颈动脉粥样硬化斑块对脑梗死患者病情及其复发的影响

Effect of carotid atherosclerotic plaque on severity and recurrence of patients with cerebral infarction

目的 探讨颈动脉粥样硬化斑块对脑梗死患者病情及复发的影响。方法 本研究采用前瞻性队列法设计。应用多普勒超声进行颈动脉斑块探查及定性,将患者分为斑块组和无斑块组。采用NIHSS评分法评估入选患者入院时、入院后第7 d、第14 d神经功能。对患者进行1年的随访,观察脑梗死复发情况。结果 根据多普勒超声结果将患者分为斑块组173例（70.3%）和无斑块组73例（29.7%）。与无斑块组比较,斑块组年龄、NIHSS评分及高血压、糖尿病、高脂血症、高纤维蛋白原血症的比率均显著高于无斑块组（P〈0.05~0.01）。在完成随访的患者中,斑块组脑梗死复发39例（24.84%）,复发时间为10.12个月;非易损斑块患者脑梗死复发时间为11.82个月,混合斑块患者为10.62个月,易损斑块患者为9.13个月。无斑块组脑梗死复发7例（10.45%）,复发时间为11.56个月。斑块组脑梗死复发率显著高于,复发时间显著早于无斑块组（均P〈0.05）。易损斑块患者复发时间显著早于非易损斑块患者（P=0.034）。结论 颈动脉粥样硬化斑块可使急性脑梗死的病情加重,复发率增高,尤其是易损斑块患者。

Objective To explore the effect of carotid atherosclerotic plaque （CAP） on severity and recurrence of patients with cerebral infarction （CI）. Methods The prospective cohort study was utilized in this research. Existence and type of CAP were detected by Doppler ultrasound, and patients were divided into plaque group and without plaque group. The patients was evaluated by NIHSS on admission and 7 d, 14 d after admission, and patients were followed up for 1 year. The condition of CI recurrence was be observed. Results According to the Doppler ultrasound, patients were divided into plaque group （173 cases, 70.3% ） and without plaque group （73 cases, 29. 7% ）. Compared with without plaque group, age, NIHSS .score and incidences of hypertension, diabetes, hyperlipidemia, hyperfibrinogenemia were significantly increased （ P 〈 0. 05 - 0. 01 ）. In the patients who were conducted follow-up, cerebral infarction recurrence was in 39 cases （24.84%） in plaque group, recurrence time was 10.12 month. The recurrence time was 11. 82 month in patient with non-vulnerable plaque, it was 10.62 month in patient with mixed plaque, and it was 9.13 month in patient with vulnerable plaque. Cerebral infarct recurrence was in 7 cases （10. 45% ） in without plaque group, recurrence time was 11.56 month. The recurrence rate in plaque group was significant increased than that in without plaque, however, the recurrence time for without plaque group was longer than that for plaque group （all P 〈 0. 05 ）. The recurrence rate and recurrence time in patient with vulnerable plaque was significantly earlier than that in patient with non-vulnerable plaque （ P = 0. 034）. Conclusion The CAP in patients with acute CI can exacerbate the disease, and increase recurrence rate. It is especially in patients with vulnerable plaque.