中重度颈动脉分叉处狭窄斑块形态与前循环缺血的关系

The Relationship Among Atherosclerotic Plaque Surface Morphology in Carotid Bifurcation with High-Grade Stenosis and Anterior Circulation Ischemia

目的探讨≥50%狭窄颈动脉分叉处斑块形态、位置与前循环缺血症状的关系,以及脑血管病危险因素对斑块形态的影响。方法回顾性分析我院2012年1月至2014年1月我院神经内科住院的单侧颈内动脉分叉处狭窄≥50%的患者的64排CTA检查结果。依据临床表现和MRI或CT检查结果分为症状性和非症状性颈动脉组,比较症状性与非症状性颈动脉分叉处斑块形态(光滑斑块、不规则斑块、溃疡斑块)的差异性,溃疡位置对临床表现的影响,以及斑块形态与脑血管病危险因素的关系。结果共入组286人,其中男性250人(87.4%),女性36(12.6%),平均年龄(66.67±8.17)岁。症状性颈动脉组134人(46.9%),非症状性颈动脉组152人(53.1%)。观察到不规则斑块99人(34.6%),光滑斑块37人(12.9%),溃疡斑块150人(52.4%)。症状组患者光滑斑块出现比例明显低于非症状组(6.0%VS19.1%),而溃疡斑块的出现比例明显高于非症状组(62.7%VS 43.4%),两组间斑块构成比明显不同(P=0.000);症状组斑块溃疡位于狭窄近端的比例明显高于非症状组(81.0%VS 63.4%),差异有统计学意义(P=0.02);溃疡斑块患者女性比例(18.0%)高于不规则斑块(6.1%)和光滑斑块患者(8.1%),差异有统计学意义(P=0.01),并且溃疡斑块高脂血症比例(68.0%)高于及不规则斑块(59.6%)和光滑斑块患者(37.8%),差异有统计学意义(P=0.003)。结论单侧颈动脉分叉处≥50%狭窄患者中,斑块形态及溃疡的位置与前循环缺血症状有关,高脂血症及女性患者对斑块形态有影响。

Objective To explore the relationship between Surface Morphology and location of atherosclerotic Plaque and anterior circulation ischemia in patients suffering carotid Bifurcation with High-Grade（≥50%）Stenosis.The influence of crebrolvascular risk factors to plaque surface morphology also be investigated.Methodswe carried out a retrospective study,Symptomatic or asymptomatic Patients with high-grade（≥50%）unilateral carotid Bifurcation stenosis in the department of neurology in our hospital from January2012 to January2014 were enrolled in groups,which all were evaluated by CT angiography for their neck vessels.According to clinical features and MRI or CT examination results,patients were divided into symptomatic or asymptomatic carotid artery groups.The difference of Plaque morphology（smooth,irregular,ulcerated）between two groups is compared;The influence of the location of the ulcer to clinical presentation and effect of crebrolvascular risk factors to plaque surface morphology also be compared.Results 286 eligible cases including250 men（87.4%）and36 women（12.6）were collected,the average age is（66.67±8.17）years,134（46.9%）patiens are symptomatic,152（53.1%）patients are asymptomatic.plaques were classified as：smooth 37（12.9%）,irregular 99（34.6%）and ulcerated150（52.4%）.The incidence of ulcerated plaque in symptomatic group is higher than asymptomatic group（62.7% VS43.4%）,and the incidence of smooth paque is lower than asymptomatic group（6.0% VS19.1%）,constituent ratio among is significant different（P=0.000）;There are differences in rate of ulceration in proximal to the point of maximum luminal stenosis among two groups（81.0%vs63.4%,P=0.02）;The portion of women with ulcerated plaque（18.0%）is higer than those with smooth（8.1%）or irregular plaque（6.1%）,the difference has a statistical significant;The portion of hyperlipidmia with ulcerated plaque（68.0%）is higer than those with smooth（37.8%）and irregular plaque（59.6%）,the difference has a statistical significant.Conclution To patients suffering carotid Bifurcation with High-Grade（≥50%）Stenosis,there is a relationship between surface morphology of plaque and location of ulcer and anterior circulation ischemia,hyperlipidmia and female have a influence on surface morphology of plaque.