北京市东城社区40岁以上人群脑动脉狭窄的流行病学调查

目的 研究40岁以上人群脑动脉狭窄的患病率及分布规律和相关危险因素,为我国脑血管病的防治提供依据.方法 以社区40岁以上人群为研究对象,采用经颅多普勒超声(transcranial doppler,TCD)和颈动脉双功能彩超检测颅内外动脉,以NASCET方法判断狭窄程度.结果 男、女两性及总体颅内外动脉狭窄的患病率均随年龄增长而增高(P＜0.01),≥75岁组男性颅内外动脉狭窄率明显高于女性(P=0.01).应用Logistic回归分析结果显示,性别、年龄、原发性高血压、糖尿病、高血脂、超重和吸烟是脑动脉狭窄的独立危险因素.结论 脑动脉狭窄的患病率与性别、年龄、原发性高血压、糖尿病、高血脂、超重和吸烟等有关系,控制上述危险因素对脑动脉狭窄的预防和治疗有一定意义.     

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。     

住院精神分裂症患者阻塞性睡眠呼吸暂停低通气综合征的初步筛查

目的 调查住院精神分裂症患者中阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的患病情况.方法 对825例住院精神分裂症患者进行有关体重指数、打鼾、嗜睡情况等问卷调查,运用体重指数、打鼾程度评价及嗜睡评价量表评分进行OSAHS的初步筛查,并对OSAHS可能的危险因素进行分析.结果 初步筛查OSAHS患者61例（男性53例,女性8例）,患病率为7.39%（男性8.6%,女性3.8%）,男性患病率显著高于女性患病率（χ2=5.462,P＜0.05）.OSAHS患者中伴发高血压、糖尿病、高血脂的发生率（分别为36.1%,41.0%,44.3%）高于住院精神分裂症患者伴发高血压、糖尿病、高血脂的发生率（分别为21.6%,18.5%,25.4%）,存在统计学差异（χ2=6.746,17.837,10.256;均P＜0.01）.结论 住院精神分裂症患者中具有较高的OSAHS患病率,高血压、糖尿病和高脂血症可能是OSAHS危险因素.     

血脂、颈动脉粥样硬化与缺血性脑血管病的关系

目的：探讨血脂、颈动脉粥样硬化与缺血性脑血管病的关系。方法：2001年6月-2004年12月在佛山市第一人民医院诊治的缺血性脑血管病患者为病例组，共1583例，其中男性902例（57．0％），女性681例（43．0％），年龄38～89岁，平均（60．02±10．35）岁；同时期保健科随机选取的400名健康体检人群作为对照组。将动脉粥样硬化斑块分为稳定型和不稳定型。记录血脂和颈动脉粥样硬化情况并进行对比分析。结果：Logistic回归分析表明，颈动脉斑块与年龄、高血压史和胆固醇水平有显著相关性。有高血压、糖尿病、血浆低密度脂蛋白-胆固醇（LDL-C）水平增高和吸烟史的患者，颈动脉狭窄发生率显著增高。病例组总胆固醇、三酰甘油和LDL-C与对照组有显著差异。缺血性脑血管病患者颈动脉粥样硬化发生率显著高于普通人群。结论：血脂异常和颈动脉粥样硬化是缺血性脑血管病的重要因素。     

青海省城乡社区中老年卒中患病率及危险因素研究

目的 了解青海省城乡中老年人群卒中患病率及卒中的人群和城乡分布特征,并进一步探讨发病的 危险因素。 方法 本研究采用整群抽样调查方法,对青海省西宁市中庄社区和民和县官亭镇40岁以上人群进 行卒中患病率和发病高危因素调查。收集问卷调查、体格检查、实验室化验、经颅多普勒（transcranial Doppler sonography,TCD）及颈动脉超声检查及头部影像检查资料,采用单因素和多因素Logistic回归方 法分析卒中发病的危险因素。 结果 共筛查40岁以上人群4100例,其中卒中患者314例,总患病率7.65%,其中城市居民的卒中患 病率明显高于农村（10.33% vs 4.85%,P =0.007)。城市居民男性卒中患病率高于女性（12.21% vs 8.00%,P =0.026)。多因素Logistic回归模型分析结果显示：高血压和增龄是本组研究人群卒中的危险 因素;其中城市居民卒中的危险因素包括增龄、高血压、高血脂;农村居民卒中的危险因素为高血压, 保护因素为体力劳动。 结论 青海省城乡社区卒中患病率处于较高水平,城乡居民卒中的危险因素有所不同。     

上海流浪精神分裂症患者心血管危险因素患病率的回顾性评估(英文)

背景:心血管疾病在中国日益增长,但是贫困精神病患者心血管疾病的危险因素患病率尚不明确。目标:评估无家可归的精神分裂症患者中心血管疾病四个主要危险因素的患病率-高血压,高血糖,高血脂及吸烟-并确定与这些危险因素相关的因素。方法:我们回顾了从2007年5月到2013年4月期间,在上海嘉定精神卫生中心住院的精神分裂症以及分裂样精神病患者病历,包括181名无家可归的患者和181非无家可归的患者。比较了两组间人口学特征和心血管事件的危险因素。使用逻辑回归模型确定了与四个风险因素中一种或多种存在关联的因素。结果:两组患者的高血压和高血脂症的患病率范围为19%到20%(男性和女性的患病率范围相同);这些比率和一般人群报道的相似。两组患者的高血糖患病率介于11%和15%之间(男性和女性的患病率范围相同)。在男性患者中吸烟是非常普遍的(无家可归男性吸烟率82%,非无家可归男性吸烟率78%),但是在中国女性患者吸烟远没有那么普遍(无家可归女性吸烟率7%,非无家可归女性吸烟率5%)。Logistic回归分析发现,男性,年龄,城市(与农村相比)与四大心血管危险因素中的一种或多种独立相关。无家可归与心血管危险因素的患病率不相关。结论:本研究是对中国流浪精神病患者的心血管危险因素的第一个研究报告。这项研究有几个重要因素没有评估(如抗精神病药物的类型、剂量和使用时间),尽管如此,该研究还是能表明在中国,流浪与精神疾病患者心血管疾病风险增高无关,与高等收入国家不同。对于中国不断增多的流浪者而言,还需要进一步的前瞻性研究来探索他们所需的最佳医疗服务模式。     

脑卒中高危人群中颈动脉粥样硬化的现况调查及危险因素分析

目的了解脑卒中高危人群颈动脉粥样硬化(Carotid atherosclerosis,CAS)的发病情况及相关的危险因素。方法对海口市美兰区40岁以上的居民筛查,筛选出脑卒中高危人群进一步颈部血管超声检查、实验室检查。分CAS组和非CAS组,统计分析CAS的发病率及相关危险因素。结果 CAS检出率44.7%。性别、年龄、吸烟、肥胖、高血压、高血脂、糖尿病、既往脑卒中史,高Hcy和FBS在2组比较差异有统计学意义(P<0.05)。结论年龄、男性、吸烟、超重、高血压、高血脂、糖尿病、既往脑卒中史,高Hcy和FBS均为海口市美兰区脑卒中高危患者CAS的独立危险因素。     

颈动脉支架置入术对认知功能的影响

<正>随着人们对脑血管疾病认识的深入,越来越多的颈动脉狭窄被临床医师所发现和积极干预。大量研究已经证实,动脉粥样硬化引起的颈动脉狭窄是缺血性脑血管病的独立危险因素,在65岁人群中男性颈动脉狭窄的发生率高达75%、女性达62%,颈动脉狭窄率50%的发生率分别为     

缺血性脑血管病与颈动脉粥样硬化的关系

目的 探讨颈动脉粥样硬化与缺血性脑血管病的关系。方法 以2001年6月至2004年12月在我院住院的1583例急性缺血性脑血管病患者为研究对象，应用超声诊断仪检测双侧颈动脉，采用非条件Logistic回归分析颈动脉粥样硬化的危险因素及与缺血性脑血管病的关系。结果 86．5％（1369／1583）患者存在不同程度颈动脉粥样硬化；脑梗死组颈动脉粥样硬化患病率（1087／1266，85．9％）较短暂性脑缺血发作组（198／317，62．5％）高。颈动脉粥样硬化病变特点以斑块居多（1286／1583，81．2％），而中重度狭窄发生率较低（214／1583，13．5％）；颈动脉斑块以颈总动脉分叉处最多见（665／1286，51．7％）。斑块发生率及颅外段颈动脉狭窄程度与脑血管病危险因素有明显相关性。结论 佛山地区缺血性脑血管病患者颈动脉粥样硬化病变可能以斑块居多，颈动脉粥样硬化与缺血性脑血管病有关。     

上海市浦东新区某社区老年脑卒中高危人群筛查结果分析

目的了解上海市浦东新区三林社区老年脑卒中高危人群危险因素暴露情况及其人群分布特征,为制定老年脑卒中高危人群防治策略提供依据。方法于2015-2017年采取整群抽样方法对浦东新区三林社区65岁及以上常住户籍人口开展现场询问调查和相关的体格检查,进行血脂、空腹血糖、糖化血红蛋白、同型半胱氨酸、心电图检测,以筛查缺血性脑卒中高危人群及其危险因素。结果 2015-2017年筛查居民总数为9195人,筛查出脑卒中高危人群1504人,高危人群比例为16.78%,有短暂性脑缺血发作史或者卒中史535人(5.82%),危险因素≥3项的高危人群969人(10.54%)。1504名高危人群中危险因素暴露率从高到低依次为高血压、超重、高血脂、糖尿病、卒中史、吸烟史、家族史、缺乏运动、房颤。969例危险因素≧3的高危人群中,女性糖尿病、高血脂暴露率高于男性,男性吸烟率、超重高于女性。参加筛查的社区人群中,高Hcy血症的检出率为53.72%。男性检出率为63.8%,女性为45.7%,差异有统计学意义。结论三林地区65岁以上人群高危人群检出率与上海其他地区相似;高血压、超重、高血脂是暴露率最高的三项危险因素。男性和女性某些危险因素暴露情况有差异。高同型半胱氨酸血症在高龄、男性人群检出率高。应结合不同人群的危险因素发生情况实施定期随访管理,以达到预防脑卒中的目的。     

Significance of ultrasound evaluation of carotid atherosclerotic plaque for diagnosing ischemic cerebrovascular disease

BACKGROUND: Carotid artery is the main source for craniocerebral blood supply. Its intimal plaque formation and arterial stenosis degree both are the risk factors for ischemic cerebrovascular disease. Therefore, the close relationship of carotid atherosclerotic plaque and ischemic cerebrovascular disease, and ultrasound evaluation of carotid atherosclerotic plaque have become the hot spot in studying ischemic cerebrovascular disease. OBJECTIVE: This study was to detect the degree of carotid atherosclerosis of ischemic cerebrovascular disease patients by ultrasonography, and to analyze the situation of carotid atherosclerosis and its relationship with clinic. DESIGN: Clinical randomized concurrent control experiment. SETTING: Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA. PARTICIPANTS: Totally 60 outpatients and inpatients with ischemic cerebrovascular disease, 42 males and 18 females, admitted to Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA between January 2006 and December 2006 were involved in the patient group. They met the diagnosis criteria of ischemic cerebrovascular disease constituted by the 4th Cerebrovascular Disease Conference in 1996, and were confirmed to suffer from ischemic cerebrovascular disease by skull CT and MRI. Another 20 subjects who received healthy examination concurrently in the same hospital, 12 males and 8 females, were involved in the control group. Informed consents of detected items were obtained from involved subjects. METHODS: The plaque thickness of mid portion, distal end and crotch of common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA) and vertebral artery (VA) of involved subjects, who received health examination was separately detected with color Doppler ultrasonograph (HDI-5000). Then, total integral of plaque was calculated. The intima-media thickness (IMT) was measured with two-dimensional ultrasonography. The inner diameter stenosis degree of subjects who had plaque was measured. Blood flow parameters were recorded, and stenosis degree and plaque area were calculated. Blood flow volume of bilateral carotid artery and VA was separately measured with ultrasound equipment software, and brain blood flow volume was calculated. MAIN OUTCOME MEASURES: Atherosclerotic degree and blood flow volume of patients of two groups. RESULTS: Sixty patients with ischemic cerebrovascular disease and twenty subjects who received health examination participated in the final analysis. ①The IMT thickness, total plaque score, and total plaque area of patient group was significantly superior to that of control group, respectively（t=5.216–10.158，P < 0.05）. ② There were significant differences in the stenosis degree of CCA, ICA and VA between patient group and control group （t=6.720–12.816，P < 0.05）. ③ The blood flow volume of CCA, ICA, VA and brain of patient group was significantly lower than that of control group, respectively (t=2.872–10.860, P < 0.05). CONCLUSION: Ischemic cerebrovascular disease patients have different degrees of changes in atherosclerosis and arterial blood flow.     

Evidences of vascular origin of cochleovestibular dysfunction

OBJECTIVES: When the vascular disorder of the cochleovestibular system is mentioned, the diagnosis is based on exclusion of other diseases. Since arteries of the cochleovestibular system cannot be directly visualized, physicians must deduce from the vascular risk factors and the vascular lesion of other territories to the vascular cochleovestibular disease. MATERIALS AND METHODS: Authors analyzed the data of 19 patients with vertigo. Detailed blood tests, complete neurootological and audiological examination including ABR, carotid and vertebral artery Doppler sonography, MRI and MRA was performed. RESULTS: Cochleovestibular examination and ABR showed abnormalities in 73.7%, either carotid and vertebral artery Doppler or MRI showed abnormalities in 57.9%. MRA was abnormal in 47.4%. In most of the patients multiple risk factors of cerebrovascular disorder could be found. CONCLUSIONS: The cochleovestibular system disorders can be considered to be of vascular origin if the examinations exclude other diseases, if the patients have vascular risk factors and if other territories of brain accessible for imaging methods show vascular disorders.     

Prevalence of and risk factors associated with carotid artery stenosis: the Troms? Study.

BACKGROUND AND PURPOSE: To assess prevalence, distribution, ultrasound characteristics and determinants of carotid artery stenosis in a large, population-based study of both women and men. METHODS: A total of 6,727 persons aged 25-84 years were screened for extracranial stenosis with Duplex ultrasound of the right carotid artery. Risk factors were compared in 225 persons with stenosis and 5,514 persons without. RESULTS: The prevalence of carotid stenosis was higher in men than in women, where 3.8% (95% CI, 3.2-4.6%) had carotid stenosis, compared to 2.7% (95% CI, 2.2-3.3%) in women (p = 0.001). The prevalence gradually increased by age in both genders. Cholesterol, HDL cholesterol, fibrinogen, systolic blood pressure levels and current smoking were independently associated with carotid artery stenosis in both women and men. The presence of carotid stenosis was significantly associated with a history of cerebrovascular disease, coronary heart disease and peripheral artery disease. For each 10% increase in the degree of carotid stenosis, the risk of having had a cerebrovascular event increased by 26%. CONCLUSIONS: The prevalence of carotid stenosis in the general population, as measured by ultrasound, is low. Age, male gender, smoking, total cholesterol, HDL cholesterol (inverse), fibrinogen and systolic blood pressure are all independent predictors of carotid artery stenosis.     

The subclavian steal phenomenon: a common vascular disorder with rare neurologic deficits

Three hundred twenty-four patients with reversed vertebral artery blood flow were reviewed for cerebrovascular events. Neither the presence nor the type of vertebral artery steal (permanent, n = 204; intermediate, n = 120) determined neurologic symptoms, which rather were related to coincidental carotid obstructions or abnormal flow velocity patterns in the basilar artery. Most patients (n = 209; 64%) had no neurologic symptoms. Hemispheric events (n = 99; 31%) occurred most frequently in patients with additional carotid lesions and nonhemispheric events in a few patients (n = 16; 5%) often with bilateral vertebral steal. Intracranial Doppler studies from the vertebral and basilar arteries excluded spontaneous retrograde basilar artery perfusion in any of a subgroup of 50 patients examined in addition. Thus, blood flow reversal in extracranial arteries is a marker for atherosclerotic vascular disease in general, rather than an indicator of a patient's risk to develop cerebrovascular events from hemodynamic insufficiency in the territory affected. Surgical treatment is discouraged for most patients with this benign flow abnormality.     

颈内动脉扭曲与脑缺血的相关性研究

目的研究颈内动脉扭曲与脑缺血的相关性,探讨脑缺血的危险因素。方法回顾性分析存在颈内动脉扭曲但无椎动脉扭曲患者51例(实验组),选取无颈内动脉及椎动脉扭曲患者45例为对照组;比较实验组和对照组脑缺血的发生率;对研究资料进行单因素和多因素回归分析。结果实验组脑缺血发生率明显高于对照组,差异有统计学意义(χ2=51.6,P=0.001)。年龄与脑缺血呈正相关(P=0.008)、动脉狭窄与脑缺血呈正相关(P=0.023)、动脉扭曲与脑缺血存在相关可能性(P=0.055)。动脉扭曲和动脉狭窄是脑缺血的危险因素(P=0.009,P=0.002),但年龄不是脑缺血的危险因素(P=0.107)。结论颈内动脉扭曲是脑缺血的危险因素之一,应列入临床干预的对象中。     

Critical carotid and vertebral arterial occlusive disease and cough syncope.

BACKGROUND AND PURPOSE: Cough syncope typically occurs in patients with known chronic lung disease. The mechanism usually involves a combination of decreased venous return, increased cerebrospinal fluid pressure, and secondary hypocapnia, all resulting in cerebral arterial vasoconstriction. Cough syncope has not in the past been associated with occlusive cerebrovascular disease. CASE DESCRIPTION: We describe a 50-year-old man with a 6-month history of episodes of loss of consciousness during paroxysms of coughing. Physical examination showed asymmetrical upper extremity blood pressures and carotid and subclavian artery bruits. Pulmonary function studies were normal. Ultrasound and angiography showed total occlusion of the left common carotid artery, right internal carotid artery, and right vertebral artery; tight stenosis of the right subclavian artery; and a hypoplastic left vertebral artery. The patient had a left subclavian-to-left common carotid artery bypass and has had no syncope since that time. CONCLUSIONS: To our knowledge, this is the first reported case of cough syncope and severe cerebrovascular disease in which surgery led to amelioration of symptoms. Cerebrovascular occlusive disease may contribute to cough syncope.     

症状性颈、椎动脉狭窄的临床诊断与血管内介入治疗

目的探讨颅外段颈、椎动脉狭窄的临床诊断方法,评价颈、椎动脉狭窄血管内介入治疗的临床应用价值。方法对106例颅外段颈动脉和椎动脉狭窄患者的临床表现、颈部血管超声、全脑血管造影和血管内介入治疗等相关资料进行系统回顾。结果(1)颈部血管听诊发现血管杂音95例(89.6%),脑血管疾病危险因素排序依此为高脂血症83例(78.3%)、高血压62例(58.5%)、糖尿病49例(46.2%)、长期饮酒44例(41.5%)、吸烟41例(38.7%)和高尿酸血症23例(21.7%);(2)本组患者DSA发现单纯颅外段颈动脉狭窄40例,单纯椎动脉起始部狭窄30例,颅外段颈动脉和椎动脉狭窄合并存在36例,共检出狭窄血管169条;(3)104例患者血管内成功植入支架123枚,术后即刻DSA显示狭窄程度10%~20%,围手术期严重并发症3例(2.88%),92例患者术后6~12个月随访无短暂性脑缺血发作(TIA)及新发脑梗死。结论血管内介入诊疗技术在症状性颈、椎动脉狭窄的临床诊治中具有重要价值。     

脑梗死患者的颅外颈动脉超声与CT血管造影的比较

目的:比较颈部超声检查与颈部CTA对颅外颈动脉硬化性狭窄斑块的敏感性。方法:对比分析我科住院的61例脑梗死患者的双侧颈总动脉、颈动脉分叉处、颈内动脉超声检查和CTA检查结果。结果:61例患者中,超声发现斑块110处,CTA发现斑块124处,两者对于颈动脉的斑块检出率差异无显著性意义,两者狭窄程度的一致性是55%,但CTA对颈动脉分叉处斑块敏感性高于超声波检查,对钙化斑更敏感。超声检查血管狭窄的程度高于颈部CTA的结果,超声未能显示椎动脉异常。结论:脑梗死患者的颈部CTA检查优于超声检查,特别适用于椎基底动脉供血不足患者。     

Anomalous origins of the calcarine and parieto-occipital arteries

Understanding cerebrovascular anatomy and its variations is of utmost importance in treating vascular malformations. The two patients presented here demonstrate yet to be reported anomalous origins of the cortical branches of the posterior cerebral artery. In one patient, fetal calcarine arteries were identified arising from the internal carotid arteries bilaterally with no calcarine branches arising from the posterior circulation and the basilar artery giving rise to terminal parieto-occipital arteries. Additionally, with vertebral artery injections, we found the dominant arterial supply to the right parieto-occipital artery arose from the right internal carotid artery and right posterior communicating artery and the dominant arterial supply to the left parieto-occipital artery arose from the right vertebral artery. A second patient demonstrated anomalous origins of the calcarine and parietal occipital branches from the supraclinoid left internal carotid artery. Understanding this complex cerebrovascular anatomy is important in the endovascular treatment of cerebrovascular aneurysms and malformations.     

Unilateral stenosis of the vertebral artery — Secondary finding with no prognostic relevance?

Summary The outcome of 142 patients suffering from ischemic cerebral circulation disorders was followed up over a period of 33 months on average. The spontaneous course of 25 patients with unilateral, hemodynamically ineffective stenoses of the vertebral artery was compared with that of 107 patients without vertebral artery stenoses. Within the first 12 months, novel clinically manifest cerebrovascular events were observed in 16.0% of patients without vertebral artery stenosis (deaths 5.0%), but in only 4.3% of the patients with vertebral artery stenosis (no deaths). Within 30 months, only 2 of the 13 patients with vertebral artery stenosis had suffered a new cerebrovascular attack. At the end of the observation period, 39.3% of the patients without vertebral artery stenosis and 48.0% of the patients with vertebral artery stenosis were significantly disabled in their social life or had died. An additional unilateral hemodynamically irrelevant vertebral artery stenosis did not influence the rate of reinfarction or the remission of neurological deficits, independently of age, the degree of the circulatory disorder, the vascular territory involved, the presence of an organic psychosyndrome, or of additional stenoses in the carotid arteries. Consequently, a vertebral artery stenosis narrowing the vessel diameter to less than 1/3 is without prognostic relevance.