缺血性脑卒中患者颈动脉斑块稳定性及狭窄的危险因素分析

Analysis of risk factors for carotid artery plaques stability and stenosis in patients with ischemic stroke

目的 探讨缺血性脑卒中患者颈动脉斑块稳定性及狭窄的危险因素。方法 收集2020年5月至2021年5月于湘南学院附属医院住院接受诊治的159例缺血性脑卒中患者的临床资料,根据颈动脉斑块稳定性将患者分为斑块稳定组(n=67)和斑块不稳定组(n=92)。另根据颈动脉狭窄程度将患者分为轻度狭窄组(n=108)和中重度狭窄组(n=51)。比较斑块稳定组与斑块不稳定组、轻度狭窄组与中重度狭窄组患者的临床特征,分析缺血性脑卒中患者颈动脉斑块不稳定及颈动脉中重度狭窄的危险因素。结果 斑块稳定组患者的年龄、高血压比例、糖尿病比例、低密度脂蛋白胆固醇(LDL-C)水平、糖化血红蛋白(HbA1c)水平及D-二聚体/纤维蛋白原比值(DFR)均低于斑块不稳定组患者,载脂蛋白E(ApoE)水平高于斑块不稳定组患者,差异均有统计学意义(P<0.05)。轻度狭窄组患者的年龄、高血压比例、糖尿病比例、LDL-C水平、HbA1c水平及DFR均低于中重度狭窄组患者,ApoE水平高于中重度狭窄组患者,差异均有统计学意义(P<0.05)。多因素分析结果显示,年龄、高血压、糖尿病、LDL-C水平、HbA1c水平、ApoE水平及DFR均是缺血性脑卒中患者颈动脉斑块不稳定和颈动脉中重度狭窄的影响因素(P<0.05)。结论 年龄、高血压、糖尿病、LDL-C水平、HbA1c水平、ApoE水平及DFR均与缺血性脑卒中患者颈动脉斑块不稳定和颈动脉狭窄密切相关,值得深入研究。

Objective To analyze the risk factors for carotid artery plaques stability and stenosis in patients with ischemic stroke.Method The clinical data of 159 patients with ischemic stroke who were hospitalized and treated in the Affiliated Hospital of Xiangnan University from May 2020 to May 2021 were collected.According to the stability of carotid artery plaques,the patients were divided into plaque stable group of 67 cases and plaque unstable group of 92 cases.According to the degree of carotid artery stenosis,the patients were divided into mild stenosis group of 108 cases and moderate to severe stenosis group of 51 cases.The clinical characteristics of patients with plaque stable group and plaque unstable group,as well as those with mild stenosis group and those with moderate to severe stenosis group were compared,the risk factors for unstable carotid artery plaques and moderate to severe carotid artery stenosis in patients with ischemic stroke were analyzed. Result The age, the ratio of hypertension, the ratio of diabetes, the low density lipoprotein-cholesterol (LDL-C) level, the glycosylated hemoglobin (HbA1c) level and the D-dimer to fibrinogen ratio (DFR) of patients in the plaque stable group were lower than those in the plaque unstable group, and the apolipoprotein E (ApoE) level was higher than that in the unstable group, all the differences above were statistically significant (P<0.05). The age, the ratio of hypertension, the ratio of diabetes, the LDL-C level, the HbA1c level and the DFR of patients in the mild stenosis group were lower than those in the moderate to severe stenosis group, and the ApoE level was higher than that in the moderate to severe stenosis group, and the differences were statistically significant (P<0.05). Multivariate analysis showed that age, hypertension, diabetes, LDL-C level, HbA1c level, ApoE level and DFR were risk factors of carotid plaque instability and moderate to severe carotid stenosis in ischemic stroke patients (P<0.05). Conclusion The age, hypertension, diabetes, LDL-C level, HbA1c level, ApoE level and DFR are closely related to unstable carotid artery plaques and moderate to severe carotid artery stenosis in patients with ischemic stroke, and it is worth further study.