不同类型脑白质疏松与颈动脉粥样硬化斑块相关性研究

目的探讨不同类型脑白质疏松症(LA)与颈动脉粥样硬化(AS)斑块的关系。方法LA患者208例,按入院时头颅磁共振成像(MRI)的脑白质疏松部位分为三组:脑室周围型(第一组)、皮质下型(第二组)、混合型(第三组)。第一组68例,其中单侧型21例,双侧型47例;第二组66例,其中单侧型30例,双侧型36例;第三组74例,其中单侧型22例,双侧型52例。通过彩色多普勒超声仪、MRI检测各组颈动脉AS斑块,并对颈动脉AS斑块及狭窄情况进行分组分析。结果彩色超声检测208例LA患者,141例存在颈动脉AS斑块,阳性率为67.79%。其中第一组阳性率为54.41%(37/68),第二组75.76%(50/66),第三组72.97%(54/74),第二、三组与第一组相比有统计学意义。第一组单侧型LA的彩色超声检测颈动脉AS斑块11例阳性,其中LA与斑块同侧者6例,双侧型26例阳性,11例发生在双侧;第二组中,单侧型LA中22例斑块阳性,LA与斑块同侧者12例,双侧型28例阳性,9例发生在双侧;第三组中,单侧型LA16例斑块阳性,LA与斑块同侧者7例,双侧型38例阳性,13例发生在双侧。三组彩色超声检测颈动脉AS斑块积分情况:稳定性斑块积分分别为2.32±0.46、2.65±0.28、3.02±0.35,三组无显著性差异;不稳定性斑块积分分别为3.29±0.42、7.68±0.37、6.97±0.51,第二、三组较第一组P(0.01。MRI检测AS斑块三组分级情况:Ⅰ级斑块分别占54.88%、35.71%、38.21%(45/82、40/112、47/123),Ⅱ级斑块分别占24.39%、27.68%、27.64%(20/82、31/112、34/123),Ⅲ级斑块分别占20.73%、36.61%、34.15%(17/82、41/112、42/123)。在MRI检测颈动脉重度狭窄(≥50%)患者52例中,LAⅠ级15例,Ⅱ级19例,Ⅲ级18例,无显著性差异。结论颈动脉AS斑块是LA的危险因素,且与皮质下LA相关性更密切,不稳定性斑块在其中起重要作用,颈动脉AS斑块破裂后可能通过颅内Willis动脉环可导致患侧或健侧甚至双侧脑白质疏松,而颈动脉AS斑块致颈动脉狭窄与LA的程度并不呈比例。提示我们应针对LA尤其是皮质下型LA患者常规开展颈动脉AS斑块的检测并积极干预不稳定性斑块,这对于减缓或阻止LA发展具有积极的临床意义。

The research on relativity of different kinds of leukoaraiosis and atherosclerosis plaque

Objective To explore the relativity of different kinds of leukoaraiosis （LA） and carotid atherosclerosis（AS） plaque.Methods 208 LA patients were divided into 3 groups according to their brain magnetic resonance imaging （MRI）： circumventricular type （Group I）,subcortex type （Group Ⅱ） and mixed type （Group Ⅲ）. There were 68 subjects in Group I and 21 were unilateral type and the other 47 were bilateral type. 66 subjects were in Group Ⅱ,30 were unilateral type and the other 36 were bilateral type. 74 subjects were in Group Ⅲ,22 were unilateral type and the other 52 were bilateral type. Color doppler flow imaging and MRI were used to detect the carotid AS plaques in all groups. All data of the carotid AS plaques and the narrow of carotid were analyzied by groups. Results There were 141 patients in total 208 LA patients were detected by color doppler flow imaging （CDFI） to have AS plaques and the positive rate was 67.79%. The positive rate of Group I was 54.41% （37/68）,positive rate in Group Ⅱwas 75.76% （50/66） and in Group Ⅲ it was 72.97% （54/74）. There were statistical significant between Group I,Ⅱ and Group Ⅲ. 11 cases of unilateral type LA in Group I had carotid AS plaques detected by CDFI ,and 6 subjects showed the same side of LA and plaques. 26 cases of bilateral type LA in Group I had carotid AS plaques ,and 11 subjects showed both sides of LA and plaques. In Group Ⅱ,22 cases of unilateral type LA had carotid AS plaques ,and 12 subjects showed the same side of LA and plaques. 28 cases of bilateral type LA had carotid AS plaques ,and 9 subjects showed both sides of LA and plaques. In Group Ⅲ,16 cases of unilateral type LA had carotid AS plaques ,and 7 subjects showed the same side of LA and plaques. 38 cases of bilateral type LA had carotid AS plaques ,and 13 subjects showed both sides of LA and plaques. The scores of stable plaques detected by CDFI in 3 groups were respectively 2.32±0.46,2.65±0.28 and 3.02±0.35 and there were no statistical difference in 3 groups. Scores of vulnerable plaques were 3.29±0.42,7.68±0.37 and 6.97±0.51 respectively. There were statistical significances between Group Ⅱ,Group Ⅲ and Group I （P﹤0.01）. AS plaques in all groups were detected by MRI and scored into 3 grades. Proportion of plaques of Grade I in 3 groups were 54.88%,35.71% and 38.21% （45/82、40/112、47/123）respectively. Proportion of plaques of Grade Ⅱ were 24.39%,27.68 %and 27.64%（20/82、31/112、34/123） respectively. Proportion of plaques of Grade Ⅲ were 20.73%、36.61%、34.15%（17/82、41/112、42/123）in 3 groups respectively. In 52 patients whose cortid was severiouly narrow（≥50%） detected by MRI,there were 15 LA patients whose plaques scored Grade I,19 scored Grade Ⅱ and 18 scored Grade Ⅲ. And there were no statistical difference of narrow level in 3 Grades. Conclusion The carotid AS plaque was the risk factor of LA,especially with much closer relationship with LA of subcortex type. The vulner ability of AS played an important pole in LA. The fragments from rupture of carotid AS plaques would probably lead to leukoaraiosis in affected side or normal side or both sides through Willis cerebral arterial circulations. The narrow of carotid suffered from AS plaques were out of proportion to severity of LA. Our research suggested that we should detect carotid AS plaques routinely in LA patients specific to those of subcortex type and take active intervention to the vulnerable plaques,which was positively significant to slow down or hold back the progression of LA.