急性脑梗死患者脑白质疏松与颈内动脉狭窄及溃疡性斑块的关系

目的探讨急性脑梗死患者脑白质疏松（LA）与颈内动脉狭窄和溃疡斑块的关系。方法连续纳入首次发病的急性脑梗死患者102例。均行头部MRI及颈部血管DSA检查,确定颈内动脉病变情况。根据MRI将患者分为LA（70例）组和无LA组（32例）,再根据LA的部位将其分为皮质下LA组（46例）和脑室周围LA组（53例）。分析LA的部位、病变的程度与颈内动脉狭窄及溃疡斑块的关系,采用多因素Logistic回归分析影响不同部位LA的相关因素。结果①LA组与无LA组颈内动脉狭窄及溃疡斑块的发生率（44.3%比56.3%,21.4%比9.4%）差异均无统计学意义,P〉0.05。②皮质下LA组中,26.1%（12/46）的患者有颈内动脉溃疡斑块,高于皮质下无LA组的10.7%（6/56）,P〈0.05;皮质下LA与颈内动脉溃疡斑块呈低度正相关,r=0.201,P〈0.05。两组颈内动脉狭窄的发生率分别为56.5%和48.2%,差异无统计学意义,P〉0.05。③脑室周围LA组与脑室周围无LA组比较,颈内动脉狭窄及溃疡斑块的发生率差异均无统计学意义,P〉0.05。④多因素Logistic回归分析显示,年龄（OR=1.071,95%CI：1.014～1.131）、高血压（OR=2.953,95%CI：1.006～8.671）、颈内动脉溃疡斑块（OR=1.949,95%CI：1.286～3.142）是皮质下LA的独立预测因素;年龄（OR=1.069,95%CI：1.010～1.131）和高血压（OR=3.293,95%CI：1.984～11.020）是脑室周围LA的独立相关因素。结论急性脑梗死患者中,颈内动脉溃疡斑块的发生可能与皮质下LA相关,与脑室周围LA无明显关系。

Relationships between leukoaraiosis and internal carotid artery stenosis and ulcerated plaques in patients with acute cerebral infarction

Objective To investigate the relationships between leukoaraiosis(LA) and internal carotid artery stenosis and ulcerated plaques in patients with acute cerebral infarction.Methods A total of 102 consecutive patients with the first onset of acute cerebral infarction were enrolled in the study.They were all underwent neck vascular examinations with magnetic resonance imaging and digital subtraction angiography(DSA).The internal carotid artery lesions were identified.The patients were divided into LA or non-LA groups according to their MR,and they were redivided into a subcortical LA group and periventricular LA group according to the location of LA.The relationships between the location and severity of LA and internal carotid artery stenosis and ulcerated plaque were analyzed.Multivariate logistic regression analysis affected the relevant factors of different locations of LA.Results ①The incidences of internal carotid artery stenosis and ulcerated plaques had no significant difference between the LA group and the non-LA group(all P>0.05).②In the subcortical LA group,26.1% patients(12/46) had ulcerated carotid plaques,which was higher than 10.7%(6/56) in the non-subcortical LA group(P<0.05).A low positive correlation was observed between the subcortical LA and ulcerated carotid plaques(r=0.201,P<0.05).The incidences of the internal carotid artery stenosis were 56.5% and 48.2% respectively in both groups.The difference was not statistically significant(P>0.05).③There was no significant difference in the incidence of ulcerated carotid plaques between the periventricular LA group and the periventricular non-LA group(P>0.05).④Multivariate analysis showed that age(OR=1.071,95% CI 1.014-1.131),hypertension(OR=2.953,95% CI 1.006-8.671),and ulcerated carotid plaques(OR=1.949,95% CI 1.286-3.142) were the independent predictors of subcortical LA;the independently associated factors of periventricular LA were age(OR=1.069,95% CI 1.010-1.131) and hypertension(OR=3.293,95% CI 1.984-11.020).Conclusion Among the patients with acute cerebral infarction,ulcerated carotid plaques are associated with the subcortical leukoaraiosis,and there is no significant relationship with the periventricular leukoaraiosis.