颈动脉超声对冠状动脉粥样硬化性心脏病合并缺血性脑血管疾病患者颅内动脉狭窄性病变的预测价值

目的探讨颈动脉超声评价冠状动脉粥样硬化性心脏病(CAD)合并缺血性脑血管(ICVD)患者颅内动脉狭窄性病变的预测价值。方法对209例经血管造影证实冠状动脉狭窄(≥70%)同时合并缺血性脑血管疾病的患者采用彩色多谱勒超声(CDFI)和经颅多普勒超声(TCD)分别检查颈动脉和颅内动脉,并将患者分为脑动脉狭窄组与非狭窄组,分别比较两组患者颈动脉超声检查结果中差异有统计学意义的指标。结果颈动脉球部内-中膜(IMT)增厚、不均质回声斑块、多发斑块、颈动脉狭窄与CAD患者合并颅内动脉狭窄性病变之间具有良好的相关关系,(P<0.05)。结论颈动脉内膜增厚、不均质回声斑块,多发斑块、颈动脉狭窄与CAD合并ICVD患者颅内动脉狭窄性病变之间有明显的相关性。采用CDFI对冠状动脉狭窄的患者进行颈动脉检测,在心脑血管事件高危人群中进行筛选,对临床诊断与治疗具有重要的指导意义。     

缺血性脑血管病患者颈动脉内-中膜厚度及斑块分级对颅内外大动脉狭窄的预测价值

目的探讨缺血性脑血管病(ICVD)患者颈动脉内-中膜厚度(IMT)和斑块分级对颅内外大动脉狭窄的预测价值。方法对459例ICVD患者进行颈动脉IMT及斑块检测。采用数字减影血管造影(DSA)对患者颅内外大动脉进行检查。根据有无颅内外大动脉狭窄及狭窄部位将患者分为无动脉狭窄组、颅外动脉狭窄组、颅内动脉狭窄组和颅内外动脉狭窄组;根据狭窄程度又将各狭窄组分轻、中、重度狭窄亚组。比较各组间颈动脉IMT及斑块分级,分析其对颅内外大动脉狭窄的预测价值。结果本组中399例ICVD患者(86.9%)伴颅内外大动脉狭窄。各狭窄组间对应亚组的颈动脉IMT及斑块分级比较,差异均无统计学意义。各狭窄组中,中、重度狭窄亚组颈动脉IMT≥1.07 mm,斑块分级为3,均较无动脉狭窄组及轻度狭窄亚组显著增高(P<0.05~0.01)。ROC分析结果显示,颈动脉IMT增厚及斑块分级增加可预测中、重度颅内外大动脉狭窄(均P<0.01)。将颈动脉IMT≥1.07 mm及斑块分级为3作为预测中、重度颅内外大动脉狭窄的截断值,其敏感度均≥49.17%,特异度均≥81.67%,准确度均≥62.78%。结论颈动脉IMT≥1.07 mm及斑块分级为3对I...     

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.     

进展性缺血性脑卒中与颈动脉粥样硬化的关系

目的 探讨进展性缺血性脑卒中与颈动脉粥样硬化的关系.方法 选取2010年6月～2010年12月入住吉林大学白求恩第一医院的进展性缺血性脑卒中患者50例(A组)及非进展性脑梗死患者50例(B组),用彩色多普勒超声对所有患者进行双侧颈总动脉及颈内动脉探查.结果 动脉斑块最易在颈总动脉分叉处形成,两组比较无显著差异,P＞0.05;A组颈动脉粥样硬化斑块中不稳定斑块多于B组,P＜0.05;A组患者中、重度颈动脉粥样硬化例数多于B组,P ＜0.05;A组患者中、重度颈动脉狭窄例数多于B组,P＜0.05.结论 进展性缺血性脑卒中与非进展性缺血性脑卒中颈动脉粥样硬化斑块都最易发生在颈总动脉分叉处;颈动脉粥样硬化不稳定斑块与进展性缺血性脑卒中关系密切,可能是导致脑梗死早期进展的重要危险因素;进展性缺血性脑卒中重度颈动脉粥样硬化及重度颈动脉狭窄明显高于非进展性脑梗死,也是发生进展性缺血性脑卒中的危险因素.     

2型糖尿病无症状性颅内动脉狭窄与颈动脉粥样硬化的相关性研究

目的 探讨2型糖尿病无症状性颅内动脉狭窄与颈动脉颅外段粥样硬化病变之间的关系.方法 采用经颅多普勒超声和颈动脉超声检测无脑卒中2型糖尿病患者颅内外动脉,分别判断颅内动脉狭窄及颈动脉颅外段内中膜厚度、斑块形成和狭窄程度(狭窄程度≥50%或完全闭塞),分析颅内动脉狭窄与颈动脉粥样硬化病变之间的关系及危险因素.结果 194例患者中42例(21.65%)发生颅内动脉狭窄,其中大脑中动脉受累者30例(15.46%);123例(63.40%)存在颈动脉粥样硬化性病变.颅内动脉狭窄组患者高龄(t=-3.054,P=0.003)、长糖尿病病程(U=2172.500,P=0.002)、合并高血压(x2=9.986,P=0.002)及颈动脉病变(x2=14.086,P=0.000)比例明显高于无狭窄组(均P＜0.01).单因素分析提示,颅内动脉和大脑中动脉狭窄与颈动脉粥样硬化病变程度相关(U=1929.000,1519.000;均P=0.000).多因素Logistic回归分析显示,合并高血压(OR=2.849,95%CI:1.247～6.508;P=0.013)和颈动脉病变(OR=4.838,95%CI:1.778～13.167;P=0.002)为2型糖尿病无症状性颅内动脉狭窄的独立危险因素.结论 2型糖尿病无症状性颅内动脉狭窄与颈动脉粥样硬化病变相关,颈动脉颅外段粥样硬化可能是国人2型糖尿病无症状性颅内动脉狭窄的独立预测因素.     

青年急性腔隙性梗死伴颅内血管狭窄的危险因素和分布特征分析

目的探讨急性腔隙性梗死(lacunar infarction,LI)青年患者的血管危险因素及其分布特征,为预防和治疗提供科学依据。方法收集我院神经内科住院的青年急性腔隙性梗死患者40例,年龄18~45岁,均行头颅MRI、MRA、颈部血管彩超、血脂等检查,根据头颅血管磁共振检查结果分为颅内动脉狭窄组和无颅内动脉狭窄组。对观察指标结果进行统计学分析。结果 40例青年腔梗患者中22例存在颅内大动脉狭窄(狭窄组),18例无狭窄(无狭窄组),经分析发现,颅内动脉狭窄组的甘油三酯、低密度脂蛋白胆固醇、颈动脉斑块形成较无颅内动脉狭窄差异有统计学意义(P0.05)。而吸烟、饮酒、高血压、尿酸、空腹血糖、高胆固醇、高密度脂蛋白胆固醇2组比较差异无统计学意义(P0.05)。颅内动脉狭窄组中15例为单发血管狭窄,7例为多发狭窄,单发与多发血管狭窄血管危险因素比较差异无统计学意义(P0.05);单纯前循环狭窄13例,单纯后循环狭窄7例,单纯前、后循环颅内动脉狭窄间血管危险因素比较差异无统计学意义(P0.05)。结论青年腔梗合并颅内动脉狭窄患者多于无颅内动脉狭窄患者,且颅内动脉狭窄组甘油三酯、低密度脂蛋白胆固醇、颈动脉斑块形成均显著高于无颅内动脉狭窄组。青年腔梗单发与多发颅内血管狭窄之间的危险因素比较无显著差异;颅内动脉狭窄多发生于前循环,且单纯前、后循环颅内动脉狭窄组之间危险因素比较无显著差异(P0.05)。     

C反应蛋白与高密度脂蛋白胆固醇比值预测缺血性脑卒中患者颈动脉斑块易损性的诊断价值研究

目的探讨缺血性脑卒中患者C反应蛋白与高密度脂蛋白胆固醇比值(CHR)对颈动脉斑块易损性的预测价值。方法回顾性纳入2019年1月-2020年1月在保定市第一中心医院神经内科就诊的急性缺血性脑卒中患者349例。所有研究对象均行超声检查了解颈动脉斑块情况,并依据超声结果将其分为无斑块组、稳定斑块组、不稳定性斑块组。比较各组的危险因素、血脂、炎性指标的差异。采用受试者工作特征(ROC)曲线估计各指标对颈动脉斑块易损性的预测价值。结果不稳定斑块组的C反应蛋白、CHR高于稳定斑块组,差异有统计学意义(P 0.05); ROC曲线显示,相比单一的C反应蛋白,CHR能更可靠的预测颈动脉斑块的不稳定性。结论CHR对颈动脉易损斑块有较高的预测价值,可作为识别颈动脉斑块易损性的新的循环生物标记物。     

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。     

颈动脉内-中膜厚度和斑块对颅内动脉狭窄严重程度的预测价值

目的观察缺血性脑血管病(ischemic cerebrovascular disease,ICVD)患者颈动脉内-中膜厚度(com-mon carotid intima media thickness,CCA-IMT)和斑块与颅内动脉狭窄程度的相关性,评价其对颅内动脉狭窄严重程度的预测价值。方法对151例ICVD患者行数字减影全脑血管造影(digital subtraction angiography,DSA),根据DSA结果将患者分为颅内动脉正常、轻、中、重度狭窄组,所有患者在造影前均进行CCA-IMT、斑块检测和常规生化检测。结果中度、重度狭窄组CCA-IMT、斑块分级(carotid plaques score,CPS)较正常组及轻度狭窄组显著增高(P0.05),正常组、轻度狭窄组间及中、重度狭窄组间CCA-IMT、CPS差异无统计学意义(P0.05),CCA-IMT、CPS与颅内动脉狭窄程度呈正相关(P0.01)。CCA-IMT、CPS对中度以上颅内动脉狭窄预测价值的ROC曲线下面积分别为0.755、0.742,CCA-IMT≥1.2mm、CPS=3作为截断值预测中度以上颅内动脉狭窄的阳性似然比最高(分别为6·35、2·74)、有相对高的特异度(分别为93.5%、77.4%)和敏感度(分别为41.3%、62%)。Logistic回归分析显示,在调整了糖尿病、收缩压、舒张压的影响后,CCA-IMT≥1.2mm、CPS=3预测中度以上颅内动脉狭窄的比值比分别为5.603、3.427。结论CCA-IMT、CPS与颅内动脉狭窄程度呈正相关,CCA-IMT≥1.2mm、CPS=3对中度以上颅内动脉狭窄有一定的预测价值。     

彩色多普勒超声检测颈动脉粥样硬化与老年缺血性脑血管病的分析

目的探讨彩色多普勒超声检测颈动脉粥样硬化及对老年缺血性脑血管病(ICVD)的预测价值。方法选取120例ICVD患者为观察组,120例健康体检志愿者为对照组,采用彩色多普勒超声对2组患者颈动脉粥样硬化斑块进行检查,并对比分析。结果观察组患者IMT1.0 mm、颈动脉粥样硬化斑块形成、混合斑及硬斑率均显著高于对照组(P0.01);观察组管腔狭窄显著多于对照组(P0.01);观察组颈总动脉(CCA)内径显著大于对照组(P0.01),观察组颈总动脉舒张期峰值流速(EDV)、收缩期峰值流速(PSV)均显著低于对照组(P0.01)。结论彩色多普勒超声能够对颈动脉粥样硬化情况作出准确评价,对于缺血性脑血管病的预测具有重要临床意义。     

Stroke risk factors and development of collateral flow in carotid occlusive disease

Background and purpose – Blood flow through collateral vessels compensates for reduced blood flow through stenotic or occluded extracranial carotid arteries. Previous studies have shown that extent of collateral flow influences likelihood of stroke and its outcome. Here we analyzed the relationship between stroke risk factors (hypertension, coronary artery disease, diabetes mellitus, tobacco smoking and hypercholesterolemia) and number of patent intracranial collaterals detected by transcranial Doppler ultrasonography. Subjects and methods – We studied 182 patients with various degrees of angiography proven unilateral stenosis of the internal carotid artery. Contribution of the anterior and posterior communicating arteries to the perfusion of the cerebral hemisphere on the side of the stenosis or occlusion was evaluated by a series of compression tests performed during continuous insonation of the middle cerebral artery. The number of detected collateral vessels was correlated with analyzed stroke risk factors. Results – Subjects with stenosis more than 75% or occlusion of the internal carotid artery had a higher frequency of two major intracranial collateral vessels ( P 0.01 and P 0.001, respectively). Hypertensive patients with stenosis more than 75% or total carotid occlusion were more likely to have only a single collateral vessel than patients without hypertension ( P 0.01 and P 0.05, respectively). Other risk factors did not influence the patency of preformed collateral vessels. Conclusions – Hypertension hindered the development of preformed intracranial collateral vessels in our patients with carotid occlusive disease.     

Risk factors for atherosclerosis of cervicocerebral arteries: intracranial versus extracranial

OBJECTIVES: To search for factors determining the site of atherosclerosis of the cervicocerebral arteries in patients from Bangkok (Thailand) with ischemic stroke in the carotid territory. MATERIAL AND METHODS: Patients with the clinical syndrome of stroke or transient ischemic attack in the carotid territory or with ocular stroke were retrospectively studied. They were divided into an intracranial and an extracranial carotid stenosis group based on their vascular imaging. The stroke risk factors were then compared. RESULTS: There were 49 cases with extracranial carotid stenosis and 51 with intracranial stenosis. Among the patients with extracranial stenosis, 98% had associated intracranial disease, whereas none of those with intracranial stenosis had more than 50% of extracranial carotid stenosis. The presence of diabetes mellitus and a history of ischemic heart disease were found to be significantly more prevalent among patients with extracranial internal carotid artery stenosis. CONCLUSION: Diabetes mellitus as well as a history of ischemic heart disease were found to be more significantly prevalent in patients with combined extracranial internal carotid artery and intracranial stenosis. Extracranial carotid stenosis might represent a more severe atherosclerotic process of the cervicocerebral circulation when compared with intracranial stenosis.     

症状性颈动脉狭窄伴有同侧中动脉狭窄的介入治疗效果研究

目的   比较单纯颈动脉支架置入术治疗和联合颈动脉、大脑中动脉支架置入术治疗症状性颈动脉狭窄伴有中动脉狭窄的缺血性卒中或短暂性脑缺血发作（transient ischemic attack,TIA）患者短期终点事件发生率。 方法  回顾2010年1月～2013年12月采用血管内支架治疗症状性颈动脉狭窄伴有同侧大脑中动脉狭窄的缺血性卒中或TIA患者的临床资料。根据治疗情况将患者分为单纯颈动脉支架置入术治疗组和联合颈动脉、大脑中动脉支架置入术治疗组。比较两组术后90?d终点事件（包括同侧缺血性卒中复发、症状性脑出血及死亡风险）的发生率。 结果  共有21例患者纳入本研究,男性15例,女性6例,平均年龄（58.5±3.6）岁,其中16例患者进行了颈动脉支架治疗,5例患者进行了颈动脉联合中动脉支架治疗。颈动脉支架治疗组90?d终点事件发生3例（18.75%）,颈动脉联合中动脉支架治疗组发生1例终点事件（20%）,两组间差异无显著性（P=0.952）。两组发生的终点事件均为缺血性卒中复发,无症状性脑出血及死亡患者。 结论  对于伴有颈动脉及大脑中动脉狭窄的缺血性卒中或TIA患者,与单纯颈动脉支架治疗相比同时进行颈动脉及大脑中动脉支架治疗手术未减少术后90?d同侧缺血性卒中复发风险。     

缺血性卒中患者颅内动脉狭窄的相关危险因素分析

目的 探讨颅内动脉狭窄的狭窄程度、相关危险因素与缺血性脑卒中的关系,为缺血性卒中的防治提供重要依据.方法 90例缺血性卒中患者根据全DSA检查结果分为非狭窄组(狭窄<30%)与颅内动脉狭窄组(狭窄≥30%或闭塞),分析颅内动脉狭窄程度与年龄、性别、高血压、糖尿病、高脂血症、冠心病、家族史、总胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白胆同醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白 A1(ApoA1)、载脂蛋白B(ApoB)、血清脂蛋白(Lpa)等相关危险因素的关系.结果 (1)本组患者颅内动脉狭窄发生率为67.78%,发生率最高为大脑巾动脉,其次颈内动脉颅内段和椎基底动脉颅内段,发生率最低为大脑后动脉.(2)有高血压、糖尿病的缺血性卒中患者容易发生颅内动脉狭窄,其同归系数、OR值、P值分别为1.659、5.256、0.002,1.657、5.241、0.046.(3)颅内动脉狭窄组HDL-C含量[(0.99±0.30)mmol/L]比非狭窄组[(1.30±0.50)mmol/L]明显降低,差异有统计学意义(t=3.603,P=0.001).(4)年龄、性别、吸烟、既往卒中史、脑血管病家族史、TC、TG、LDL-C、ApoA1、ApoB、Lpa在两组间比较差异无统计学意义(P>0.05).结论 缺血性卒中患者颅内血管狭窄的主要危险因素有高血压、糖尿病,保护因素有HDL-C.     

颈动脉狭窄闭塞性病变后交通支开放与椎动脉起始段狭窄的关系

目的探讨颈动脉狭窄闭塞性病变(≥70%)患者后交通支开放与否与椎动脉起始段狭窄的关系。方法对160例经血管造影证实颈动脉动脉狭窄(≥70%)并行外科治疗(内膜剥脱术、颈动脉支架术)的患者分为后交通支开放组与后交通支未开放组,术前及术后均采用彩色多普勒血流成像(CDFI)检测双侧颈动脉及椎动脉,分别比较两组患者双侧椎动脉起始段狭窄的发生率。结果后交通支开放组椎动脉起始段局部流速术前(后交通支开放)明显高于术后(后交通支关闭)。后交通支关闭前后椎动脉起始段峰值流速(PSV)与舒张末流速(EDV)分别为100.76±74.84cm/s、81.54±54.29 cm/s(P=0.000);后交通支开放患者占50%(80/160),其中椎动脉起始段存在狭窄支数占45.6%(73/160),后交通支未开放患者占50%(80/160),其中椎动脉起始段存在狭窄支数占28.1%(45/160),两者之间存在显著差异(P=0.002)。结论颈动脉狭窄闭塞性病变后交通支开放患者,椎动脉起始段狭窄的发生率显著升高。     

The Prevalence of Asymptomatic Intracranial Large-Vessel Occlusive Disease: The Role of Diabetes

OBJECTIVE: To investigate the prevalence of asymptomatic intracranial stenosis using transcranial Doppler ultrasonography in patients with evidence of asymptomatic carotid stenosis. BACKGROUND: Symptomatic atherosclerotic intracranial largeartery stenosis accounts for approximately 10% of ischemic strokes annually. It is unknown whether a significant risk for stroke is associated with asymptomatic intracranial stenosis, especially in patients with known asymptomatic carotid disease. DESIGN AND METHODS: Transcutaneous real-time B-mode Doppler ultrasonography was performed on 510 patients referred for the evaluation of asymptomatic carotid bruits. A peak systolic flow velocity > 1.40 m/s indicated carotid stenosis. Transcranial Doppler ultrasound was performed to identify intracranial large-artery disease. The peak systolic flow velocity indicating stenosis was > 120 cm/s for anterior circulation and > 100 cm/s for posterior circulation. Demographic and cerebrovascular risk factor information was recorded at the time of examination. Chi-square analysis with Pearson correction was performed to examine the significance of the findings. RESULTS: Five hundred ten patients (252 male, 258 female) aged 71.4 +/- 10.45 years were studied. The laboratory's accuracy was previously established as 93% for each technique for laboratory certification. Two hundred patients (39.2%) were found to have extracranial carotid stenosis, and 66 (12.9%) were found to have intracranial stenosis. Thirty-seven patients (56%, P < .01) were found to have concurrent stenosis. In patients with intracranial stenosis, 19 (28.8%, P < .03) had diabetes, and 26 (39.4%, p < .03) had coronary disease. There was no corresponding correlation with extracranial carotid disease and diabetes or coronary artery disease. CONCLUSIONS: The prevalence of patients with asymptomatic intracranial stenosis with concurrent carotid stenosis was greater than expected. Coexisting diabetes and coronary disease were significant risk factors in this population. Doppler ultrasonography may be a useful technique in delineating asymptomatic intracranial stenosis in those patients with existing carotid stenosis. Further studies are needed to clarify the risk of this population for stroke from asymptomatic intracranial stenosis and to determine optimal therapy.     

缺血性卒中患者颅内外血管狭窄率研究

目的:研究缺血性卒中患者颅内外血管狭窄或闭塞的发生率,并对其相关病因进行分析。方法:对经CT/MRI/DWI诊断的缺血性卒中患者的人口构成情况进行登记,了解其相关危险因素。并经TCD和/或MRA了解其颅内外血管狭窄或闭塞的情况。结果:579例缺血性卒中患者中,颅内外血管狭窄的发生率为70.98%(411/579例);411例大动脉狭窄或闭塞患者中,以大脑中动脉狭窄或闭塞最常见(64.48%),其次为颈内动脉(50.36%)。大动脉狭窄或闭塞的主要原因为动脉粥样硬化,引起动脉粥样硬化的危险因素的发病率依次为:高血压病(77.24%),吸烟(63.68%)。通过Logistic回归分析发现,糖尿病、高血压、吸烟是血管狭窄的主要相关危险因素(P值均<0.05)。结论:国内缺血性卒中患者颅内外血管狭窄或闭塞的发生率高,其主要病因为动脉粥样硬化,糖尿病是大动脉狭窄或闭塞的最主要危险因素。