颈动脉斑块形成常见危险因素的多因素分析及临床护理对策

目的分析影响颈动脉粥样斑块形成的常见临床危险因素,为临床防治提供科学依据。方法收集2005年6月～2006年12月在我院检查颈动脉彩超的住院患者279例,首先对颈总动脉的内膜-中层厚度(IMT)行多重回归,筛选影响颈动脉粥样硬化的因素;再将资料分为颈动脉有无斑块两组行二项分类Logistic回归及单因素分析,进一步筛选影响颈动脉斑块形成的因素;最后比较危险因素亚组间斑块积分和指数的大小。结果颈总动脉的IMT受年龄(Age)、收缩压(SBP)及低密度脂蛋白(LDL)影响(Beta=0.242,Page=0.000;Beta=0.152,Psbp=0.013;Beta=0.115,PLDL=0.048),但颈动脉有无斑块形成主要受年龄及SBP影响(ORage=1.087,Page=0.000;ORSBP=1.036,PSBP=0.000)。颈动脉斑块的检出率,60岁以上组高于60岁以下组(χ~2=58.379,P=0.000),高血压病组高于非高血压病组(χ~2=18.206,P=0.000);结论颈动脉粥样斑块形成的主要危险因素有年龄、收缩压和LDL,对后两者进行健康教育,提高治疗依从性,能更有效地防治动脉粥样硬化的发生和进展。

Clinical analysis of the factors influencing the formation of carotid plaque and It's strategy for clinical care

Objective To analyze the common clinical factors influencing the formation of carotid atherosclerotic plaque,and to provide a scientific basis for it＇s clinical prevention and treatment.Method From Jun 2005 to December 2006,the data of 279 hospitalized patients undergoing the examination of cervical part artery color Doppler ultrasonography were collected and analyzed.Firstly,multinomial regression was used to screen out the influencing factors of common carotid artery intima-media thickness（IMT）.Then the data were divided into two groups,one with plaque and the other without plaque.Binary logistic regression and one-way analysis were carried out to screen out the factors influencing the formation of carotid plaque,Finally,the Crouse score and index of carotid plaque were compared between the subgroups of factors.Result The IMT of common carotid artery was influenced by age,systolic blood pressure（SBP）and low density lipoprotein（LDL）（Beta=0.242,P=0.000;Beta=0.152,P= 0.013;Beta=0.115,P=0.048respectively）,however,the formation of carotid plaque was mainly influenced by age and SBP（ORage=1.087,Page=0.000;ORSBP=1.036,PSBP=0.000,respectively）.And the detection rate of carotid plaque in the patients more than 60years old was higher than that in the patients less than 60 years old（χ~2 =58.379,P=0.000）,while that in the patients with hypertension was higher than that in the patients without hypertension（χ~2=18.206,P=0.000）.Conclusion This study finds that age,systolic blood pressure and low-density lipoprotein are the major factors influencing the formation of carotid atherosclerotic plaque.And effective interference in the reversable risk factors,such as high blood pressure and hyperlipemia,by providing patients with personalized health education may be more effective in preventing and treating atherosclerotic occurrence and development.