下肢动脉硬化闭塞症患者颅内/外动脉狭窄的特点及危险因素

目的 研究下肢动脉硬化闭塞症（peripheral artery disease，PAD）并发颅内/外动脉狭窄的发生率、危 险因素以及与临床症状的关系。 方法 选取2016年7月-2017年7月PAD患者共155例，收集患者临床资料。PAD临床症状根据Fontaine 分类分为I 期无症状，II 期间歇性跛行，II I 期静息痛，I V期足趾溃疡、坏疽。根据经颅多普勒超声 （transcranial Doppler，TCD）结果将颅内外动脉狭窄程度分为无狭窄、轻中度狭窄（＜70%）和重度狭窄 或闭塞（≥70%）。分析颅内/外动脉狭窄在PAD患者中的发生率，PAD合并颅内/外动脉狭窄的危险因 素以及PAD下肢缺血程度及围手术期卒中发生与颅内/外动脉狭窄的关系。 结果 本研究中合并颅内和/或颅外动脉狭窄的PAD患者共99例（63.9%），其中颅外段动脉狭窄与 颅内段动脉狭窄分别为66例（42.6%）和67例（43.2%）。PAD合并颅外段动脉重度狭窄或闭塞27例 （17.4%），合并颅内段动脉重度狭窄或闭塞4例（2.6%）。年龄比值比（odds ratio，OR）1.041，95%可信 区间（confidence interval，CI）1.004～1.080，P =0.030]和吸烟（OR 2.728，95%CI 1.125～6.619，P =0.026） 是PAD合并颅外段动脉狭窄的危险因素。糖尿病（OR 2.196，95%CI 1.079～4.470，P =0.030）是PAD合 并颅内段动脉狭窄的危险因素。吸烟（OR 3.57，95%CI 1.078～11.411，P =0.037）是PAD合并颅内/外段 动脉重度狭窄的危险因素。与无颅内动脉狭窄患者相比，PAD合并颅内动脉狭窄患者更容易发生严重 下肢缺血症状（Ⅱ期和Ⅲ期）（67.2% vs 50.0%，P =0.032）。与轻中度颅外段动脉狭窄相比，PAD合并 颅外段动脉重度狭窄或闭塞的患者更容易发生围手术期卒中（17.4% vs 1.1%，P =0.006）。 结论 PAD合并颅内/外动脉狭窄发病率较高，颅内动脉狭窄患者PAD临床症状更严重，而颅外动脉 重度狭窄或闭塞则可能导致围手术期卒中发生率升高。

Characteristics and Risk Factors of Intra-/extracranial Artery Stenosis in Patients with Peripheral Artery Disease

Objective To investigate the incidence, risk factors and clinical symptoms of peripheral artery
disease (PAD) complicated by intra-/extractranial artery stenosis.
Methods A total of 155 patients with PAD from July 2016 to July 2017 were selected and the
clinical data of the patients were collected for the study. The clinical symptoms of PAD were
classified according to Fontaine classification: stage I, without symptoms; stage II, intermittent
claudication, stage III, resting pain; stage IV, toe ulcers and gangrene. The degree of intra-/
extracranial artery stenosis was divided into non-stenosis, mild to moderate stenosis (<70%),
and severe stenosis or occlusion (≥70%) by TCD. The incidence and the risk factors of intra-/
extracranial artery stenosis in PAD patients, and the correlation between lower limb ischemia and
intra-/extracranial artery stenosis were analyzed. The effect of intra-/extracranial artery stenosis on
the occurrence of perioperative stroke was elucidated.Results A total of 99 (63.9%) PAD patients had intracranial and/or extracranial artery stenosis,
including 66 cases (42.6%) of extracranial artery stenosis and 67 cases (43.2%) of intracranial artery
stenosis, respectively. 27 PAD patients (17.4%) had severe stenosis or occlusion of extracranial
artery, and 4 PAD ones (2.6%) with severe stenosis or occlusion of intracranial artery. Age (OR 1.041,
95%CI 1.004-1.080, P =0.030) and smoking (OR 2.728, 95%CI 1.125-6.619, P =0.026) were risk
factors for PAD patients with extracranial artery stenosis. Diabetes (OR 2.196, 95%CI 1.079-4.470,
P =0.030) was a risk factor for PAD patients with intracranial artery stenosis. Smoking (OR 3.57,
95%CI 1.078-11.411, P =0.037) was a risk factor for PAD patients with severe stenosis of intra-/
extracranial artery. Severe ischemic symptoms of lower extremity (stage II and III), were more
likely to occur in PAD patients with intracranial artery stenosis (P =0.032). Comparing with mild
to moderate extracranial artery stenosis, PAD patients with severe stenosis or occlusion were more
prone to occurring perioperative stroke (P =0.006).
Conclusion The incidence of intra-/extracranial artery stenosis in PAD patients is relatively high.
The clinical symptoms of PAD patients with intracranial artery stenosis were more serious. Severe
stenosis or occlusion of extracranial artery may increase the incidence of perioperative stroke.