颈动脉粥样硬化性中度狭窄进展的影响因素分析

目的应用彩色多普勒血流显像(CDFI)评估颈动脉粥样硬化性狭窄进展的影响因素。方法回顾性连续纳入存储系统中2009年1月至2014年12月通过CDFI首次评估为颈动脉粥样硬化性中度狭窄(狭窄率为50%~69%),并且于初检后完成12、24、36个月CDFI规律复查的患者279例。记录病变血管残余管径及血流动力学参数变化,并根据病变血管狭窄程度是否进展为重度狭窄(狭窄率为70%~99%)或闭塞,分为进展组(40例)及非进展组239例,进一步分为稳定组(210例)和改善组(29例)]。比较两组患者的常见脑血管病危险因素、服用降脂类药物(阿托伐他汀20 mg/d)等对狭窄进展的影响。将两组差异有统计学意义的单因素进一步通过Logistic回归分析,比较这些因素对颈动脉狭窄进展的影响。结果进展组24、36个月时狭窄病变的残余管径较稳定组和改善组均明显减小,差异有统计学意义(均P0.05),而狭窄处及其远段收缩期峰值流速比值均明显高于稳定组和改善组(均P0.05)。在脑血管病危险因素中,高血压(OR=2.686,95%CI:1.120~6.442,P=0.027)和吸烟(OR=2.265,95%CI:1.081~4.746,P=0.030)是影响颈动脉狭窄进展的主要危险因素。规律性服用阿托伐他汀是延缓颈动脉狭窄进展的保护因素(OR=0.383,95%CI:0.178~0.827,P=0.01)。结论 CDFI可以客观评估颈动脉狭窄的进展。吸烟和高血压是加速狭窄进展的独立危险因素,规律性服用阿托伐他汀有助于延缓颈动脉狭窄的进展。

Progression of moderate stenosis of carotid atherosclerosis:an analysis of influencing factors

Objective To assess the influencing factors of the progression of carotid atherosclerotic stenosis using color Doppler flow imaging (CDFI). Methods From January 2009 to December 2014, a total of data 279 consecutive patients first assessed by CDFI as moderate stenosis of carotid atherosclerosis (stenosis rate 50 -69%)and regularly reexamined with CDFI at 12,24 and 36 months after initial examination were enrolled retrospectively. The residual diameter of vascular lesions and the changes of hemodynamic parameters were documented,and they were divided into either a progression group (n = 40)or a non-progression group (n = 239,and the non-progression group was divided into steady groupn = 210]and improved group n = 29])according to whether the degree of stenosis progressed into severe stenosis (stenosis rate 70 -99%)or occlusion. The effects of the risk factors for common cerebrovascular disease and taking lipid lowering drugs (atorvastatin 20 mg/ d)on stenosis progression were compared in patients between the 2 groups. There were significant differences in hypertension,smoking and the regular use of atorvastatin . The effects of those factors on the progression of carotid stenosis were compared further through Logistic regression analysis. Results The residual vascular diameters of stenosis at 24,and 36 months were reduced obviously in the progression group compared with those of the non-progression group. There was significant difference (all P < 0. 05),and both the stenotic sites and distal peak systolic flow velocity ratio were significantly higher than those of the steady group and improved group (all P < 0. 05). Among the risk factors for cerebrovascular disease,hypertension (OR,2. 686,95% CI 1. 120 -6. 442,P = 0. 027)and smoking (OR,2. 265,95% CI 1. 081 -4. 746,P = 0. 030)were the major risk factors for affecting the progression of carotid stenosis. Regularly taking atorvastatin was a protective factor of delaying the progression of carotid stenosis (OR,0. 383,95% CI 0. 178 -0. 827,P = 0. 015). Conclusions CDFI may objectively evaluate the progression of carotid stenosis. Smoking and hypertension are the independent risk factors for affecting the progression of carotid stenosis,and regularly taking atorvastatin contributes to delay the progression of carotid stenosis.