颈动脉重度狭窄或闭塞导致脑梗死发病机制的研究

The study on pathogenesis of cerebral infarction caused by severe carotid artery stenosis or occlusion

目的探讨重度颈动脉颅外段(ICA)狭窄或闭塞患者急性脑梗死的发病机制。方法采用CDFI或TCD筛选75例颈动脉颅外段重度狭窄或闭塞导致的急性脑梗死患者,利用TCD检测脑梗死患者颅内血液动力学变化,采用乳胶增强免疫比浊法测量hs-CRP水平,根据MRI定位对脑梗死模式进行分类,分析颈动脉颅外段重度狭窄或闭塞与脑梗死模式的关系;分析血清hs-CRP水平与颈动脉不稳定斑块及脑梗死模式之间的相关性。结果 (1)区域梗死(Ⅰ型)和分水岭梗死(Ⅴ型)发生率较高,颈动脉颅外段重度狭窄或闭塞与脑梗死模式有关(P<0.01)。(2)不稳定斑块组hs-CRP水平明显高于稳定斑块组(P<0.01),hs-CRP水平与脑梗死模式之间无相关性(P>0.05)。结论 (1)重度颈动脉颅外段狭窄的程度能影响脑梗死的模式,是急性脑梗死主要病因之一。(2)血清hs-CRP升高与脑梗死关系密切,是脑梗死的致病因子。

Objective To investigate pathogenesis in patients with acute cerebral infarction by severe extracranial carotid stenosis or occlusion. Methods 75 patients with acute cerebral infarction by severe extracranial carotid stenosis or occlusion were selected by CDFI or TCD,intracranial blood dynamics change of patients in cerebral infarction was detected by TCD,their hs-CRP levels were tested with immunoturbidimetric assay,According to MRI targeting,cerebral infarction patterns was classified,the relationship between severe carotid artery stenosis or occlusion and cerebral infarction patterns was analysed. The correlation between hs-CRP levels and unstable carotid plaque,cerebral infarction patterns were analyzed. Results（ 1） Territorial infarction and border zone infarction had higher rate,there was correlation between severe extracranial carotid stenosis or occlusion and cerebral infarction patterns（ P〈 0. 01）.（ 2） Unstable plaque group hs-CRP levels were significantly higher than the stable plaque group（ P 〈0. 01）. There was no correlation between hs-CRP levels and cerebral infarction patterns（ P 〉0. 05）. Conclusion（ 1） Severe extracranial carotid stenosis can influence the patterns of cerebral infarction,and it is a major cause of acute cerebral infarction.（ 2） There was significant correlation between high level of hs-CRP and cerebral infarction. hs-CRP is a causative agent of cerebral infarction.