老年急性缺血性脑卒中患者疾病分型和严重程度与颈动脉斑块性质和血液流变学的关系

目的 探讨>65 岁急性缺血性脑卒中患者颈动脉斑块性质，以及外周血液流变学指标与卒中病情严重程度的关系，为临床早期判断病情和预测疾病转归提供参考。方法 选取2016 年10 月—2018 年10 月永康市第一人民医院首次诊断急性缺血性脑卒中患者300 例。根据牛津郡社区卒中计划将患者分为完全前循环型组、部分前循环型组、后循环型组和腔隙型组。另选择>65 岁无脑卒中健康志愿者50 例作为对照组。采用多普勒超声检测颈动脉内中膜厚度（IMT）、斑块数量、最大长径和性质，全自动生化分析仪检测全血黏度、血浆黏度、红细胞压积（HCT）、血沉（ESR）、血浆纤维蛋白原（Fib）、胆固醇、甘油三酯和血糖水平。结果 完全前循环型组、部分前循环型组、后循环型组和腔隙型组IMT 较对照组增厚、斑块数量较对照组增多、最大长径较对照组变大、全血黏度、血浆黏度、HCT、ESR 及Fib 水平均较对照组升高（P <0.05），完全前循环型组、部分前循环型组和后循环型组各指标数值均较腔隙型组升高（P <0.05）。中、重度组IMT、斑块数量、最大长径、全血黏度、血浆黏度、HCT、ESR 及Fib 数值较轻度组升高（P <0.05），重度组各指标数值较中度组升高（P <0.05）。结论 >65 岁老年人急性缺血性脑卒中严重程度往往与颈动脉斑块形成和血液流变学异常有关。

Relationshop between carotid plaque nature, hemorheology andclassification, severity of disease in elderly peoplewith acute ischemic stroke

Objective To analyze carotid plaque nature by color doppler ultrasound and peripheralhemorheological parameters by blood biochemistry in people more than 65 years with acute ischemic stroke (AIS)for assessing severity of stroke. Method A total of 300 AIS patients for first diagnosis from October 2016 to October2018 were enrolled, including total anterior circulation group (TACI), partial anterior circulation group (PACI),posterior circulation group (POCI) and cavity type group (CA) according to oxfordshire community stroke project(OCSP), and other 50 healthy persons more than 65 years as control group. Then we used doppler ultrasound todetect carotid intima-media thickness (IMT), plaque number, maximum length and nature, whole blood viscosity,plasma viscosity, hematocrit (HCT), erythrocyte sedimentation rate (ESR), plasma fibrinogen (Fib), cholesterol (TC),triglyceride (TG) and blood sugar with automatic biochemical analyzer. Results IMT, number of plaques, maximum length diameter, whole blood viscosity, plasma viscosity, HCT, ESR and Fib in TACI, PACI, POCI and CA groups were all significantly increased compared with control group (P < 0.05). Moderate and severe group were higher than mild group (P < 0.05), and the severe group was higher than the moderate group (P < 0.05). Conclusions The severity of acute ischemic stroke in patients over 65 year old is often related to the formation of carotid plaque and hemorheology.