中老年人患缺血性脑卒中风险评估

目的探讨缺血性脑卒中高危人群颈部动脉血管结构改变,评估该人群将来患缺血性脑卒中的风险性。方法用彩色多普勒超声仪分别对100例患有缺血性脑卒中危险因素的人群和100例健康体检者颈部动脉内径及粥样硬化斑块形成的情况进行检测,并对检测结果进行分析比较。结果高危组人群颈部动脉粥样硬化发病48例,高于对照组14例,有显著性差异（P〈0．05）,动脉硬化的程度及狭窄程度均高于对照组。粥样硬化斑块形成39例,高于对照组12例,均有显著性差异（P〈0．01）,各组动脉内径明显变小,有显著的差异性（P〈0．05）。结论高危组人群颈部动脉内径明显变小且粥样硬化改变明显,有患缺血性脑卒中高风险性。     

多血管床动脉粥样硬化斑块与脑血管事件相关性研究进展

脑动脉、冠状动脉及周围动脉的粥样硬化斑块的病理特点及危险因素具有一定差异性。 而单一血管床及多血管床的动脉粥样硬化斑块均对脑血管事件具有一定的预测价值。本文对以上内 容进行综述,旨在更好地理解不同血管床动脉粥样硬化的发病过程、疾病特征及相关风险,为动脉 粥样硬化卒中的病因学诊断、治疗和预防提供参考。     

短暂性脑缺血发作患者颈部大动脉粥样硬化病变的超声研究

目的应用彩色多普勒超声检查TIA患者颈部大动脉粥样硬化性斑块的特征,并探讨颈部大动脉粥样硬化病变与TIA的关系。方法以68例TIA患者为观察对象,以60例体检健康者为对照,用彩超扫描颈动脉颅外段,观察动脉粥样斑块的特征并进行比较。结果 TIA组动脉粥样硬化斑块发生率为69.12%,对照组为20%;TIA组明显高于对照组。狭窄>50%的病例更多见于TIA组;椎-基底动脉系统TIA患者锁骨下动脉起始处的斑块发生率明显多于颈内动脉系统TIA患者。结论彩色多普勒超声可作为颈部大动脉粥样硬化检测的可靠方法。颈部大动脉粥样硬化的形成与TIA的发病密切相关。     

急性脑血管病患者肱动脉血流动力学改变

目的 :探讨急性脑梗死、脑出血患者肱动脉血流动力学改变。方法 :对 2 67例急性脑梗死、脑出血及健康对照组采用高分辨的血管外超声法 ,分别测量其肱动脉内径及血流速度。结果 :脑梗死组基础血管内径较健康对照组明显扩张 ,其血流速度较对照组降低 ;含化硝酸甘油后脑梗死、脑出血组血管扩张均明显差于健康对照组 (P <0 0 5 ) ;反应性充血时脑梗死组肱动脉血管扩张明显差于脑出血组及对照组 (P <0 0 5 ) ,脑出血组与对照组间无统计学差异 (P >0 0 5 )。结论 :急性脑梗死及脑出血患者均存在肱动脉血流动力学改变 ,且以脑梗死患者为重。脑卒中患者肱动脉血流动力学检测具有重要临床应用价值。     

消栓颗粒在颈动脉粥样硬化斑块治疗中的疗效观察

目的 探讨消栓颗粒对颈动脉粥样硬化斑块的干预效果。方法 收集广西贵港市中西医结合骨科医院神经内科确诊为颈动脉粥样硬化斑块的患者共175例为研究对象,采取随机分组法分成观察组和对照组,每组均给予阿司匹林肠溶片100 mg/d+阿托伐他汀钙片20 mg/晚口服,而观察组在上述基础上加用消栓颗粒口服,治疗前、后进行颈动脉超声检测,检测颈动脉粥样硬化内-中膜厚度(IMT)和斑块面积大小,并随访至6个月。结果 观察组在降低IMT、缩小主要斑块面积和改善颈动脉狭窄方面均优于对照组; 经随访半年未发现新发缺血性脑血管事件。结论 消栓颗粒有较好的抗颈动脉粥样硬化作用,与阿司匹林肠溶片、阿托伐他汀钙联合应用可以取得叠加效果,即能更好地改善颈动脉粥样硬化,促进斑块消退,降低动脉狭窄率,对减少脑血管事件的发生获益。     

颈部血管彩超评价缺血性脑血管病的临床意义

目的探讨颈部血管彩色超声对缺血性脑血管疾病的临床意义。方法选取40例缺血性脑血管疾病患者为研究组,选取同期40例非缺血性脑血管疾病患者为对照组,对2组患者进行颈部血管彩超检查,观察检查结果。结果研究组颈动脉粥样硬化斑块检出率达100.0%。对照组为15.0%,研究组明显高于对照组(P0.05)。研究组颈动脉狭窄程度检出率87.5%,对照组为10.0%,研究组明显高于对照组(P0.05)。结论临床对缺血性脑血管疾病患者应用颈部血管彩色超声可以较好对颈动脉狭窄进行诊断,对预防或治疗缺血性脑血管疾病具有重要的临床意义。     

进展性脑梗死与同型半胱氨酸相关性研究

目的研究同型半胱氨酸与进展性脑梗死、颈动脉粥样硬化之间的关系。方法选择急性进展性脑梗死患者60例为实验组,同时期非进展性脑梗死患者60例作为对照组。均通过颈动脉彩色多普勒超声检测颈部血管动脉粥样硬化斑块及狭窄程度,同时测定血清Hcy水平。结果 进展性脑梗死患者血清Hcy明显高于对照组,且实验组颈动脉IMT值明显高于对照组,实验组颈部血管斑块检出率及不稳定斑块发生率均高于对照组组,实验组颈部血管狭窄发生率及重度狭窄率均显著高于非进展组,上述差异均具有统计学意义（P〈0.05）。结论 血同型半胱氨酸水平与进展性脑梗死相关,且与颈动脉粥样硬化、血管狭窄紧密相关。     

辛伐他汀对高血压并颈动脉粥样硬化血管内皮功能的影响

目的研究合并颈动脉粥样硬化的原发性高血压患者血管内皮舒张功能与颈动脉硬化,hsCRP的关系以及辛伐他汀对其的影响。方法选取40例合并颈动脉粥样硬化的高血压患者（研究组）和40例无颈动脉斑块的高血压患者（对照组）,于给药前和给药3个月后采用彩色多普勒超声检查颈动脉内膜中层厚度（IMT）、粥样硬化斑块积分、血管内皮依赖性舒张功能（FMD）、非内皮依赖性舒张功能（NMD）、测定血超敏C反应蛋白（hsCRP）、血脂水平和空腹血糖（FBG）等,研究组予以辛伐他汀20mg／晚口服。结果2组比较,研究组FMD低于对照组,而IMT,hsCRP值高于对照组,差异有统计学意义（P〈0．05）;研究组辛伐他汀治疗后FMD显著改善,IMT、粥样硬化斑块积分、hsCRP减低（P〈0．05）;FMD与IMT,hsCRP、TG呈负相关（P〈0．05）。结论合并颈动脉粥样硬化的原发性高血压患者存在内皮功能障碍,辛伐他汀可显著改善血管内皮功能,稳定动脉斑块。     

彩色多普勒超声联合检测对动脉粥样硬化脑梗死的诊断价值

目的探讨彩色多普勒超声、踝肱指数及hs-CRP联合检测对动脉粥样硬化脑梗死的诊断价值。方法选择2014-01—2017-01在徐州市中医院就诊的100例脑梗死患者为观察组,同期选择100例健康体检者为对照组。采用免疫比浊增强法检测hs-CRP水平,对所有患者行彩色多普勒超声检查。采用多普勒超声探测仪测量踝肱指数,测量患者上臂肱动脉和足背动脉收缩压,计算踝肱指数。结果观察组动脉狭窄检出率为62.00%,显著高于对照组6.00%,观察组中重度狭窄程度占59.68%,狭窄程度较对照组严重,差异有统计学意义(P0.05);观察组及对照组动脉粥样硬化部位多为颈总动脉分叉处(P0.05),观察组斑块性质多为软斑,对照组多为硬斑、混合斑(P0.05);观察组hs-CRP水平为(7.72±2.03)mg/L,显著高于对照组(2.11±0.21)mg/L;观察组踝肱指数为(0.93±0.14),显著高于对照组(1.18±0.28),差异有统计学意义(P0.05)。观察组颈总动脉阻力指数检出率明显高于对照组(P0.05)。结论脑梗死患者动脉粥样硬化斑块多为软斑,且动脉血管狭窄程度较严重,颈总动脉阻力指数较大,hs-CRP水平显著高于非脑梗死患者,彩色多普勒超声和hs-CRP水平联合对动脉粥样硬化脑梗死患者具有较好的诊断性。     

青中年脑梗死与颈动脉粥样硬化的关系

目的 研究中青年脑梗死与颈动脉粥样硬化的关系.方法 应用彩色多普勒超声仪对中青年脑梗死患者 66 例、36例非脑血管病患者和正常体检者(对照组)行颈部血管超声检查.检测血管壁的厚度和斑块的大小及厚度,观察颈动脉粥样硬化斑块的数目及部位,计算斑块积分及血管狭窄程度.结果 中青年脑梗死患者颈动脉内膜增厚,动脉粥样硬化斑块的发生率明显高于对照组,斑块积分为轻中度的颈动脉粥样硬化,颈动脉血管多为轻中度狭窄.结论 颈动脉粥样硬化与青中年脑梗死关系密切,颈动脉超声检查对脑梗死的发生有极好的预测价值.     

踝肱指数与缺血性卒中患者颅内动脉狭窄数量的相关性

目的 观察踝肱指数（ankle brachial index,ABI）对缺血性卒中患者颅内动脉狭窄数量的预测价值。方法 测量243例行脑血管造影的缺血性卒中患者的踝肱指数,并收集其相关临床资料。结果 ABI异常、颈动脉斑块、既往卒中史、年龄与缺血性卒中患者颅内动脉狭窄数量有关。多因素Logistic回归分析结果显示：年龄、ABI是狭窄血管数量的独立预测因子。不同ABI值与颅内动脉狭窄数量之间存在负相关性（rs=-0.233,P＜0.01）,线性相关分析显示两者之间存在线性趋势。结论 ABI与颅内动脉狭窄数量有一定的相关性。     

Impairment of endothelial function in patients with spontaneous cervical artery dissection: evidence for a general arterial wall disease

BACKGROUND AND PURPOSE: Cervical artery dissection (CAD) accounts for 10-20% of ischemic strokes in young adults. Although trauma and preexisting disorders of the arterial wall are the main predisposing factors, most CADs are considered 'spontaneous'. We hypothesized that CAD could originate in systemic vascular disease bound to the intima-media interface without clinical signs. If this hypothesis is true, endothelium-dependent vasodilation would be impaired in response to a physiological stimulus such as an increase in blood flow. METHODS: Flow-mediated arterial dilation was studied in 65 consecutive patients with spontaneous CAD: 26 with carotid artery dissection (ICAD), and 39 with vertebral artery dissection (VAD). CAD patients with vascular risk factors, trivial or obvious cervical trauma, or connective tissue disease were excluded. Twenty-three patients with ischemic stroke of unknown cause were included as controls. Using high-resolution ultrasonography, brachial artery diameter was measured at rest, during post-ischemic hyperemia (flow-mediated endothelium-dependent dilation), and after sublingual glyceryl trinitrate spray (endothelium-independent dilation). RESULTS: The mean +/- SD values of the flow-mediated vasodilation index were 5.7 +/- 6.2% in ICAD, 5.0 +/- 9.3% in VAD and 13.2 +/- 6.5% in controls (p < 0.0005), without any difference between ICAD and VAD. Endothelium-independent dilation mean values were 21.5 +/- 9.5% in ICAD, 25.1 +/- 12.5% in VAD, and 20.8 +/- 8.4% in controls, without a significant difference between groups (p = 0.49). CONCLUSIONS: These results give evidence of impaired endothelium-dependent vasodilation in CAD patients that is not the result of stroke, and suggest that an underlying abnormality of the arterial wall layers may predispose to CAD.     

经颅多普勒超声和颈动脉超声检测无脑缺血症状的2型糖尿病患者颅内外动脉粥样硬化病变

目的 分析无脑缺血症状的2型糖尿病患者颅内动脉粥样硬化性狭窄和颅外颈动脉粥样硬化病变的发生频率及分布特征,并探讨其危险因素.方法 对94例无脑缺血症状的2型糖尿病住院患者用经颅多普勒超声(TCD)和颈动脉超声判断颅内外动脉粥样硬化病变,颅内动脉只分析狭窄,颅外动脉病变包括颈动脉斑块及狭窄.分析各危险因素的影响.结果 55例(58.5%)有颅内外动脉粥样硬化病变.22例(23.4%)发现有颅内动脉狭窄,明显高于颅外颈动脉狭窄或闭塞(3/94,3.2%,χ~2=16.66,P＜0.01).大脑中动脉是颅内最常受累的动脉(狭窄率17.0%),占狭窄动脉数的58.5%.48例(51.0%)有颅外颈动脉粥样斑块或狭窄.Logistic多元回归分析显示糖尿病病程和合并高血压是颅内外动脉粥样硬化病变的独立危险因素.结论 无脑缺血症状的2型糖尿病住院患者,半数以上有颅内外动脉粥样硬化改变,且与糖尿病病程及合并高血压有关,提示对上述高危患者应常规进行超声检测.     

Characteristic features of in vivo skin microvascular reactivity in CADASIL.

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is caused by mutations in the Notch3 receptor expressed at the surface of vascular smooth muscle cells. The functional consequences of the disease at the peripheral microcirculation level are incompletely elucidated. In this study, we aimed to assess, in vivo, the endothelium-dependent and independent vasodilation of the skin microvasculature in CADASIL patients. Twenty-three affected subjects were compared with 23 gender and age-matched controls. The brachial artery endothelium-dependent and endothelium-independent vasodilation were assessed after forearm cuff occlusion and nitroglycerin administration. Skin vasoreactivity to transcutaneous administration of acetylcholine and sodium nitroprussiate, and after postocclusive hyperemia were measured by Laser Doppler flowmetry. The maximum changes in the diameter of the brachial artery after the cuff release or after nitroglycerin administration did not differ between patients and controls. With iontopheresis, only the peak value of the dose response was found decreased in normocholesterolemic patients after nitroprussiate administration. The postocclusive test revealed a large increase of the time to peak value and whole duration of the hyperemic response in CADASIL patients. The results of this study show that the skin vasoreactivity is altered in CADASIL. Particularly, the kinetics of reactive hyperemia after cuff occlusion is dramatically changed with a lengthened and delayed response. This characteristic pattern may be related to the specific ultrastructural modifications related to Notch3 gene mutations involving smooth muscle cells in the microvasculature.     

短暂性脑缺血发作患者颈动脉超声的改变及与糖代谢状况的关系研究

目的 探讨短暂性脑缺血发作（transient ischemic attack,TIA）住院患者颈动脉超声的改变及其相关影响因素以及颈动脉粥样硬化（carotid atherosclerosis,CAS）与糖代谢异常的关系。方法 收集2007年7月～2009年3月在我院神经内科住院的经临床诊断为TIA的患者129例,记录患者临床资料,检查生化指标,对患者进行颈动脉超声检查。结果 本组有92例患者存在不同程度的CAS,发生率71.3%,其中70例检出有动脉粥样硬化（atherosclerosis,AS）斑块,78例有颈总动脉内膜－中层厚度增加,16例有颈动脉中重度狭窄。年龄、高血压史、体质指数（BMI）、低密度脂蛋白胆固醇（LDL-C）、餐后2h血糖（2hPG）、糖化血红蛋白（HbA1c）是TIA患者发生CAS的独立危险因素;伴糖调节受损TIA患者和伴糖尿病的TIA患者各颈动脉超声指标均高于正常糖耐量TIA患者（P<0.05）;但糖调节受损TIA患者和糖尿病TIA患者之间以上指标比较,差异无统计学意义（P>0.05）。结论 TIA患者大多存在不同程度的CAS,CAS的发生与年龄、高血压史、BMI、低密度脂蛋白胆固醇LDL-C、2hPG、HbA1c等危险因素有关。TIA患者合并糖代谢异常的比例较高,糖调节受损TIA患者其CAS程度与糖尿病TIA患者类似。     

Measurement of ankle brachial index for assessment of atherosclerosis in patients with stroke

BACKGROUND: Though atherosclerosis is generally regarded as a risk factor for stroke, its quantitative assessment in patients with stroke has not yet been reported. Recently, the ankle brachial index (ABI) has been receiving increasing attention as a noninvasive measurement of atherosclerosis. In this study, we investigated ABI to determine the degree of atherosclerosis in patients with stroke. METHODS: ABI was measured in 114 patients who had suffered a stroke, and the significance of differences between the ABI of the stroke subgroups and that of the normal group was investigated. The correlation of ABI with the degree of cerebral artery stenosis was also investigated. RESULTS: There was no significant difference in ABI between the hemorrhagic groups and the normal group, but in the infarction group (p = 0.0002) ABI was significantly less than the normal group. ABI was significantly correlated with the degree of stenosis in the intracranial internal carotid artery and middle cerebral artery (p < 0.0001, respectively). CONCLUSIONS: A strong relationship between ischemic stroke and atherosclerosis was demonstrated quantitatively by ABI measurement. A decrease in ABI may be a risk factor for ischemic stroke.     

缺血性脑血管病患者颈动脉粥样硬化程度与循环内皮祖细胞的相关性分析

目的探讨缺血性脑血管病患者颈动脉粥样硬化程度与循环内皮祖细胞(EPCs)的相关性。方法根据CD133和KDR标记,采用流式细胞仪检测缺血性脑血管病患者(包括TIA、急性脑梗死、颈动脉粥样硬化)和健康体检者外周血内皮祖细胞(EPCs)数量变化。结果缺血性脑血管病患者EPCs数量较对照组明显减少(P<0.01);随着颈动脉粥样硬化程度加重,EPCs数量呈降低趋势,颈动脉重度狭窄与轻度和中度狭窄相比有差异(P<0.05);急性脑梗死和TIA患者较单纯颈动脉粥样硬化患者EPCs数量明显增加(P<0.01)。结论缺血性脑血管病患者EPCs与颈动脉粥样硬化程度呈负相关,可反映颈动脉粥样硬化的程度;急性缺血可能会增加EPCs的动员。     

彩色多普勒超声对脑梗死与颈动脉粥样硬化的相关性分析

目的探讨颈动脉粥样硬化斑块与脑梗死的关系。方法将病例分为脑梗死组及非脑梗死组,使用彩色多普勒超声检测颈动脉内膜-中层的厚度(intima-medium thickness,IMT)及粥样硬化斑块。结果70例脑梗死患者44例颈总动脉IMT增厚,颈动脉粥样硬化斑块检出率85%;70例非脑梗死者10例颈总动脉IMT增厚,粥样硬化斑块检出率33%,2组有显著差异(P<0.001)。结论颈动脉粥样硬化与脑梗死密切相关。彩色多普勒超声是检测颈动脉粥样硬化斑块最简捷的方法,能早期发现颈动脉粥样硬化,对临床预防脑梗死有重要意义。     

Arterial intima-media thickness and its relationship with cardiovascular disease and atherosclerosis: a possible contribution of medium-sized arteries

The intima-media thickness (IMT) of the arterial wall, measured by B-mode ultrasonography, has been related to cardiovascular disease and atherosclerosis in many studies, most of which have considered carotid and common femoral arteries. No study has related the IMT of medium-sized arteries (e.g. brachial) to the atherosclerotic process. The aim of this study was to evaluate whether more peripheral arteries (e.g. brachial, superficial femoral and popliteal) represent a good model in studies of arterial wall IMT, as well as carotid artery. Twenty-six male patients with demonstrated coronary artery disease (median age 63 yrs; range 41-70) and twenty-four male controls (median age 62 yrs; range 53-74) were studied. The far-wall IMT of the common carotid, brachial, superficial femoral and popliteal arteries was measured by high-resolution B-mode ultrasonography. Its relationship with ischemic cardiovascular disease and the presence of atherosclerotic plaques in all the arteries was also evaluated. Mean IMT values were higher in patients than controls, more so in superficial femoral artery (IMT difference 0.08 mm [95% confidence interval 0.02 - 0.14]) and popliteal artery (0.08 [0.01-0.15]) than in common carotid artery (0.02 [-0.07-0.11]) or brachial artery (0.01[-0.01-0.03]). The difference did not change after adjustment for age. The prevalence of plaques was consistently higher in patients than controls, except for brachial artery, in which no plaque was found either in patients and controls. In all the arteries except brachial we found an association between increase in IMT and number of plaques. Age was strongly related to the presence of plaques in the carotid artery, and less markedly in superficial femoral and popliteal arteries. The brachial artery does not seem a good model to study atherosclerosis by ultrasound measurements of arterial IMT, whereas superficial femoral and popliteal arteries might be chosen for these studies besides carotid artery.     

Associations between trait anxiety, insulin resistance, and atherosclerosis in the elderly: a pilot cross-sectional study

Anxiety has been shown to be associated with cardiovascular disease. Atherosclerosis is responsible for the vast majority of cardiovascular events. Recent evidence is accumulating to show that insulin resistance (IR) plays a central role in determining the clinical manifestations of established atherosclerotic lesions. The current preliminary study aimed to investigate the associations between trait anxiety, IR, and atherosclerotic progression in healthy elderly subjects with normal fasting glucose and without metabolic syndrome. Thirty-five healthy elderly subjects (19 males and 16 females, mean age 64.5+/-4.7 years) were enrolled in this study. Trait anxiety was measured using a questionnaire corresponding to the trait anxiety scale taken from the State and Trait Anxiety Inventory. The homeostasis model assessment (HOMA-R) and plasma leptin-to-adiponectin ratio (L/A ratio), which are convenient IR indexes calculated from fasting blood sampling, were examined. As measurements of atherosclerotic progression, we performed two ultrasound methods, namely brachial artery flow-mediated dilation (FMD), an endothelial function assessment quantitatively reflecting the endothelium-dependent vasodilation responses following hyperemia, and measurement of carotid intima-media thickness (IMT). The severity of trait anxiety was positively associated with HOMA-R and L/A ratio, and negatively associated with the percent change of brachial artery FMD (%FMD). HOMA-R and L/A ratio were positively associated with carotid IMT, and L/A ratio was negatively associated with %FMD. These data showed the associations between trait anxiety, IR indexes and endothelial dysfunction or atherosclerotic progression. This pilot study, with a cross-sectional design, supports the promising role of IR for clarifying the pathophysiological mechanism by which anxiety contributes to an increasing risk of atherosclerosis.