缺血性脑卒中患者动脉粥样硬化分布的临床研究

目的探讨急性缺血性脑卒中不同亚型与颈动脉粥样硬化分布的相关性。方法通过经颅多普勒超声(TCD)和颈动脉彩色多普勒血流成像(CDFI)方法检测颅内、外动脉粥样硬化程度,并结合病史、生化指标及影像学提示的病变部位进行综合分析。结果411例急性缺血性脑卒中患者,颅内动脉狭窄率为38.93%(160/411),颈动脉颅外段狭窄率24.09%(99/411)。颈动脉颅外段狭窄者年龄大、吸烟比例高,与无狭窄者比较差异有统计学意义(P=0.020,0.013);而颅内动脉狭窄者糖尿病发病率明显高于无狭窄者(P=0.005)。411例中皮质梗死49例、皮质下梗死108例、腔隙性梗死72例和短暂性脑缺血发作30例,颈动脉颅外段狭窄者以皮质梗死为主(P=0.001),并且动脉内-中膜层厚度明显增加(P=0.020);而颅内动脉狭窄者以腔隙性梗死更多见(P=0.016)。颅内、外动脉狭窄者的年龄、性别、血糖及血脂之间差异无统计学意义(均P>0.05)。结论临床和影像学检查所确定的急性缺血性脑卒中亚型与颅内、外动脉粥样硬化的病变部位相关,提示发病的原因可能不同。糖尿病与吸烟是引起颅内、外动脉病变的重要原因。

Clinical study of the distribution of atherosclerosis in the patients with ischemic stroke

Objective To study the relationship between the clinical subtypes of acute ischemic stroke and the distribution of carotid atherosclerosis. Methods The extent of intra- and extra- cranial atherosclerosis were detected with transcranial Doppler (TCD) and color Doppler flow imaging (CDFI). Comprehensive analysis was performed on medical history, laboratory examination and lesion site in the brain indicated by radiological imaging. Results Among 411 patients with acute ischemic stroke, 160 cases (38.93%) suffered with intracranial artery stenosis, and 99 cases (24.09%) with extracranial carotid artery stenosis. Compared with patients without carotid stenosis, those with stenosis were often seen in elder patients (P = 0.020) and smokers (P = 0.013), while the morbidity of diabetes was significantly higher in intracranial artery stenosis patients than those without stenosis (P = 0.005). In this group, 49 patients had cortical infarction, 108 had subcortical infarction, 72 had lacunar infarction and 30 had transient ischemic attack. Cortical infarction presented more frequently in patients with extracranial carotid artery stenosis (P = 0.001), and media-intima thickness was more significant (P = 0.020), whereas lacunar infarction presented more frequently in patients with intracranial artery stenosis (P = 0.016). Between the patients with extracranial artery stenosis and intracranial artery stenosis, the indexes such as age, sex, plasma glucose and blood lipid showed no statistical difference (P > 0.05, for all). Conclusion The patterns of acute ischemic stroke determined by clinical and radiological examination is related to the location of intra- and extra- cranial atherosclerosis, which would suggest their different underlying pathogenesis. Diabetes and smoking is the major causes of extra-and intracranial artery diseases.