颈动脉粥样硬化斑块成分与脑缺血症状的相关性研究

Research on the association between components of carotid atherosclerosis plaque and the symptoms of cerebral ischemia

目的分析颈动脉斑块的不稳定成分与患者术前脑缺血症状的相关性,并探讨与临床症状较为密切的组织学影响因素。方法收集2014年6月至2015年4月间48例颈动脉狭窄患者的病变侧狭窄率数据、术前相关脑缺血症状以及经颈动脉内膜剥脱得到的颈动脉斑块的病理资料。根据患者是否出现具体的脑缺血症状进行分组,分析临床判断的脑缺血症状与斑块成分的相关性。结果 48例患者有脑缺血症状组30例,无症状组18例。有症状组斑块成分中出现薄纤维帽和不完整纤维帽的频率显著高于无症状组(66.7%vs 33.3%,P<0.05),语言障碍组的斑块出现血栓形成的比例更高(80.0%vs 27.9%,P<0.05),有一过性瘫痪组斑块更容易出现纤维帽不完整、血栓形成和溃疡(P<0.05),脑梗死组斑块更易出现血栓形成和明显出血(88.9%vs 38.5%,P<0.05)。血栓形成、溃疡形成、明显出血分别对一过性语言障碍[比值比(OR)=10.333]、一过性瘫痪(OR=7.000)和脑梗死(OR=12.800)影响最明显。结论患者的临床脑缺血症状,可以提示颈动脉斑块不稳定成分的存在;没有症状的患者的颈动脉斑块相当一部分是不稳定的,在评价斑块性质时其他检查是不可或缺的。

Objective To evaluate the association between the symptoms of cerebral ishcemia and components of carotid atherosclerosis plaque and explore the histology factors of clinical symptoms.Methods48 patients with carotid artery stenosis were recruited from June 2014 to April 2015,and were divided into two groups based on their symptom of cerebral ischemia.Datas of carotid artery stenosis,the symptoms of cerebral ischemia and the pathological components of carotid plaque were also collected at the same time.Correlation statistical methods were used to determine the association of clinical symptoms of cerebral ischemia and plaque components.Results Of 48 patients,30 were patients with clinical symptoms and 18 were patients without clinical symptoms.The proportion of fibrous capand incomplete fibrous cap in the carotid plaque among patients with clinical symptoms of cerebral ischemia was higher than that among patients without symptoms(P<0.05).Patients with language disorder had more thrombosis plaques(80.0% vs 27.9%,P<0.05).Patients with transient paralysis had more fibrous cap,thrombosis plaques and ulcer(P<0.05)in the carotid plaque.Patients with cerebral infarction has more thrombosis and significant plaque hemorrhage(88.9% vs 38.5%,P<0.05).Thrombosis,ulceration,and significant plaque hemorrhage was the most related influence factor for language disorder [odds ratio(OR)=10.333],transient paralysis(OR=7.000)and cerebral infarction(OR=12.800),respectively.Conclusions Clinical symptoms of cerebral ischemia can prompt the exist of a unstable component of the carotid artery plaque;and quite a plque of patients with no symptoms is unstable;other methods are essential when evaluating the stibility of plaque.