早期神经功能恶化急性卒中患者的颈动脉粥样硬化超声特征  

The ultrasound characteristics of carotid atherosclerosis in acute stroke patients with early neurological deterioration

作　　者：陈胜江[1] 段广才[2] 陈梅[1] 张周龙[1] 谢瑜娟[1] 黄丽娜[1] 杜敢琴[1] 富奇志[1] 

机构地区：[1]河南科技大学第一附属医院,洛阳471003 [2]郑州大学公共卫生学院,450001

出　　处：《国际脑血管病杂志》2010年第4期254-258,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨早期神经功能恶化（early neurological deterioration,END）急性卒中患者的颈动脉粥样硬化超声特征。方法END定义为入院第7天时国立卫生研究院卒中量表评分较入院时至少增加2分。128例入院24h内接受颈动脉超声检查的急性缺血性卒中患者中，38例出现END的患者作为END组，40例危险因素相匹配的非END患者作为非END组。比较两组颈动脉粥样硬化超声特征。结果END组斑块积分[（16．7±4．4）mm对（13．3±3．5）mm，t=2．673，P=0．009）、内膜-中膜横截面积[（26．4±8．5）mm^2对（20．5±6．8）mm^2，t=3．394，P=0．001]、动脉僵硬指数（28．94±4．29对21．22±5．85，t=6．618，P=0．000）以及不稳定斑块（66．7％对43．3％，Х^2=9．164，P=0．003）、偏心性斑块（62．8％对45．6％，Х^2=5．008，P=0．025）、狭窄≥50％（71．1％对37．5％，）（Х^2=8．828，P=0．003）和负性重构（28．9％对7．5％，）（Х^2=6．087，P=0．014）的构成比均显著高于非END组，而扩张系数[（14．74±8．66）×10^-6／Pa对（19．16±9．35）×10^-6／Pa，t=2．163，P=0．034]和顺应系数[（0．49±0．13）×10^-4mm^2／Pa对（0．58±0．11）×10^-4mm^2／Pa，t=3．307，P=0．001]均显著低于END组。结论斑块积分、内膜-中膜横截面积、动脉僵硬度、不稳定斑块、偏心性斑块、狭窄≥50％、负性重构、扩张性和顺应性等超声特征可能有助于预测急性卒中的END。Objective To explore the ultrasound characteristics of carotid atherosclerosis in acute stroke patients with early neurological deterioration （END）. Methods END was defined as a increase by at least two points in the National Institutes of Health Stroke Scale between admission and day 7. Among 128 patients with acute stroke in whom carotid ultrasound examinations were performed within 24 hours after admission, 38 patients with END and 40 risk-matched patients without END were included in the END group and the non-END group, respectively. The ultrasound characteristics of carotid atherosclerosis were compared in both groups. Results Plaque score （16.7 ±4.4 mm vs. 13.3 ±3.5 mm, t=2.673, P =0.009）, intima-media cross-sectional area （26.4 ± 8.5 mm^2 vs. 20. 5 ± 6.8 mm^2, t = 3. 394, P = 0. 001）, arterial stiffness index （28.94±4.29 vs. 21.22 ±5.85, t =6. 618, P =0. 000）, and the rates of unstable plaque （66.7% vs. 43.3%, Х^2 =9. 164, P =0. 003）, eccentric plaque （62.8% vs. 45.6%, Х^2 =5.008, P =0. 025）, stenosis ≥50% （71.1% vs. 37.5%,Х^2 =8. 828, P =0. 003）, and negative remodeling （28.9% vs. 7. 5%, Х^2 =6. 087, P =0. 014） in the END group were significantly higher than those in the non-END group, while the distensibility coefficient （[ 14. 74± 8.66] × 10^ -6/pa vs. [ 19.16± 9.35 ] × 10 ^-6/pa, t =2. 163, P =0. 034） and compliance coefficient （[0. 49 ±0. 13] × 10^-4 mm^2/pa vs. [0. 58 ±0. 11 ] ×10^-4 mm^2/pa, t =3.307, P =0. 001） were significantly lower than those in the non-END group. Conclusions The ultrasound characteristics such as plaque score, intima-media cross-sectional area, arterial stiffness index, unstable plaque, eccentric plaque, stenosis ≥ 50%, negative remodeling, distensibility and compliance may be useful to predict END in patients with acute stroke.

关 键 词：卒中 颈动脉疾病 颈动脉狭窄 动脉粥样硬化 超声检查 多普勒 

分 类 号：R743.3[医药卫生—神经病学与精神病学]