between the ischemic stroke group and the control group.The calcium score （338.57 ＆#177; 77.35 vs.147.79 ＆#177; 64.52; t =4.065,P =0.045）,total calcified volume （372.22 ＆#177; 78.73 mm3 vs.197.27 ＆#177;61.12 mm3; t =4.740,P =0.031）,and calcification quality （70.33 ＆#177; 13.83 mg vs.32.44 ＆#177; 12.27 mg; t =6.673,P =0.011） of the ischemic stroke group were significantly higher than those of the control group.In patients with ischemic stroke,there were no significant differences in the carotid artery calcification score （335.50 ＆#177; 85.95 vs.312.73 ＆#177; 90.61; t =0.052,P =0.820）,total calcified volume （357.91 ＆#177; 88.93 mm3 vs.311.71 ＆#177; 81.43 mm3; t=0.071,P=0.791）,and calcium quality （59.68＆#177; 17.36 mg vs.51.29 ＆#177; 18.69 mg; t =0.071,P =0.791） between the symptomatic sides and non-symptomatic sides.Multivariate logistic regression analysis showed that the carotid artery calcification score （odds ratio [OR] 4.963,95% confidence interval [CI] 5.932-18.994; P=0.019）,total calcified volume （OR 5.967,95% CI 3.940-14.993; P =0.015）,and calcium quality （OR 6.815,95% CI 4.703-21.946; P =0.007） were the independent risk factors for ischemic stroke.The ROC curve analysis of carotid artery calcification score showed that when it was 231.25,it had a predictive value for acute ischemic stroke.The sensitivity was 85.4%,specificity was 89.9%,positive predictive value was 87.1%,and negative predictive value was 89.1%.The area under the ROC curve was 0.891 （95% CI 0.808-0.913; P =0.027）.Conclusions Carotid artery calcification is one of the independent risk factors for ischemic stroke.Carotid artery calcification score has some predictive value for acute ischemic stroke.