探讨颈动脉硬化患者发生缺血性脑卒中的相关危险因素  

Relative Risk Factors of Ischemic Stroke in Patients with Carotid Atherosclerosis

作　　者：廖姗 李超[1] 阮骊韬[2] 宋艳[2] 李奇光 徐成 王重阳[1] 穆岩[1] 李筱笛 Liao Shan;Li Chao;Ruan Litao(Medical Affairs Department of Xi'an Mental Health Center,Xi'an,Shanxi 710061;Department of Ultrasound Medicine,First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shanxi 710061,China)

机构地区：[1]西安市精神卫生中心医务科,陕西西安710061 [2]西安交通大学第一附属医院超声医学科,陕西西安710061

出　　处：《四川医学》2021年第5期457-463,共7页Sichuan Medical Journal

摘　　要：目的探讨颈动脉硬化患者发生缺血性脑卒中的相关危险因素,并将其危险因素进行量化分析。方法选取2019年9月至12月在西安交通大学第一附属医院超声科行颈动脉超声检查有斑块形成的253例患者,按照有无发生缺血性脑卒中分为有病组和无病组两组,对其一般资料及各部位血管壁剪切应力(WSS)值分别行单因素、Logistic多因素回归及ROC曲线分析。结果有病组的年龄、血糖、收缩压、脉压差、脉压差指数、糖尿病、高血压患病率及降三高(血糖、血脂、血压)药物的服药率均高于无病组;而低密度脂蛋白胆固醇(LDL-C)和总胆固醇(TC)较无病组降低。脉压差(OR=1.07,95%CI 1.00~1.13,P<0.05)和左侧颈动脉分叉处前壁(前LCCABIF)WSSa值(OR=3.85,95%CI 1.02~14.50,P<0.05)为缺血性脑卒中发生的独立危险因素。经ROC曲线分析,得出脉压差为49.5 mmHg时是缺血性脑卒中的最佳诊断临界点;左侧颈动脉分叉处前壁WSSa=1.985 pa为诊断是否发病的最佳临界点。结论脉压差和左侧颈动脉分叉处前壁WSSa值可以作为颈动脉硬化患者发生缺血性脑卒中的独立预测指标,同时当脉压差值>49.5 mmHg和(或)左侧颈动脉分叉处前壁斑块处WSSa值>1.985 pa时发病风险高。Objective To explore related risk factors of ischemic stroke in patients with carotid atherosclerosis,and to quantitatively analyze risk factors.Methods From September to December 2019,253 patients with plaque formation in our hospital were selected.They were divided into two groups:a diseased group and a disease-free group according to whether ischemic stroke occurred or not.General data and vascular wall shear stress(WSS)of each part were analyzed by single factor,logistic multiple factor regression and ROC curve analysis.Results In diseased group,blood sugar,systolic blood pressure,pulse pressure difference,pulse pressure difference index,prevalence of diabetes and hypertension,and three-high(blood sugar,blood lipid,blood pressure)medication rates of disease group were higher than those of disease-free group.Low density lipoprotein cholesterol(LDL-C)and total cholesterol(TC)were lower than those in disease-free group.Pulse pressure difference(OR=1.07,95%CI 1.00~1.13,P<0.05)and WSS value of anterior wall of the left carotid artery bifurcation(anterior LCCABIF)(OR=3.85,95%CI 1.02~14.50,P<0.05)were an independent risk factor for ischemic stroke.After ROC curve analysis,it was concluded that pulse pressure difference of 49.5 mmHg was the best diagnostic cut-off point for ischemic stroke.Anterior wall WSS=1.985 pa at the left carotid artery bifurcation was the best cut-off point for diagnosis.Conclusion Pulse pressure difference and WSS of anterior wall at the left carotid artery bifurcation could be used as independent predictors of ischemic stroke in patients with carotid atherosclerosis.Moreover,when pulse pressure difference is greater than 49.5 mmHg and/or WSS of anterior wall plaque at the left carotid artery bifurcation is greater than 1.985 pa,risk of disease is high.

关 键 词：颈动脉斑块 血管壁剪切应力 缺血性脑卒中 

分 类 号：R445.1[医药卫生—影像医学与核医学]