西安市脑梗死患者颈动脉粥样硬化的临床特点及其与OCSP卒中亚型的相关性

Characteristics of carotid artery atherosclerosis in patients with acute cerebral infarction and their relationship with ischemic stroke subtypes in Xi'an

目的 探讨急性脑梗死患者颈动脉粥样硬化的临床特点及其与牛津郡社区卒中项目（Oxfordshire Community Stroke Project,OCSP）卒中亚型的相关性. 方法 采用前瞻性研究方法,连续登记我院2010-01～2011-12间入院的急性脑梗死患者,对纳入的患者全面收集相关的临床资料,行颈部血管B超检查,收集相关观测指标,并根据OCSP分型标准进行卒中亚型分型. 结果 1128例急性脑梗死患者有318例（28.2％）存在颅外段颈动脉狭窄,其中狭窄＞50％的发生率为10.1％（114例）;有675例（59.8％）颈动脉检出粥样硬化斑块,且半数以上为不稳定性斑块（52.6％,576/975）;有453例（40.2％）的颈总动脉内膜-中膜厚度（CCA-IMT） ＞1.0 mm.本组OCSP各亚型构成比分别为：部分前循环梗死（PACI） 31.6％ （357例）,腔隙性梗死（LACI） 26.1％（294例）,完全前循环梗死（TACI） 23.9％（270例）,后循环梗死（POCI） 18.4％（207例）.完全前循环梗死（TACI）患者不稳定斑块检出率最高（56.7％,153/270）;腔隙性梗死（LACI）患者稳定性斑块的检出率最高（46.9％,138/294）;不同卒中亚型患者颈动脉斑块性质不同,差异有统计学意义（x2=209.96,P＜0.005）.完全前循环梗死（TACI）患者CCA-IMT厚度最高,与其他三型比较差异有统计学意义（P＜0.05）. 结论 急性脑梗死患者颈动脉粥样硬化很常见;不稳定斑块与完全前循环梗死亚型关系密切,可能是该亚型患者的病因之一.

Objective To study the characteristics of carotid artery atherosclerosis in patients with acute cerebral infarction and their relationship with ischemic stroke subtypes according to Oxfordshire Community Stroke Project （OCSP） criteria.Methods Data were collected prospectively from consecutive acute cerebral infarction inpatients in our hospital from January 2010 to December 2011.After completing medical records and auxiliary diagnostic studies,all included patients with acute cerebral infarction were examined by color Doppler ultrasound and classified into four major ischemic stroke subtypes based on OCSP criteria.The characteristics of the carotid artery lesions were observed,and the relationship between OCSP stroke subtypes and carotid artery atherosclerosis was analyzed.Results A total of 1 128 patients were enrolled in this study.Of all the patients,318 patients showed carotid artery stenosis,including 114 patients with carotid artery stenosis ＞ 50％.Atherosclerotic plaque was found in 675 patients and more than half was unstable plaques （52.6％,576/975）.Totally 453 patients with the common carotid artery intima-media thickness（CCA-IMT） more than 1.0 mm were detected.According to OCSP criteria,there was 357 cases（31.6％）of partial anterior circulation infarct,294 cases （26.1％） of lacunar infarct,270 cases（23.9％） of total anterior circulation infarct,and 207 cases （18.4％） of posterior circulation infarct.The detection rate of unstable plaque in total anterior circulation infarct （TACI） group was the highest（56.7％,153/270）.The detection rate of stable plaque in lacunar infarct （LACI） group was the highest （46.9％,138/294）.The carotid plaque composition was significantly different among four groups （x2 =209.96,P ＜ 0.005）.Among OCSP stroke subtypes,the level of CCA-IMT was significantly higher in TACI group than those in the other three groups （P ＜ 0.05）.Conclusion The carotid artery atherosclerosis is common in patients with acute cerebral infarction.There is a close relationship between the unstable plaque and the total anterior circulation infarct （TACI） subtypes,and the unstable plaque may be one of the causes of the total anterior circulation infarcts （TACI） subtypes.