急性缺血性脑卒中颈动脉粥样硬化的危险因素研究

Risk Factors of Carotid Atherosclerosis in Patients with Acute Ischemic Stroke

背景颈动脉粥样硬化(CAS)是脑卒中重要的病理基础,在动脉粥样硬化的斑块形成和发展过程中,免疫、炎性反应等因素起着十分重要的作用。近年来,随着人们物质生活和饮食结构的变化,以及人口老龄化趋势的影响,脑血管疾病在我国的发病率逐年增高,使卒中防治工作日趋严峻。目的探讨急性缺血性脑卒中发生CAS的危险因素。方法选择2014年1月-2018年11月任丘康济新图医院神经内科住院的急性缺血性脑卒中患者4048例,采用自行设计的问卷进行资料收集。内容包括:一般情况、体格检查、实验室检查及颈动脉超声。将颈动脉斑块形成和狭窄定义为CAS,采用单因素、多因素Logistic回归分析探究急性缺血性脑卒中患者发生CAS的影响因素。结果入组人群中平均年龄(64.8±11.3)岁,其中男2506例(61.91%)、女1542例(38.09%),颈动脉正常169例(4.17%)、内膜中层厚度增厚577例(14.25%),斑块形成2362例(58.35%)、颈动脉狭窄940例(23.22%)。多因素Logistic回归分析显示,性别〔OR(95%CI)=2.785(1.790,4.333)〕、年龄〔OR(95%CI)=1.129(1.108,1.150)〕、文化程度〔OR(95%CI)=0.632(0.425,0.942)〕、糖尿病史〔OR(95%CI)=2.443(1.467,4.069)〕、脑卒中史〔OR(95%CI)=2.136(1.371,3.328)〕、吸烟〔OR(95%CI)=1.603(1.057,2.431)〕、TC〔OR(95%CI)=1.545(1.304,1.830)〕、LDL-C〔OR(95%CI)=1.893(1.365,2.596)〕、脂蛋白a〔OR(95%CI)=1.001(1.000,1.002)〕是急性缺血性脑卒中患者发生CAS的独立影响因素。结论吸烟、收缩压、舒张压、LDL-C、脂蛋白a是急性缺血性脑卒中发生CAS重要的可干预的危险因素,积极控制卒中危险因素,可延缓CAS病变,减少急性缺血性脑卒中的发生。

Background Carotid atherosclerosis(CAS) is an important pathological basis of cerebral infarction,and factors such as immunity and inflammatory response play an important role in the formation and development of atherosclerotic plaques.With the changes in material life and diet structure in recent years,as well as the influence of the aging of population,the incidence of cerebrovascular diseases has increased year by year in China,which makes the prevention and treatment of stroke increasingly severe. Objective To investigate the risk factors of CAS in patients with acute ischemic stroke(AIS). Methods A total of 4 048 patients with AIS who were admitted to the Department of Neurology of Kangji Xintu Hospital of Renqiu from January 2014 to November 2018 were selected and investigated by self-designed questionnaires.The contents of the questionnaire included the general condition,physical examination,laboratory examination and carotid ultrasound.The formation and stenosis of carotid plaques were defined as CAS,and the influence factors of CAS in patients with AIS were analyzed by univariate and multivariate Logistic regression methods. Results The average age of the enrolled population was(64.8±11.3),which included 2 506(61.91%) males and 1 542(38.09%) females.There were 169(4.17%) cases with normal carotid artery,577(14.25%)cases with intimal thickening,2 362(58.35%)cases with plaque formation,and 940(23.22%)cases with carotid artery stenosis.Multivariate Logistic regression analysis showed that gender[OR(95%CI)=2.785(1/790,4.333)],age[OR(95%CI)=1.129(1.108,1.150)],educational level[OR(95%CI)=0.632(0.425,0.942)],diabetes[OR(95%CI)=2.443(1.467,4.069)],stroke[OR(95%CI)=2.136(1.371,3.328)],smoking [OR(95%CI)=1.603(1.057,2.431)],TC[OR(95%CI)=1.545(1.304,1.830)],LDL-C[OR(95%CI)=1.893(1.365,2.596)],and lipoprotein a[OR(95%CI)=1.001(1.000,1.002)] were independent influence factors for CAS in Patients with AIS. Conclusion Smoking,systolic blood pressure,diastolic blood pressure,LDL-C and lipoprotein a are important risk factors for CAS that can be intervened in AIS.Active control of risk factors for stroke can delay the occurrence of CAS lesions and reduce the incidence of stroke.