缺血性脑血管病患者颈动脉粥样硬化斑块和狭窄的超声研究

目的观察缺血性脑血管病患者的颈动脉斑块性质、分布特点及狭窄情况,探讨颈动脉斑块和狭窄的分布规律。方法缺血性脑血管病患者340例,行颈部血管超声检查.其中短暂性脑缺血发作(TIA)患者105例(TIA组),脑梗死患者235例(脑梗死组);又根据年龄分为青年组(54例),中年组(137例)和老年组(149例)。结果随年龄增加,缺血性脑血管病患者危险因素:高血压、糖尿病、冠心病、吸烟、家族史显著增加(P<0.01)。脑梗死组颈动脉内膜中层厚度明显高于TIA组(P<0.01);70%～99%血管狭窄斑块发生率高于50%～69%血管狭窄和<50%血管狭窄(P<0.01);老年组斑块发生率、颈动脉狭窄的发生率高于中年组及青年组(P<0.01)。结论超声检查显示不稳定斑块与缺血性脑血管病的关系更为密切,导致颈动脉狭窄的斑块中,以软斑块和混合性斑块多见。超声检查可以用于颈动脉狭窄患者的诊断及监测。

The ultrasound study of carotid atherosclerotic plaque and stenosis in patients with ischemic cerebrovascular disease

Objective To investigate the characteristics and distribution of carotid antherosclerotic plaques and carotid stenosis in patients with ischernic cerebrovascular disease and to explore the regularity of distribution of carotid stenosis and atherosclerotic plaques. Methods 340 cases of ischemic cerebrovascular disease(including 105 TIA patients and 235 cerebral infarction patients) underwent carotid vascular ultrasonography. The examinations included intima-media thickness (IMT)and the location, size,morphology and echo of carotid plaque, the diameter of proximal and distal stenoses. Results The risk factors were increased with age (P<0.01). The carotid IMT of cerebral infarction patients was thicker than that of TIA patients (P<0.01). The incidence of stenosis and the number of the unstable plaques which caused stenosis in cerebral infarction patients were higher than those in TIA patients. The incidence of plaques in 70%-99% stenosis group was higher than that in 50%-69% stenosis group and <50% stenosis group (P<0.01). The incidences of plaque and carotid stenosis in old-aged group were higher than those in the middle-aged group and young group (P<0.01). Conclusion Ultrasound examination can be used for diagnosis and monitoring of carotid stenosis. Soft and mixed plaques were closely associated with carotid stenosis, suggesting that monitoring and treating soft and mixed plaques may be useful to delaying the development of carotid stenosis.