无症状性颈动脉狭窄患者颅脑灌注缺损与脑卒中发病风险的相关性

The association between craniocerebral perfusion defect and stroke risk among patients with asymptomatic carotid artery stenosis

目的探讨颅脑灌注缺损与无症状性颈动脉狭窄(ACAS)患者缺血性脑卒中发病风险的相关性。方法连续纳入2017年10月至2020月3月就诊于丽水市人民医院的ACAS患者。所有患者均完成基线颅脑CT灌注及头颈部血管CTA检查。基于CT灌注的平均通过时间(MTT)图像将患者分为灌注缺损组和灌注正常组,然后前瞻性随访评估这两组患者两年内的缺血性脑卒中发病率,经二元Logistic回归分析患者发生缺血性脑卒中的影响因素。结果共有106例患者纳入分析,在两年的随访期内共有13例(12.26%)患者发生狭窄同侧缺血性脑卒中事件,其中灌注缺损组5例(5/18,27.78%),灌注正常组8例(13/88,9.09%),灌注缺损组缺血性脑卒中的发生率显著高于灌注正常组(χ^(2)=4.850,P<0.05)。重度血管狭窄组缺血性脑卒中事件的发生率显著高于中度血管狭窄组,差异有统计学意义(χ^(2)=4.026,P<0.05)。不规范用药组缺血性脑卒中的发生率显著高于规范用药组(χ^(2)=6.255,P<0.05)。二元Logistic回归分析显示,灌注缺损和高脂血症是ACAS患者发生缺血性脑卒中事件的危险因素[OR(95%CI)=6.455(1.444~28.865)、5.307(1.293~21.786),P<0.05],规范用药是ACAS患者发生缺血性脑卒中事件的保护因素[OR(95%CI)=0.110(0.024~0.500),P<0.05]。结论颅脑灌注缺损能增加ACAS患者发生缺血性脑卒中事件的风险,而坚持规范用药则能有效降低该风险。

Objective To investigate the association between craniocerebral perfusion defect and ischemic stroke risk in patients with asymptomatic carotid artery stenosis(ACAS).Methods Patients with ACAS who visited Lishui People's Hospital from October 2017 to March 2020 were consecutively enrolled.All patients underwent baseline cerebral CT perfusion and head-neck CT angiography.Based on mean transit time(MTT)images of CT perfusion,patients were divided into two groups:the perfusion defect group and the normal perfusion group.Prospective follow-up was conducted to assess the incidence of ischemic stroke within two years in both groups.Binary Logistic regression analysis was performed to analyze the influencing factors of ischemic stroke.According to different craniocerebral perfusion defect conditions,stratified Chi-square test was used to analyze the correlation between stenosis degree,medication compliance and the risk of ischemic stroke.Results A total of 106 patients were enrolled in the final analysis.During the 2-year follow-up period,13(12.26%)patients experienced stenosis ipsilateral ischemic stroke events,including 5(5/18,27.78%)cases in the perfusion defect group and 8(13/88,9.09%)cases in the normal perfusion group,the incidence of ischemic stroke in the perfusion defect group was significantly higher than that in the normal perfusion group(χ^(2)=4.850,P<0.05).The incidence of ischemic stroke events was significantly higher in the severe vascular stenosis group than that in the moderate vascular stenosis group(χ^(2)=4.026,P<0.05).The incidence of ischemic stroke was significantly higher in the non-compliant medication group than that in the compliant medication group(χ^(2)=6.255,P<0.05).Binary logistic regression analysis showed that perfusion defect and hyperlipidemia were risk factors for ischemic stroke events in ACAS patients[OR(95%CI)=6.455(1.444-28.865),5.307(1.293-21.786);P<0.05],while medication compliance was a protective factor[OR(95%CI)=0.110(0.024-0.500),P<0.05].Conclusion Craniocerebral perfusion defect significantly increases the risk of ischemic stroke in patients with ACAS,while adherence to medication compliance effectively reduces this risk.