下肢动脉硬化闭塞症合并无症状颈动脉狭窄发生率及危险因素分析

Prevalence of asymptomatic carotid artery stenosis in patients with arteriosclerosis obliterans of lower extremities and risk factor analysis

目的分析下肢动脉硬化闭塞症合并无症状颈动脉狭窄的发生率及危险因素，并初步评估其对下肢动脉病变治疗的影响。方法纳入北京协和医院血管外科2012年9月1日至2014年9月1日期间收治的348例既往无神经病学病史与症状的下肢动脉硬化闭塞症患者，回顾性收集术前颈动脉超声检查及流行病学资料，以局部斑块情况和收缩期峰值流速为指标，诊断是否存在颈动脉狭窄并对狭窄程度进行评估，狭窄程度≥50％定义为存在颈动脉狭窄，采用二元Logistic回归分析寻找与其相关的危险因素，并对颈动脉狭窄组与非狭窄组下肢动脉病变治疗方式的选择进行比较。结果共77例患者合并颈动脉狭窄（22．1％），狭窄程度≥70％或闭塞者44例（12．6％）。吸烟（OR=2．122，95％CI：1．143—3．940）、冠状动脉粥样硬化性心脏病（OR=1．939，95％CI：1．058～3．552）、高血压病（OR=1．882，95％CI：1．025～3．457）是与其相关的危险因素。对合并颈动脉狭窄的患者，临床医生对下肢动脉病变采用全麻手术治疗的比例为6．5％，明显低于未合并颈动脉狭窄者的18．1％（χ^2=6．142，P=0．013）。结论下肢动脉硬化闭塞症合并无症状颈动脉狭窄的发生率较高，吸烟、冠心病、高血压病是与其相关的危险因素。

Objective To evaluate the prevalence of asymptomatic carotid artery stenosis in patients with arteriosclerosis obliterans of lower extremities, and evaluate its effect on the treatment strategies for lower extremity artery lesions. Methods Totally 348 patients with arteriosclerosis obliterans of lower extremities who had no cerebrovascular symptoms or events in the past were enrolled from September 2012 to September 2014 in the Department of Vascular Surgery, Peking Union Medical College Hospital. Preoperative color doppler uhrasonography results of carotid arteries and demographic characteristics were retrospectively collected. The peak systolic velocity and the presence of plaque on gray-scale in the internal carotid arteries were used for diagnosing and grading internal carotid artery stenosis. A stenosis ≥50% was diagnosed as carotid artery stenosis. Binary logistic regression analysis was used to evaluate related risk factors. Treatment strategies for the artery lesions of lower extremities were compared between those with and without asymptomatic carotid artery stenosis. Results Seventy-seven （22. 1% ） patients were found to have carotid artery stenosis. Forty-four （ 12. 6% ） patients were found to have a stenosis ≥70% or occlusion. Smoking （OR = 2. 122,95% CI：1. 143 -3. 940）, coronary artery disease （OR = 1. 939,95% CI： 1. 058 - 3. 552） and hypertension （ OR = 1. 882,95% CI： 1. 025 -3.457） were found to be related risk factors. In patients combined with asymptomatic carotid stenosis, open surgery with general anesthesia was less frequently used than those without asymptomatic carotid stenosis （6. 5% vs 18. 1% , χ^2 = 6. 142, P = 0.013）. Conclusions Prevalence of asymptomatic carotid artery stenosis is high in patients with arteriosclerosis obliterans of lower extremities. Smoking, coronary artery disease and hypertension are related risk factors.