颈动脉易损斑块与缺血性脑卒中复发的相关性分析

有研究表明,有些缺血性脑卒中患者是由颈动脉病变引起,而且与粥样斑块的稳定性有关。本次实验分析颈动脉易损斑块与缺血性脑卒中复发的相关性,现报告如下。1资料与方法1.1研究对象2011-07—2013-03在我院进行治疗的缺血性脑卒中复发患者共110例,男63例,女47例,年龄34～82岁,中位年龄67岁;高血压72例,糖尿病14例,冠心病17例,有吸烟史37例。     

缺血性卒中相关易损斑块检测方法

缺血性卒中是我国的常见病、多发病,易损斑块在缺血性卒中的发生过程中发挥了重要的作用.本文综述了易损斑块的血清学、无创性及有创性非血清学检测方法研究进展,旨在早期发现易损斑块,通过积极的干预预防缺血性卒中的发生.     

磁共振斑块成像与缺血性卒中的相关性研究进展

动脉粥样硬化易损斑块破裂是导致缺血性卒中的主要原因。与组织病理学对照研究证实,
高分辨率磁共振成像可以无创性评价动脉粥样硬化斑块的负荷、成分及其易损性。大量研究显示,
脑血管粥样硬化斑块的磁共振表现特征与缺血性卒中具有明显的相关性。本文将从磁共振斑块成
分特征与缺血性脑血管事件的相关性方面进行综述,为缺血性卒中的病因学诊断和疾病的预防提供
重要依据。     

颈动脉高分辨磁共振与缺血性卒中

正缺血性卒中占所有卒中的80%以上[1]。颅外颈动脉粥样硬化被认为是缺血性卒中的危险因素,约20%的缺血性卒中是由颈动脉粥样硬化性斑块引起[2],颈动脉斑块破裂形成栓子或者引起颈动脉狭窄均可导致缺血性卒中,颈动脉高分辨磁共振成像(high resolution magnetic resonance imaging,HRMRI)检查对预测早期缺血性卒中患者的预后,选择恰当的治疗方案,具有十分重要的意义。颈动脉的影像学检查有多种,包括超声     

颈动脉易损斑块的超声研究进展

缺血性脑卒中是目前致死率及致残率最高的疾病之一 [1].易损斑块是缺血性脑卒中独立危险因素,因此如何早期识别易损斑块,从而有效干预易损斑块成为关注热点.现就超声检查在寻找易损斑块中的应用作一综述.     

双侧颈动脉易损斑块磁共振血管壁成像 临床应用1例分析

正1病例介绍患者,男,73岁,因"间断性头晕1年,晕厥发作2次"于2012年2月17日入院。患者自述间断头晕1年多,自以为是感冒症状,未予以重视。曾出现无任何诱因晕厥2次,伴短暂意识障碍,10min后意识恢复,发作时未跌倒,不伴有肢体障碍、麻木、抽搐、两便失禁情况,无肢体乏力无头痛、恶心、呕吐等症状。既往史:既往有冠状动脉粥样硬化性心脏病史10年,口服肠溶阿司匹林100 mg/d,阿托     

颈动脉斑块的超声表现与神经血管症状

介绍近年来颈动脉斑块的超声形态结构特征及其血流动力学特点与神经血管症状的关系。相关临床症状与致病机制的研究概况     

颈动脉斑块稳定性相关因素研究进展

颈动脉粥样硬化是缺血性卒中常见病因。在西方国家,因颈动脉粥样硬化造成的缺血性卒中占19%￣35%[1]。Rothwell等[2]发现,颈动脉粥样硬化致颈动脉狭窄继发远端血流量减少者缺血性卒中的发生率并不高,提示动脉狭窄程度不再是单一预测缺血性卒中的发生指标。近年来该领域的相关研     

NO与缺血性脑卒中患者颈动脉粥样硬化斑块的相关性分析

目的分析NO与缺血性脑卒中患者颈动脉粥样硬化斑块的相关性。方法采用随机抽样的方法选择2014-06—2015-06在我院治疗的缺血性脑卒中患者100例,其中50例为缺血性脑卒中出现颈动脉粥样硬化斑块的患者,50例为缺血性脑卒中未出现颈动脉粥样硬化斑块的患者,比较2组NO水平,测得观察组颈动脉内膜中层厚度(IMT),分析NO与IMT的相关性。结果对照组NO水平为(30.19±7.98)mmol/L,观察组为(36.63±9.25)mmol/L,观察组NO水平明显高于对照组(P0.05);2组HDL、TG以及D-D水平相比无明显差异(P0.05)。观察组中NO与IMT存在正向相关性(r=0.541,P0.05)。结论缺血性脑卒中伴颈动脉粥样硬化斑块的患者NO水平明显高于缺血性脑卒中无颈动脉粥样硬化斑块患者,两者具有密切的相关性,临床诊断中可将NO水平作为一个重要观察指标评估患者是否发生颈动脉粥样硬化,也能够为脑卒中患者的治疗提供指导和依据。     

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.     

Autonomic dysfunction in ischemic stroke with carotid stenosis

Xiong L, Leung HW, Chen XY, Han JH, Leung WH, Soo OY, Lau YL, Wong KS. Autonomic dysfunction in ischemic stroke with carotid stenosis.
Acta Neurol Scand: 2012: 126: 122–128.
© 2011 John Wiley & Sons A/S. Objectives – Impaired autonomic function is common in acute ischemic stroke. Previous limited studies have suggested that atherosclerosis may affect the distensibility of the carotid sinus and then impair the cardiovascular autonomic function. This study sought to investigate cardiovascular autonomic function in patients with ischemic stroke with carotid stenosis. Methods – Eighty‐five patients with ischemic stroke (58 ones without carotid stenosis and 27 ones with carotid stenosis, average 6 months after stroke onset) and 37 elderly controls were recruited. All performed Ewing’s battery autonomic function tests. Results – From Ewing’s battery of autonomic function tests, atypical, definite, or severe autonomic dysfunction was identified in 69.0% patients without carotid stenosis and 88.9% with carotid stenosis, with significant difference between the two groups, and the prevalence of autonomic dysfunction in both groups was higher than that in controls (21.6%). Patients with carotid stenosis showed impairment of all parasympathetic tests (all P < 0.05) and one of the sympathetic tests [Mean fall in systolic blood pressure (BP) on standing: P = 0.051], and those without carotid stenosis only showed impairment in two parasympathetic tests (Valsalva ratio: P = 0.014; heart rate response to deep breathing: P < 0.001) in comparison with controls. Patients with carotid stenosis had significantly more impairment than those without carotid stenosis in some autonomic parameters (Valsalva ratio: P < 0.05; mean fall in systolic BP on standing: P < 0.05). Conclusions – Cardiovascular autonomic function is impaired in patients with ischemic stroke, but patients with carotid stenosis show more severely impaired parasympathetic and sympathetic functions.     

Proton magnetic resonance spectroscopy in patients with ischemic stroke

Proton magnetic resonance spectroscopy (¹H-MRS) is a non-invasive technique which has proved to be useful for monitoring various brain metabolites (N-acetyl-aspartate, choline, creatine-phosphocreatine, lactate). A total of 18 patients underwent a combined magnetic resonance imaging (MRI)/¹H-MRS protocol in order to evaluate the distribution of the metabolites in the various stages of cerebral ischemia. Our results show a marked decrease of N-acetyl-aspartate and a large content of Lactate during the early phases, and a decrease in N-acetylaspartate, choline and creatine-phosphocreatine (Cr-PCr) during the chronic phase.

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Sommario La risonanza magnetica protonica spettroscopica (¹H-RMS) è una tecnica non invasiva che si è dimostrata essere utile per il monitoraggio di alcuni metaboliti (N-Acetil-aspartato, Colina, Creatina-Fosfocreatina, Lattato) del tessuto cerebrale. Un totale di 18 pazienti è stato sottoposto ad un protocollo combinato di risonanza magnetica imaging e¹H-RMS per valutare la distribuzione dei metaboliti in differenti stati dell'ischemia cerebrale. I nostri risultati nelle fasi precoci mostrano un marcato decremento dell'N-Acetil-aspartato ed un notevole contenuto di lattato, mentre nella fase cronica un decremento dell'N-Acetil-aspartato, della Colina e Creatina-Fosfocreatina.

     

老年急性缺血性脑卒中患者颈动脉斑块检出率及其与脑卒中复发的相关性

目的 应用多普勒彩色超声诊断仪评估老年急性缺血性脑卒中（AIS）患者颈动脉斑块检出情况,总结斑块发生的高危因素,并分析其与AIS复发的相关性。方法 以2020年1月至2020年6月于常州市第一人民医院神经内科和老年医学科住院的首次发生AIS,并且72 h内入院的老年患者236例为研究对象。依据颈动脉超声检查结果分为颈动脉斑块组（199例）和无颈动脉斑块组（37例）。收集并分析2组患者的临床资料及随访1.5年后脑卒中复发情况。结果 老年AIS患者颈动脉斑块检出率为84.3%。60~69岁、70~79岁及≥80岁患者颈动脉斑块检出率分别为74.7%、86.9%、96.0%,随着年龄增长颈动脉斑块检出率逐渐增加。颈动脉斑块组女性、高血压史和糖尿病史的比例明显高于无斑块组（均P<0.05）。颈动脉斑块组与无颈动脉斑块组脑卒中复发事件发生率比较,差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,年龄（OR=1.070,95%CI：1.02~1.122,P=0.005）、糖尿病史（OR=2.262,95%CI：1.055~4.850,P=0.036）、颈动脉斑块（OR=8.128,95%CI：1.077~61.348,P=0.042）是AIS复发的独立影响因素。结论 老年AIS患者颈动脉斑块检出率高。年龄、性别、高血压史、糖尿病史是颈动脉粥样硬化的危险因素。年龄、糖尿病史、颈动脉斑块与脑卒中复发事件发生相关。     

Extracranial carotid plaque is increasing in Japanese ischemic stroke patients

OBJECTIVE: The objectives of this study were to investigate the prevalence of extracranial carotid plaque and the association between risk factors and carotid plaque in Japanese patients with ischemic stroke. METHODS: We consecutively recruited patients with ischemic stroke admitted to our hospital from January 2000 to September 2002. Neurologic signs and a brain magnetic resonance imaging diagnosed ischemic stroke. All subjects underwent a carotid ultrasonography. Multiple logistic regression analysis was used to determine the risk factors that independently contributed to the presence of carotid plaques. RESULTS: Carotid plaques were identified in 76.2% of the patients and bilateral plaques were found in 58.2%. These lesions were more frequent in comparison with previous Japanese reports. The risk factors that independently contributed to the presence of extracranial carotid plaques were hypertension, age, smoking and past history of ischemic stroke. CONCLUSIONS: This study demonstrates that extracranial carotid plaque is increasing in Japanese patients with ischemic stroke.     

轻型缺血性脑卒中患者脑动脉狭窄及其相关因素

目的探讨轻型缺血性脑卒中(MIS)患者脑动脉狭窄(CAS)及其相关因素。方法选取2015年1月至2018年7月安徽医科大学第一附属医院神经内科住院的402例急性MIS患者(NIHSS评分≤5分)作为研究对象,急性期即行国立卫生研究院卒中量表(NIHSS)、卒中预测工具II (SPI-II)评分,调查血管危险因素,并通过头颈计算机断层扫描动脉造影(CTA)检测CAS情况,按动脉狭窄部位和程度将其分为颅内和/或颅外动脉狭窄,轻度、中度、重度狭窄或闭塞,按照年龄分为青年组(≤44岁)、中年组(45～59岁)、老年组( 59岁),对MIS伴CAS的血管危险因素进行统计学分析,并对SPI-II评分与CAS程度进行相关分析。结果 402例MIS中331例存在CAS (82.34%)。颅内狭窄141例(42.60%),颅外狭窄77例(23.26%),颅﹣内外狭窄113例(34.14%);轻度狭窄111例(33.53%),中度狭窄63例(19.03%),重度狭窄或闭塞157例(47.43%)。青年组CAS 25例(7.55%),中年组CAS 107例(32.33%),老年组CAS 199例(60.12%);中老年组颅内CAS 233例,青年组颅内CAS 21例。有无CAS两组血管危险因素的单因素Logistic回归分析发现,CAS组年龄、糖尿病史、高脂血症史、高同型半胱氨酸血症、收缩压、D-二聚体显著升高,高密度脂蛋白胆固醇显著降低,差异有统计学意义(P 0.05)。多因素Logistic回归分析发现,CAS组年龄、糖尿病史、高脂血症史、高同型半胱氨酸血症、D-二聚体显著升高,高密度脂蛋白胆固醇显著降低,差异有统计学意义[OR=1.053,95%CI(1.027-1.079),P 0.001; OR=2.418,95%CI (1.107-5.284),P=0.027; OR=2.289,95%CI (1.204-4.353),P=0.012; OR=2.071,95%CI (1.129-3.796),P=0.019; OR=3.446,95%CI (1.243-9.554),P=0.017; OR=0.358,95%CI(0.136-0.942),P=0.037]。中老年组颅内动脉狭窄所占比例显著高于青年组,差异有统计学意义(χ~2=4.261,P=0.039)。SPI-II评分与CAS程度有显著正相关(rs=0.108,P=0.031)。结论 80%以上MIS患者存在CAS,以颅内血管狭窄为主;各年龄组CAS分布不同,以中老年组颅内动脉狭窄为主。MIS患者CAS危险因素除了年龄、血压、血糖、血脂外,同型半胱氨酸和D-二聚体亦值得关注。SPI-II评分可能对预测MIS患者CAS有重要价值。     

Correlation of intracranial atherosclerosis with carotid stenosis in ischemic stroke patients

Introduction:

Carotid stenosis is a major risk factor for ischemic stroke. However, the effect of carotid stenosis on the site of stroke is still under investigation.

Aims:

This study aimed to elucidate how the presence of carotid stenosis influenced the pattern of stroke and also how it interacted with other risk factors for stroke.

Materials and Methods:

Thirty-eight patients with ischemic stroke were included in this study and were investigated with carotid artery Doppler and magnetic resonance angiography for carotid stenosis and intracranial stenosis in the circle of Willis, respectively. Other known risk factors of stroke were also studied in and compared between the subgroups with and without carotid stenosis.

Results:

In patients without carotid stenosis, anterior cerebral artery was the commonest site of stenosis. In patients with carotid stenosis, middle cerebral artery was the commonest site of stenosis. Overall, middle cerebral artery was the commonest territory of stroke. Patients with hypertension, diabetes and history of smoking had preferential stenosis of the anterior cerebral artery.     

症状性颈动脉狭窄对急性缺血性脑卒中患者近期生存状况的影响

目的：探讨症状性颈动脉狭窄对急性缺血性脑卒中患者近期生存状况的影响。方法根据血管影像学结果，252例急性缺血性脑卒中患者分为3组，重度狭窄组32例，中度狭窄组38例以及轻度或无狭窄组182例，观察发病3个月内NIHSS评分及BI评分变化、有无卒中复发、癫痫样发作、死亡。结果与中度狭窄组比较，重度狭窄组患者神经功能恶化（OR＝2.058，95％CI0.771～6.011，P＝0.000）、生活受限更严重（OR＝2.405，95％CI1.011～5.618，P＝0.000），死亡风险升高（OR＝2.587，95％CI0.483～14.017，P＝0.000）；与轻度或无狭窄组比较，重度狭窄组神经功能进一步恶化（OR＝10.389，95％CI4.438～24.317，P＝0.000），生活受限更重（OR＝3.211，95％CI1.691～6.134，P＝0.000），死亡风险更高（OR＝4.182，95％CI1.363～12.805，P＝0.000）。结论症状性颈动脉狭窄是急性缺血性脑卒中患者近期生存状况不佳的独立危险因素，可导致神经功能恶化、生活严重受限、死亡风险升高，应采取早期干预措施。     

颈动脉狭窄在急性缺血性脑卒中的作用

目的：探讨颈动脉狭窄在缺血性脑卒中所起的作用。方法：依据临床和ＣＴ诊断标准，将４８例信院病人分为腔隙性脑梗死组（２７例）和非腔隙性脑梗死组（２１例）。两组病人均不含椎基底动脉系统和心源性栓塞所致的颈内动脉系统脑梗死及行两则颈部血管彩色多谱勒超声显像仪检测。结果：两组间脉压差和甘油三酯水平有显著差异（分别Ｐ〈０．００１，Ｐ〈０．０５）；腔隙性脑梗死组病灶同侧的颈动脉狭窄（≥５０％）发生率为１８．５％     

Homocysteine and carotid intima-media thickness in ischemic stroke patients are not correlated

INTRODUCTION: Hyperhomocysteinemia has been linked to cardiovascular morbidity and mortality by numerous authors. Whether this association is causal or not remains uncertain. The aim of the study was to investigate the association of hyperhomocysteinemia with the degree of carotid atherosclerosis in stroke patients. METHODS: We studied 97 Greek patients in our stroke unit who were hospitalized as a result of ischemic stroke between March 2006 and May 2007. The patients were divided into two groups: the first (52 patients) included stroke patients with serum levels of homocysteine below 15 mumol/L, but in the second group (45 patients) serum homocysteine exceeded this value. We measured carotid intima-media thickness (cIMT) in all patients and correlated it with serum homocysteine. RESULTS: The mean homocysteine concentration was 11.5 mumol/L in the first group and 21.5 mumol/L in the second group. Carotid IMT was 1.012 mm in the first group, and 1.015 mm in the second group, an insignificant difference. On the contrary, serum folate concentration was 21.3 nmol/L in the first group compared with 16.7 nmol/L in the second group (p < 0.001). VitB12 was 401 pmol/L in the first group and 340 pmol/L in the second group, a statistically significant difference (p < 0.001). CONCLUSIONS: Serum levels of homocysteine were not correlated with cIMT in ischemic stroke patients. Both folate and vitB12 were decreased in hyperhomocysteinemic ischemic stroke patients.