急性脑梗死患者神经功能缺损与颈动脉粥样硬化斑块关系的临床研究

Clinical research of the relationship between the neurological deficit and carotid atherosclerotic plaque in patients with acute cerebral infarction

目的:探讨急性脑梗死患者神经功能缺损与颈动脉粥样硬化斑块的关系。方法 :选择2015年8月至2019年12月期间在上海交通大学医学院附属瑞金医院就诊的急性脑梗死患者1 022例,根据美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分将患者分为轻症组(n=572)和中重症组(n=450)。同时根据颈动脉彩色多普勒超声仪检查结果,分为无斑块组(n=365)和有斑块组(n=657);并按斑块数量分为单发斑块组(n=249)、双发斑块组(n=91)和多发斑块组(n=317),按回声特点分为稳定斑块组(n=316)和不稳定斑块组(n=341)。分析各亚组在NIHSS评分轻症组和中重症组的发生率差异。结果:无斑块组中轻症患者占71.8%(262/365),有斑块组中轻症患者占43.1%(283/657),2组比较差异有统计学意义(χ^(2)=57.604,P<0.01)。单发斑块、双发斑块和多发斑块组间中重症患者所占比例差异有统计学意义(χ^(2)=9.979,P=0.007),中重症组不稳定斑块患者比例(57.4%)高于轻症组(45.8%)(χ^(2)=8.738,P=0.003)。多因素Logistic回归分析结果显示,与无斑块组对照,有斑块组NIHSS评分>3分可能性是原来的3.691倍。结论:急性脑梗死患者神经功能缺损严重性与颈动脉粥样硬化斑块发生率、斑块数量及性质有关。

Objective To investigate the relationship between the neurological deficit and carotid atherosclerotic plaque in patients with acute cerebral infarction(CI).Methods From August 2015 to December 2019,1022 patients with CI were selected from Ruijin Hospital.According to National Institute of Health stroke scale(NIHSS)score,the patients were divided into mild group(n=572)and moderate to severe group(n=450).Meanwhile,according to carotid color Doppler ultrasound,all patients were divided into non-carotid plaque group(n=365)and carotid plaque group(n=657).Furthermore,the carotid plaque group was divided into single plaque group(n=249),double plaque group(n=91)and multiple plaque group(n=317)based on the number of plaques,and according to the echo characteristics and the plaque stability,the plaque group was divided into stable plaque group(n=316)and unstable plaque group(n=341).The difference of the incidence of carotid plaque between the mild and moderate to severe group was analyzed.Results There were 71.8%(262/365)mild patients in the non-plaque group and 43.1%(283/657)mild patients in the plaque group.There was significant difference between the two groups(χ^(2)=57.604,P<0.01).There was significant difference in the proportion of moderate to severe patients among single plaque,double plaque and multiple plaque groups(χ^(2)=57.604,P<0.01).The proportion of unstable plaque in the moderate to severe group(57.4%)was higher than that in the mild group(45.8%).Multivariate Logistic regression analysis showed that the possibility of NIHSS>3 in the plaque group was 3.691 times higher than that in non-plaque group.Conclusions The severity of neurological deficit in patients with acute cerebral infarction may be related to the incidence of carotid atherosclerotic plaques,the number and character of plaques.