颈动脉粥样硬化与缺血性卒中危险分层相关性分析

目的观察急性缺血性卒中患者的颈动脉粥样硬化与卒中复发风险分层的关系。方法采用Essen卒中风险评分量表(ESRS)对82例急性缺血性卒中患者的危险因素评估后分为ESRS≥3分组(40例)和ESRS 0～2分组(42例),经彩色多普勒超声仪对两组进行评估,比较两组颈动脉粥样硬化特征和程度。结果 ESRS≥3分组与ESRS 0～2分组相比,ESR≥3分组中高龄、高血压、糖尿病和本次卒中之前有TIA或缺血性卒中的比例明显较高(P<0.05)。ESRS≥3分组颈动脉内-中膜厚度(IMT),斑块(尤其多发斑块)发生率,脂质性、钙化性斑块发生率,中、重度粥样硬化发生率明显高于ESRS 0～2分组(P<0.05)。经多因素非条件Logistic回归分析,颈总动脉IMT≥1.0 mm,脂质性、钙化性斑块,颈动脉粥样硬化程度与ESRS≥3分组卒中复发的危险因素成正相关。结论颈动脉粥样硬化与缺血性卒中复发高危风险密切相关。颈总动脉IMT、颈动脉粥样硬化的严重程度可作为卒中高危复发风险的预测指标。

The relationship between carotid atherosclerosis and risk stratification of ischemic stroke

Objective To examine the relationship between carotid atherosclerosis in acute ischemic stroke and risk stratification of the recurrent ischemic stroke. Methods The risk factors were evaluated by ESRS in 82 pa- tients with the acute ischemic stroke and divided into ESRS ≥ 3 group（ n = 40）and ESRS 0-2 group（ n = 42）. Carotid artery were assessed by color Doppler ultrasound in both groups,the difference of the characteristics of carotid athero- sclerosis between the both groups were compared. Results Compared with ESRS 0-2 group, the proportions of older patients, arterial hypertension, diabetes mellitus and previous TIA or ischemic stroke in addition to qualifying event in the ESRS ≥3 group were significantly higher（ P 〈 0.05 ）. The carotid intima-media thickness（ IMT）, the ratios of the carotid lipid and calcified plaques, moderate and severe carotid atherosclerosis in the ESRS≥3 group were significant- ly higher than that of ESRS 0-2 group （ P 〈 0.05 ）. The logistic regression analysis showed common carotid artery IMT thicker than 1.0 mm,lipid plaques and calcific plaques, the severity of carotid atherosclerosis were positively related to high risk recurrent ischemic stroke. Conclusion Common carotid artery IMT and the severity carotid atherosclero- sis may be a risk predictor in high risk patients recurrent ischemic stroke.