颈动脉狭窄斑块易损性与急性轻型缺血性脑卒中神经功能进展及早期预后的关联性

Correlation between carotid stenosis,plaque vulnerability and neurological progression,early prognosis in acute mild ischemic stroke

目的探讨颈动脉狭窄、斑块易损性与急性轻型缺血性脑卒中(AMIS)神经功能进展及早期预后的关联性。方法回顾性选取2018-10-2022-10西部战区总医院收治的90例AMIS患者,根据其发病1周内是否存在神经功能恶化(ND)分为ND组(n=24)和非ND组(n=66)。比较2组患者一般资料、血脂代谢相关指标、颈动脉狭窄情况及斑块性质。分析影响AMIS神经功能恶化的影响因素,并观察有无颈动脉狭窄及有无易损斑块患者发病30 d内预后差异。结果ND组ApoB/ApoA1比值大于非ND组(P<0.05)。ND组颈动脉狭窄发生率为66.67%,高于非ND组的28.79%(P<0.05);ND组易损斑块发生率为41.18%,高于非ND组的18.18%(P<0.05)。颈动脉狭窄、易损斑块是导致AMIS患者发生ND的独立危险因素(P<0.05)。ND组发病30 d后预后不良发生率为75.00%(18/24),高于非ND组的16.67%(9/66)(P<0.05);颈动脉狭窄患者发病30 d后预后不良发生率为62.86%(22/35),低于非颈动脉狭窄患者的12.72%(7/55)(P<0.05);存在易损斑块患者发病30 d后预后不良发生率为61.54%(16/26),低于无易损斑块患者的20.31%(13/64)(P<0.05)。结论颈动脉狭窄、易损斑块形成是影响AMIS患者发生ND的独立危险因素,临床可根据患者颈动脉狭窄状态及斑块性质评估预后。

Objective To explore the correlation between carotid stenosis,plaque vulnerability and neurological progression,early prognosis in acute mild ischemic stroke(AMIS).Methods A total of 90 patients with AMIS admitted to the Western Theater General Hospital were retrospectively enrolled between October 2018 and October 2022.According to presence or absence of neurological deterioration(ND)within 1 week after onset,they were divided into ND group(n=24)and non-ND group(n=66).The clinical data in the two groups were collected.The general data,lipid metabolism related indexes,carotid stenosis and plaque properties were compared between the two groups.The influencing factors of ND were analyzed.The differences of prognosis within 30 d after onset in patients with different carotid stenosis and vulnerable plaques status were observed.Results ApoB/ApoA1 ratio in ND group was greater than that in non-ND group(P<0.05),incidence of carotid stenosis was higher than that in non-ND group(66.67%vs 28.79%,P<0.05),and incidence of vulnerable plaques was higher than that in non-ND group(41.18%vs 18.18%,P<0.05).The carotid stenosis and vulnerable plaque were independent risk factors for ND in AMIS patients(P<0.05).Within 30 d after onset,incidence of poor prognosis in ND group was higher than that in non-ND group[75.00%(18/24)vs 16.67%(9/66),P<0.05],incidence of poor prognosis in patients with carotid stenosis was higher than that without stenosis[62.86%(22/35)vs 12.72%(7/55),P<0.05],and incidence of poor prognosis in patients with vulnerable plaques was higher than that without vulnerable plaques[61.54%(16/26)vs 20.31%(13/64),P<0.05].Conclusion Carotid stenosis and vulnerable plaque are independent risk factors for ND in AMIS patients.Clinically,prognosis can be evaluated based on carotid stenosis and plaque properties.