颈动脉系统短暂性脑缺血发作进展为脑梗死的血管因素分析

Analysis on vascular factors of progressing from transient ischemic attack to cerebral infarction

目的探讨影响颈动脉系统短暂性脑缺血发作(TIA)进展为脑梗死的血管因素。方法连续收集2011年12月至2013年12月在中国医科大学附属盛京医院神经内科住院的颈动脉系统TIA患者的临床资料,选择进行颈动脉超声、头部磁共振血管成像(MRA)及行经颅多普勒超声(TCD)评估大脑中动脉脑血管储备(CVR)的患者110例。随访3个月,根据临床表现及头部磁共振弥散加权成像(DWI)将其分为脑梗死组(n=58)和非脑梗死组(n=52例)。观察并比较两组患者的危险因素,症状对侧的颈总动脉、颈内动脉及大脑中动脉内膜中层厚度(IMT)、狭窄、斑块及大脑中动脉的屏气指数(BHI)。结果脑梗死组症状对侧的颈部动脉的软斑块、混合回声斑块及易损斑块(软斑块与混合回声斑块之和)显著高于非脑梗死组(P<0.05,P<0.01)。而两组患者症状对侧的颈总动脉、颈内动脉及大脑中动脉的IMT及狭窄>50%患者的比例无统计学差异(P均>0.05)。脑梗死组症状对侧的大脑中动脉的BHI值明显低于非脑梗死组[(1.03±0.26)%/s vs(1.18±0.33)%/s,P<0.01],提示脑梗死组症状对侧的大脑中动脉的CVR功能较非脑梗死组显著下降。结论从长远的观点来看,颈动脉系统TIA是否进展为脑梗死主要取决于大血管易损斑块的稳定性及CVR能力,而与大血管狭窄程度关系不大。

Objective To investigate the vascular factors for progressing from transient ischemic attack （TIA） of carotid system to cerebral infarction. Methods Consecutively collecting the clinical data of patients with TIA of carotid system hospitalized in neurology department of shengjing hospital affiliated to China medical university between December 2011 and December 2013,110 patients receiving carotid artery ultrasound, head magnetic resonance angiography （MRA） and transcranial Doppler （ TCD ） for evaluating cerebrovascular reserve （CVR） of middle cerebral artery were selected. The patients were divided into cerebral infarction group （ n = 58 ） and no-cerebral infarction group （ n = 52 ） according to clinical manifestation and diffusion weighted imaging （DWI） finding during follow-up of three months. The risk factors ,the intima-media thickness （IMT）, the stenosis and plaque of common carotid artery, internal carotid artery and middle cerebral artery in symptomatic contralateral corresponding part, and the breath-holding index （ BHI ） of middle cerebral artery were observed and compared between two groups. Results The soft plaque, mix-echo plaques and vulnerable plaques （ sum of soft plaque with mix-echo plaques ） in neck arteries of symptomatic contralateral corresponding part in cerebral infarction group were significantly more than those in no-cerebral infarction group （P 〈 0. 05, P 〈 0.01 ）, but there were no significant difference in IMT of symptomatic contralateral common carotid artery,internal carotid artery and middle cerebral artery and the proportions of patients with stenosis more than 50% between two groups （ all P 〉 0.05 ）. BHI value of symptomatic contralateral middle cerebral artery in cerebral infarction group was significantly lower than that in no- cerebral infarction group [ （ 1.03 ± 0. 26 ） %/s vs （ 1.18 ± 0. 33 ） %/s, P 〈 0. 01 ], namely, the CVR capacity of symptomatic contralateral middle cerebral artery in cerebral infarction group decreased significantly compared with no- cerebral infarction group. Conclusion In the long run, whether TIA of carotid system progresses to cerebral infarctiondepends mainly on the stability of vulnerable plaque of large vessels and CVR capacity while has little association with the degree of stenosis of large vessels.