老年急性缺血性脑卒中患者颈动脉斑块检出率及其与脑卒中复发的相关性

Detection rate of carotid plaque in elderly patients with acute ischemic stroke and its association with stroke recurrence

目的应用多普勒彩色超声诊断仪评估老年急性缺血性脑卒中(AIS)患者颈动脉斑块检出情况,总结斑块发生的高危因素,并分析其与AIS复发的相关性。方法以2020年1月至2020年6月于常州市第一人民医院神经内科和老年医学科住院的首次发生AIS,并且72 h内入院的老年患者236例为研究对象。依据颈动脉超声检查结果分为颈动脉斑块组(199例)和无颈动脉斑块组(37例)。收集并分析2组患者的临床资料及随访1.5年后脑卒中复发情况。结果老年AIS患者颈动脉斑块检出率为84.3%。60~69岁、70~79岁及≥80岁患者颈动脉斑块检出率分别为74.7%、86.9%、96.0%,随着年龄增长颈动脉斑块检出率逐渐增加。颈动脉斑块组女性、高血压史和糖尿病史的比例明显高于无斑块组(均P<0.05)。颈动脉斑块组与无颈动脉斑块组脑卒中复发事件发生率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄(OR=1.070,95%CI:1.02~1.122,P=0.005)、糖尿病史(OR=2.262,95%CI:1.055~4.850,P=0.036)、颈动脉斑块(OR=8.128,95%CI:1.077~61.348,P=0.042)是AIS复发的独立影响因素。结论老年AIS患者颈动脉斑块检出率高。年龄、性别、高血压史、糖尿病史是颈动脉粥样硬化的危险因素。年龄、糖尿病史、颈动脉斑块与脑卒中复发事件发生相关。

Objective To investigate the detection rate of carotid plaque using a color Doppler ultrasound diagnostic apparatus in elderly patients with acute ischemic stroke(AIS),as well as the highrisk factors for carotid plaque and its association with stroke recurrence.Methods A total of 236 elderly patients with firstepisode ischemic stroke who were admitted within 72 hours and were hospitalized in the Department of Neurology and Department of Geriatrics,First People's Hospital of Changzhou,from January to June,2020,were included.According to the results of carotid artery sonography,they were divided into carotid plaque group with 199 patients and noncarotid plaque group with 37 patients.The two groups were analyzed in terms of clinical data and stroke recurrence after 1.5 years of followup.Results The detection rate of carotid plaque was 84.3%in the elderly patients with AIS.The detection rate of carotid plaque in the patients aged 6069 years,7079 years,and≥80 years was 74.7%,86.9%,and 96.0%,respectively,suggesting that the detection rate of carotid plaque tended to increase with age.Compared with the noncarotid plaque group,the carotid group had a significantly higher proportion of female patients or the patients with a history of hypertension and diabetes(P<0.05).There was a significant difference in the incidence rate of stroke recurrence events between the carotid plaque group and the noncarotid plaque group(P=0.042).The multivariate logistic regression analysis showed that age[odds ratio(OR)=1.070,95%confidence interval(CI):1.021.122,P=0.005],diabetes(OR=2.262,95%CI:1.0554.850,P=0.036),and carotid plaque(OR=8.128,95%CI:1.07761.348,P=0.042)were independent influencing factors for stroke recurrence.Conclusions There is a high detection rate of carotid plaque in elderly patients with AIS.Age,sex,hypertension,and diabetes are risk factors for carotid atherosclerosis,and age,diabetes,and carotid plaque are associated with stroke recurrence events.