颈动脉内膜中层厚度与短暂性脑缺血发作患者卒中风险的关系

Relationship between carotid artery intima-media thickness and stroke risk in patients with transient ischemic attack

目的探讨颈动脉内膜中层厚度(IMT)和颈内动脉系统短暂性脑缺血发作(TIA)患者卒中风险之间的关系。方法回顾性分析2019年1月至2021年9月蚌埠市第三人民医院就诊的颈内动脉系统TIA患者128例的临床资料,根据是否进展为卒中分为脑卒中组(37例)与无脑卒中组(91例),依据ABCD2评分将其分为高危组(21例)、中危组(62例)和低危组(45例)。收集所有患者的一般资料,测定血脂水平及颈动脉IMT,同时观察有无斑块形成,斑块的大小、形态及性质。采用多因素logistic回归分析影响TIA后脑卒中的危险因素。结果脑卒中组症状对侧的颈动脉IMT值及颈动脉软斑、易损斑块的发生率显著高于无脑卒中组(P<0.01,P<0.05)。高危组TIA患者的症状对侧颈动脉IMT、软斑及易损斑块发生率均高于低危组(P<0.01)。中危组症状对侧的颈动脉IMT、混合斑块及易损斑块发生率高于低危组(P<0.01),高危组症状对侧的颈动脉IMT、软斑发生率高于中危组(P<0.01)。多因素logistic回归分析显示,年龄大、首次发作至就诊时间长、症状持续时间长、既往有脑梗死病史和症状对侧颈动脉IMT值高为影响颈内动脉系统TIA后脑卒中的独立危险因素(P<0.05,P<0.01)。结论TIA后脑卒中发生率较高,与IMT增厚密切相关,颈动脉IMT可能也是颈内动脉系统TIA患者进展为脑卒中的独立危险因素之一。

Objective To investigate the relationship between carotid artery intima-media thickness(IMT)and stroke risk after transient ischemic attack(TIA)in internal carotid artery.Methods A total of 128 patients with internal carotid artery TIA treated in the Third People s Hospital of Bengbu from January 2019 to September 2021 were selected and divided into the stroke group(n=37)and the non-stroke group(n=91).The patients were divided into high-risk group(n=21),medium risk group(n=62)and low-risk group(n=45)according to ABCD2 score.The general data of all patients were collected,and the blood-lipid level,carotid artery IMT and the formation of plaque(shape,size and nature)were measured and observed.Multivariate logistic regression analysis was used to analyze the independent risk factors of stroke after TIA.Results The IMT value and the incidence of carotid soft plague and vulnerable plaque on the opposite side of symptoms in stroke group were significantly higher than those in non-stroke group(P<0.01,P<0.05).The iucidences of carotid IMT and vulnerable plaque on the opposite side of symptoms in high-risk group and medium-risk group were significantly higher than those in low-risk group(P<0.01).The incidence of soft plaque in high-risk group was higher than that in medium and low-risk groups(P<0.01),while the incidence of mixed plaque in medium-risk group was higher than that in low-risk group(P<0.01).Multivariate logistic regression analysis showed that hypertension,time from first attack to visit,duration of symptoms,history of previous cerebral infarction and incidence carotid IMT on the opposite side of symptoms were the independent risk factors for stroke after internal carotid artery TIA(P<0.05,P<0.01).Conclusion TIA patients have a higher incidence of stroke,which is closely related to IMT thickening.Carotid artery IMT may also be an independent risk factor for stroke progression in patients with TIA of internal carotid artery system.