颈动脉彩超在脑卒中高危人群检查中的应用价值

目的探讨颈动脉彩色多普勒超声对脑卒中高危人群的诊断价值。方法对我院2011-05—2014-05接收的脑卒中高危人群进行问卷调查,采用颈动脉多普勒超声诊断评价不同年龄段患者颈动脉内膜厚度、颈动脉斑块形成及颈动脉狭窄的发生率,统计影响脑卒中高危患者发生脑卒中的危险因素。结果 352例脑卒中高危人群中,颈动脉内膜增厚及斑块形成分别占38.92%、32.10%,颈动脉狭窄占2.84%;60~85岁组颈动脉内膜增厚及斑块形成构成比高于50~59岁组,组间比较差异有统计学意义(P0.05);80~85岁组颈动脉狭窄的构成比显著高于其他年龄段患者(P0.01)。年龄、高血压、高血脂、吸烟饮酒及并发症种类是颈动脉斑块形成的影响因素(P0.05)。Logistic回归分析结果表明,年龄、高血压、高血脂、吸烟饮酒史、并发症种类及颈动脉斑块形成是影响脑卒中高危患者脑卒中的独立危险因素(P0.05),其中,颈动脉斑块形成对其的影响作用最大(OR=0.686,95%CI:0.565~0.698,P0.05)。结论年龄、吸烟饮酒史、并发症及颈动脉斑块形成是影响脑卒中高危患者脑卒中的独立危险因素。     

颈动脉超声应用筛查颈动脉狭窄及脑卒中高危因素分析

目的分析广西壮族自治区梧州市角嘴社区颈动脉超声应用筛查颈动脉狭窄结果及脑卒中的高危因素。方法选择2013年1月~2015年3月广西壮族自治区梧州市角嘴社区5789名居民为研究对象,对其采用问卷调查及体格检查,统计分析颈动脉超声检查的结果及脑卒中高危因素。结果调查的5789名居民中,≥60岁居民内膜增厚发生率26.65%,斑块形成率为13.67%;40~60岁居民内膜增厚发生率9.20%,斑块形成率为4.42%。≥60岁居民的内膜增厚发生率和斑块发生率均比40~60岁居民高(P0.05)。男性内膜增厚发生率27.89%,斑块形成率为11.38%,女性内膜增厚发生率8.06%,斑块形成率为7.37%。男性内膜增厚发生率和斑块发生率均比女性居民高(P0.05)。居民的脑卒中高危因素分析表明,吸烟史、高血压病、明显超重或肥胖、缺乏运动所占比例高,分别为14.32%、16.02%、16.02%、35.13%,与其他因素相比差异具有统计学意义(P0.05);高血压病、明显超重或肥胖、缺乏运动与脑卒中的发生关联较大(P0.05)。结论广西壮族自治区梧州市角嘴社区脑卒中高危人群的干预的重点方向应为降低血压、控制饮食和多运动。通过开展颈动脉血管超声检查,实现居民脑卒中前期患者的早发现、早干预、早治疗。     

颈动脉超声对颈动脉狭窄及脑卒中高危人群的应用价值

目的探讨颈动脉狭窄及脑卒中高危人群中应用颈动脉超声的临床价值。方法选取2013-03—2013-09我院神经内科接收脑卒中康复治疗140例患者的资料进行分析,运用颈部血管超声检测颈动脉内中膜厚度(IMT)及斑块等。结果140例脑卒中高危人群中,超声检出颈动脉狭窄率75.1%,其中男性颈动脉内膜增厚占70.4%,颈动脉斑块阳性占80.3%;女性颈动脉增厚占59.4%,颈动脉斑块阳性占78.3%。颈动脉狭窄患者糖尿病、高血压、吸烟、饮酒及血脂程度高于正常患者。经Pearson相关分析发现颈动脉狭窄与脑卒中危险因素相关。结论颈动脉狭窄是脑血管病发病的危险因素,超声是探查颈动脉狭窄的有效手段。     

颈部血管彩色多普勒超声在脑卒中高危人群筛查中的应用价值

目的脑卒中高危人群患者应用颈部血管彩色多普勒超声筛查的临床价值。方法选取2013—2014在我院体检的45岁以上受检者734例,对存在脑卒中高危因素的受检者与其他受检者的颈部彩超资料进行分析。结果 734例受检者中高危人群534例,脑卒中患者84例,一般人群116例,颈动脉狭窄发生率为37.47%,左侧IMT增厚10.22%,右侧IMT增厚9.40%。脑卒中高危人群与脑卒中患者颈动脉斑块检出率相比一般人群明显提高。高危人群的颈动脉血管斑块,主要为单发斑块,单发斑块发生率为26.97%,性质以规则均质为主。结论在脑卒中筛查中颈部血管彩超能够有效确定高危人群,能够准确预测颈动脉狭窄的发生,对脑卒中早期预防与控制有重要作用。     

社区脑卒中筛查有效性的分析

目的探讨社区脑卒中筛查的意义。方法对1091例北京市户籍社区居民,通过填写调查问卷、体格检查、颈动脉彩超检查的方法,对筛查的结果进行分析。结果前四位可变的危险因素为肥胖、高血压、血脂异常和糖尿病,此四种危险因素人数占总人数的百分比分别为62．0％、45．7％、28．7％和17．3％。吸烟（10．6％）、饮酒（12．6％）等不良生活方式也占较大比例。在1091例参与者中,颈动脉彩超结果显示455例（41．7％）内膜中层增厚、326例（29．9％）单发斑块、324例（29．7％）多发斑块和90例（8．2％）颈动脉狭窄。结论①社区脑卒中筛查能够了解本辖区人群的脑卒中危险因素暴露隋况,为高危人群制定相应的干预措施提供了依据。②填写调查问卷、体格检查和进行颈动脉彩超检查这种社区筛查的方法是筛检脑卒中高危人群可行有效的方法,对社区脑卒中的防控有指导意义。     

长沙市乡村居民脑卒中危险因素调查及颈动脉粥样硬化斑块影响因素分析

目的调查长沙市乡村居民脑卒中相关危险因素并分析颈动脉粥样硬化斑块的影响因素。方法通过问卷调查、体格检查、血糖和血脂的检测收集长沙市潭阳村40岁以上的常住居民脑卒中相关危险因素并进行风险评估;对高危人群进行颈动脉彩色超声检查,并分为斑块组和无斑块组;采用单因素分析和多因素logistic回归模型对颈动脉粥样硬化斑块影响因素进行分析。结果长沙市潭阳村居民常见危险因素为血脂异常(45.8%)、吸烟(37.8%)、高血压病(30.9%)、明显超重及肥胖(22.4%)、家族史(11.3%)、缺乏运动(8.7%)、糖尿病(7.0%)。男性吸烟率较女性高(P<0.05);女性血脂异常和高血压患病率较男性高(P<0.05)。单因素分析显示斑块组较对照组年龄更高、糖尿病和高血压病患病率更高(P<0.05)。logistic多元回归分析显示糖尿病、高血压病、年龄是颈动脉粥样硬化斑块的危险因素(OR值分别为2.918、1.643、1.531)。结论长沙市40岁以上乡村居民常见的脑卒中危险因素是高血压病、糖尿病、血脂异常、明显超重及肥胖、吸烟;危险因素暴露率较高且有性别差异;颈动脉粥样硬化斑块的形成主要与糖尿病、高血压病、年龄有关。     

中国包头市城镇居民脑血管狭窄的流行病学

目的发现人群中脑动脉粥样硬化病变的分布和颅内、颅外动脉狭窄的患病率。方法采用分层抽样的方法,随机抽取研究对象2482人,用标准的问卷收集资料,包括姓名、年龄、性别、吸烟状况、高血压病史、糖尿病史、高脂血症史、心脏病史,测量血压,检测血糖、血脂并进行颈动脉彩色超声和经颅多普勒(TCD)检查。结果筛查的2482人的应答率为2360人,占95%,所有2360人中,颅内动脉狭窄的患病率是8.1%,颅内外动脉狭窄的患病率是9.2%。颅内动脉狭窄的影响因素中,性别(P=0.01)、高血压(P=0.04)、糖尿病(P=0.00)在颅内动脉狭窄组和无狭窄组差异有统计学意义,其余各因素无显著性差异。颈动脉粥样硬化病变(包括内膜增厚,1个或多个斑块形成,管腔狭窄或闭塞)发生率33.4%。结论颈动脉和颅内动脉粥样硬化病变在中老年健康人群中是普遍存在的,在没有任何自觉症状的正常人群中就已经有颅内血管的狭窄,联合应用颈部血管彩色超声和TCD会发现更多的狭窄或动脉粥样硬化病变。     

颈动脉粥样硬化相关性脑缺血病变临床探讨

目的通过观察颈动脉粥样硬化相关性脑缺血病变的临床特点及发病机制,为脑血管病的防治提供依据。方法回顾性分析256例前循环缺血性卒中患者的临床特点、颈部血管彩超及TCD资料。结果颈动脉正常组、内膜增厚组、斑块形成组、管腔狭窄组脑梗死发生率分别为为19.1%、36.2%、42.5%、49.1%;3组间的差异具有统计学意义(χ2=22.16,P<0.05);颈动脉正常组、内膜增厚组、斑块形成组、管腔狭窄组侧支循环开放率分别为19.1%、36.2%、47.1%、67.9%;各组间侧支循环开放率比较,差异有统计学意义(χ2=14.16,P<0.05)。结论颈动脉内中膜厚度、侧支循环的开放与患者的临床预后显著相关。     

187例河套地区无症状性颈动脉狭窄患者危险因素调查及三年内脑梗死的发生率分析

目的探讨河套地区无症状性颈动脉狭窄的危险因素及3年内脑梗死的发生率。方法对河套地区经颅多普勒超声诊断无症状性颈动脉狭窄者187例及81例无颈动脉狭窄的人群进行病史询问,监测血压,检测血糖、血脂、血流变学分析及无症状性颈动脉狭窄的危险因素;并对187例无症状性颈动脉狭窄者随访3年,统计脑梗死的发生率。结果狭窄组与无狭窄组年龄差异无统计学意义(P>0.05),狭窄组糖尿病、高脂血症、高纤维蛋白原血症、吸烟率显著高于无狭窄组(P<0.05),狭窄组高血压发生率及饮酒率与无狭窄组差异无统计学意义(P>0.05);187例无症状性颈动脉狭窄者3年内有30例发生脑梗死,发生率为16.04%。结论糖尿病、高脂血症、高纤维蛋白原血症、吸烟是无症状性颈动脉狭窄的主要危险因素,年龄、性别、高血压、饮酒不是危险因素,无症状性颈动脉狭窄以轻度狭窄居多占48.66%,中度及重度狭窄次之,分别占29.95%、21.39%,单侧狭窄占88.77%,双侧狭窄占11.23%,无症状性颈动脉狭窄是脑梗死的危险因素,应该早期干预治疗,减少脑梗死的发生。     

缺血性脑卒中患者早期神经功能恶化相关危险因素分析

目的探讨导致缺血性脑卒中患者出现早期神经功能恶化的相关危险因素。方法选择我院收治的缺血性脑卒中患者134例,按照是否发生END分为END组46例和对照组88例,对2组性别、年龄、发病至就诊时间、体质量、吸烟史、饮酒史、糖尿病、高血压、高脂血症、冠心病、心房颤动、粥样硬化斑块、颈动脉狭窄等病史,白细胞计数、血糖、C反应蛋白、血清总胆固醇、三酰甘油、凝血酶原时间、纤维蛋白原、D-二聚体等指标以及NIHSS评分等危险因素进行单因素及多因素Logistic回归分析。结果 134例缺血性脑卒中患者中共46例患者出现END;单因素回归分析发现糖尿病、高血压、高脂血症、心房颤动等病史,颈动脉狭窄程度、粥样硬化斑块稳定程度、白细胞计数、C-反应蛋白含量、D-二聚体含量、凝血酶原时间以及NIHSS评分等显著相关(P0.05);而多因素回归分析后得到糖尿病、高血压、心房颤动病史、颈动脉狭窄超过50%、NIHSS高评分是导致缺血性脑卒中患者出现END的相关危险因素(P0.05)。结论缺血性脑卒中患者出现END会增加患者死亡的风险,且预后较差,因此应该积极地对糖尿病、高血压、心房颤动病史、颈动脉狭窄超过50%、NIHSS高评分等END的相关危险因素进行干预,帮助患者改善预后。     

高龄患者颈动脉支架置入效果和安全性分析

目的 探讨高龄颈动脉狭窄患者施行血管内支架成形术治疗的可行性和安全性.方法 回顾性分析2009年12月至2011年5月间首都医科大学宣武医院神经介入放射诊疗中心实施脑保护下血管内支架置入治疗22例超高龄颈动脉狭窄病人的临床资料,其中男16例,女6例,年龄80-85岁,平均81.8岁.21例单侧颈动脉狭窄放置1枚支架;1例左侧颈动脉狭窄合并左椎动脉狭窄同时进行了治疗,分析患者的疗效及并发症等.结果 在围手术期内出现严重并发症2例,术中出血1例,1例术后10小时出现心跳骤停,围手术期并发症发生率为9.1％,高于可以接受的6％,对所有病例随访3-18个月(平均7个月),按mRS评分0分20例,7分1例,无一例出现新发神经功能障碍.结论 高龄患者行颈动脉支架成形术的安全性和有效性还需进一步评价.     

1729例卒中高危人群颈动脉超声筛查结果分析

目的 了解社区40岁以上卒中高危人群颈动脉粥样硬化情况,为卒中高危人群的干预措施提供依 据。 方法 研究方法为横断面研究,采用知情自愿的原则,从辖区内抽取40岁以上的常住人口,用问卷筛 选出1729例卒中高危人群,对所有高危人群进行体格检查、实验室检查及颈动脉超声检查(检测颈 动脉内膜中层及斑块形态)。 结果 问卷筛查出高危人群1729例,其中男性453例（26.2%）,女性1276例（73.8%）,平均年龄 为（58.8±9.6）岁。颈动脉超声显示异常的833例（48.2%）,其中颈动脉内膜中层单纯增厚、颈动脉粥 样硬化斑块分别为98例和735例,分别占总高危人群的5.7%和42.5%,分别占超声异常高危人群的 25.1%和88.2%。按照年龄分层,40～50岁、50～60岁、60～70岁和70岁及以上组左侧颈动脉内膜中层 增厚（χ2=15.5,P =0.001）和右侧颈动脉内膜中层增厚（χ2=26.7,P＜0.001）发生率差异具有显著性; 不同年龄组动脉粥样硬化斑块的比率差异也具有显著性（χ2=48.6,P＜0.001）。 结论 卒中高危人群中,颈动脉超声异常发生率较高,颈动脉内膜增厚和动脉粥样硬化斑块形成均 有随着年龄增加而增多的趋势。     

常德市城区脑卒中患者预后因素分析

目的调查分析影响常德市城区40岁以上脑卒中患者预后的因素。方法制定统一调查表,由专门培训人员对常德城区40岁以上人群6095人进行脑卒中流行病学调查,并采用改良Rankin量表(mRS)对脑卒中患者的预后进行评定,分为预后良好组和预后不良两组。利用χ2/t检验进行单因素分析,Logistic回归进行多因素分析。结果社区调查发现628例脑卒中患者,其中预后良好者332例(52.87%),预后不良者296例(47.13%)。单因素分析显示,两组在年龄、文化水平、既往脑卒中史、吸烟史、血糖、卒中类型、脑出血按出血部位分型和血肿大小分型,缺血性脑卒中各亚型比较差异具有统计学意义(P0.05)。多因素分析显示预后不良与高龄、低文化程度、既往有脑卒中病史相关(P0.05)。结论年龄、文化水平、脑卒中病史、卒中类型是脑卒中患者预后不良的主要因素,因此要积极采取有效措施改善脑卒中患者预后。     

Isolated Upper Limb Weakness From Ischemic Stroke: Mechanisms and Outcome

Objective

To characterize isolated upper extremity (UE) weakness from stroke.

缺血性脑卒中患者颈动脉易损斑块磁共振表现

目的探讨缺血性脑卒中患者颈动脉易损斑块MR诊断价值。方法经颅MRI证实的首发或再发缺血性脑卒中患者并经过B超检查筛选颈动脉狭窄38例,分别行MR多序列及多期动态增强扫描。结果经MR图像分析,颈总动脉分叉区狭窄20例,颈内动脉狭窄或者闭塞18例,钙化8例,无钙化纤维成分为主19例,明显脂质核心6例,斑块内出血2例,脂质坏死核心2例,溃疡或者纤维帽撕裂1例。结论 MR多序列及多期动态增强扫描对颈动脉易损斑块成分显示清晰,能够动态观察易损斑块变化情况。     

体检人群劲动脉超声筛查结果及脑卒中危险因素分析

目的解体检人群中脑卒中发病风险,筛选高危人群,并分析相关危险因素,为脑卒中的预防提供依据。方法以2015-04—2016-06我院256例体检者为研究对象,进行常规体格检查和劲动脉超声筛查,包括双侧颈总动脉、颈内动脉、颈外动脉等,记录颈动脉粥样硬化斑块检出情况,并对性别、年龄、高血脂、高血压、肥胖等危险因素进行分析。结果年龄≥60岁患者斑块形成率为11.76%,高于年龄60岁的4.10%,差异有统计学意义(P0.05);男性斑块形成率为11.02%,高于女性的3.88%,差异有统计学意义(P0.05);Logistic回归分析显示,年龄、高血脂、高血压、肥胖为脑卒中的危险因素(P0.05)。结论老年人群脑卒中发病率较高,男性较女性发病率高,发生率与、高血脂、高血压、肥胖等危险因素有关。     

Assessing the risk of stroke development following retinal artery occlusion

BackgroundRetinal artery occlusion (RAO) can cause acute, painless, and irreversible loss of vision. Using a large sample population database, we investigated the possible impact of RAO and numerous other clinical and non-clinical factors on the risk of developing a subsequent cerebrovascular accident.MethodsCases of RAO were obtained from the National Inpatient Sample (NIS) database between 2002 and 2013 using ICD-9 codes. Associated morbidities and procedures were assessed in these cases with a primary hospital admitting diagnosis of stroke. Univariate and multivariate logistic regression analyses were carried out in RAO cases to determine risk factors for stroke. The Bonferroni correction method was applied.ResultsThe RAO group consisted of 19,809 cases that were separated into stroke (n=1,157, 55% male, mean age: 69±0.4 years) and non-stroke (n=18,652, 55% male, mean age: 68±0.1) cohorts. Age groups associated with reduced risk of stroke with respect to were 20-39 (OR: 0.391), 40-59 (OR: 0.842), and 60-79 (OR: 0.837). No cases of stroke were present for ages < 20. Other factors associated with a reduced stroke risk were carotid stenosis (OR: 0.187), transient ischemic attack (OR: 0.064), coronary artery disease (OR: 0.788), cardiac catheterization (OR: 0.481), and septicemia (OR: 0.333). Factors associated with an increased risk of stroke included hypertension (OR: 1.418), tobacco use (OR: 1.568), valvular disease (OR: 1.359), hyperlipidemia (OR: 1.298), and non-stroke cerebrovascular disease (OR: 2.985).ConclusionsA large patient population was used to determine that RAO patients with a history of hypertension, hyperlipidemia, tobacco usage, valvular disease, or non-stroke cerebrovascular disease had an increased risk of stroke. Patients below the age of 40 had significantly reduced the odds of stroke. Carotid stenosis, coronary artery disease, transient ischemic attacks, cardiac catheterization, and septicemia were all independently associated with a decreased risk of stroke development in RAO patients.     

Clustering of risk factors increases the incidence of echolucent carotid plaque in stroke patients

BACKGROUND: The purpose of this study was to assess the influence of clusters of risk factors on the incidence of echolucent carotid plaque in stroke patients. METHODS: A retrospective analysis of 413 stroke patients who had undergone carotid ultrasonography was performed. High-resolution B-mode ultrasonography was used to evaluate the characteristics of carotid plaque. We investigated the relationships between the incidence of echolucent carotid plaque and clustering of risk factors (hypertension, diabetes mellitus and hyperlipidemia) and stroke subtypes and transient ischemic attack (TIA). RESULTS: Echolucent plaques were present in 10.5% of patients free of risk factors, in 18.8% with a single risk factor (NS), in 27.7% with two risk factors (p <0.01) and in 50.0% with three risk factors (p <0.001), and were significantly more common in patients with multiple risk factors (odds ratio 1.79; 95% CI, 1.05-3.06; p = 0.045). Echolucent plaques were observed in 41.2% of patients with atherothrombotic infarction, in 17.6% with lacunar infarction, in 11.5% with cardioembolic stroke, and in 25.0% with TIA, and were significantly more common in patients with atherothrombotic infarction than in those with lacunar infarction or cardioembolic stroke (p<0.001), or in those with TIA (p <0.05). CONCLUSIONS: The clustering of risk factors increased the incidence of echolucent carotid plaque. Patients with multiple risk factors were at increased risk of echolucent plaque, and these had a significant relationship with atherothrombotic infarction compared with other stroke subtypes and TIA.     

High-risk carotid plaques and incident ischemic stroke in patients with atrial fibrillation in the Cardiovascular Health Study

Background and purpose

Whether carotid artery disease could improve stroke risk stratification tools in patients with atrial fibrillation (AF) remains uncertain. This study was undertaken to investigate the risk of ischemic stroke associated with occlusive and nonocclusive carotid atherosclerotic disease in patients with AF in the prospective population-based Cardiovascular Health Study.

Methods

We included participants aged ≥65 years with AF. We used multivariable Cox regression analysis to explore the risk of ischemic stroke associated with the percentage of carotid stenosis, plaque irregularity, echogenicity, and vulnerability (markedly irregular, ulcerated, or hypoechoic plaques).

Results

A total of 1398 participants were included (55.2% female, 61.7% aged 65–74 years). The maximum carotid stenosis was <50%, 50%–99%, and 100% in 94.5%, 5%, and 0.5% of participants, respectively. High-risk plaques based on echogenicity and plaque irregularity were found in 25.6% and 8.9% of participants, respectively. After a median follow-up of 10.9 years (interquartile range = 7.5–15.6), 298 ischemic strokes were recorded. There was no difference in the incidence of ischemic stroke according to the degree of carotid artery stenosis (p = 0.44), plaque echogenicity (low vs. high risk, p = 0.68), plaque irregularity (low vs. high risk, p = 0.55), and plaque vulnerability (p = 0.86). The CHA₂DS₂-VASc score was associated with an increased risk of ischemic stroke (adjusted hazard ratio = 1.28, 95% confidence interval = 1.18–1.40, p < 0.001). Both maximum grade of stenosis and plaque vulnerability were not associated with incident ischemic stroke (all p > 0.05).

Conclusions

Neither the degree of carotid stenosis nor the presence of vulnerable plaques was associated with incident ischemic stroke in this cohort of individuals with AF. This suggests that carotid disease was probably not a significant contributor to ischemic stroke in this population.