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颈动脉粥样硬化斑块与急性缺血性脑卒中的相关性研究

昝芹 陈晓荣 杨文琼

昝芹, 陈晓荣, 杨文琼. 颈动脉粥样硬化斑块与急性缺血性脑卒中的相关性研究[J]. CT理论与应用研究, 2023, 32(1): 1-8. DOI: 10.15953/j.ctta.2022.039
引用本文: 昝芹, 陈晓荣, 杨文琼. 颈动脉粥样硬化斑块与急性缺血性脑卒中的相关性研究[J]. CT理论与应用研究, 2023, 32(1): 1-8. DOI: 10.15953/j.ctta.2022.039
ZAN Q, CHEN X R, YANG W Q. Correlation between Carotid Atherosclerotic Plaques and Acute Ischemic Stroke[J]. CT Theory and Applications, 2023, 32(1): 1-8. DOI: 10.15953/j.ctta.2022.039. (in Chinese)
Citation: ZAN Q, CHEN X R, YANG W Q. Correlation between Carotid Atherosclerotic Plaques and Acute Ischemic Stroke[J]. CT Theory and Applications, 2023, 32(1): 1-8. DOI: 10.15953/j.ctta.2022.039. (in Chinese)

颈动脉粥样硬化斑块与急性缺血性脑卒中的相关性研究

doi: 10.15953/j.ctta.2022.039
基金项目: 湖北省自然科学基金面上项目(血管活性肽Salusins与缺血性脑卒中相关性研究(2012FFB02003))
详细信息
    作者简介:

    昝芹:女,锦州医科大学在读研究生,主要从事CT、MRI影像诊断,E-mail:2051070014@qq.com

    陈晓荣:女,十堰市国药东风总医院医学影像部主任医师,湖北医药学院副教授、硕士研究生导师,主要从事胸、腹部及心脑血管系统疾病影像诊断,E-mail:xiaorongchenwhy@163.com

    通讯作者:

    陈晓荣*,女,十堰市国药东风总医院医学影像部主任医师,湖北医药学院副教授、硕士研究生导师,主要从事胸、腹部及心脑血管系统疾病影像诊断,E-mail:xiaorongchenwhy@163.com

  • 中图分类号: R  814

Correlation between Carotid Atherosclerotic Plaques and Acute Ischemic Stroke

  • 摘要: 目的:运用颈动脉CTA分析颈动脉粥样硬化斑块,探讨斑块性质及部分因素与急性缺血性脑卒中的相关性,从而为急性缺血性脑卒中的预防和治疗提供参考和依据。方法:回顾性分析行颈动脉CTA检查、且在颈动脉CTA检查前或后一周内行磁共振DWI检查的患者,根据磁共振DWI判断有无前循环急性缺血性脑卒中,将患者分为急性缺血性脑卒中组(95例)和非急性缺血性脑卒中组(102例);对两组患者的临床资料、实验室资料和CTA显示的颈动脉斑块性质、斑块表面形态进行分析,比较两组之间有无统计学差异,对P<0.05的指标纳入急性缺血性脑卒中发生的多因素Logistic回归分析。结果:两组间在年龄、高血压病史、TC、TG、HDL、HCY、CysC、HbA1c指标中差异有统计学意义;两组间在斑块性质及斑块表面形态间差异有统计学意义,在颈动脉管腔狭窄程度间差异无统计学意义;多因素回归分析提示年龄≥65岁、高血压、TC、HDL、HCY及脂质斑块是急性缺血性脑卒中发生的危险因素。结论:颈动脉粥样硬化与急性缺血性脑卒中发生相关,脂质斑块是急性缺血性脑卒中发生的危险因素;颈动脉CTA可以对斑块性质进行判断,结合部分实验室指标,可以为急性缺血性脑卒中的防治提供参考和依据。

     

  • 图  1  同一患者:(a)和(b)显示右侧颈总动脉脂质、溃疡斑块,(c)显示右侧基底节区及颞顶叶急性大面积脑梗塞,(d)显示右侧颈总动脉脂质斑块所致管腔中度狭窄(黑箭头所示)

    Figure  1.  In the same patient: (a) and (b) show lipid and ulcerative plaques in the right common carotid artery, respectively; (c) shows acute massive cerebral infarction of the right basal ganglia and temporo-parietal lobe; and (d) shows moderate stenosis of the right common carotid artery due to lipid plaques (black arrow)

    图  2  同一患者:(a)和(b)显示左侧颈总动脉脂质、不规则斑块,(c)显示左侧颞顶叶急性脑梗塞,(d)显示左侧颈总动脉脂质斑块所致管腔中度狭窄(黑箭头所示)

    Figure  2.  In the same patient: (a) and (b) show lipid and irregular plaques in the left common carotid artery, respectively; (c) shows acute cerebral infarction of the left temporo-parietal lobe; and (d) shows moderate stenosis of the left common carotid artery lumen due to lipid plaques (black arrow)

    图  3  同一患者。(a)和(b)显示左侧颈总动脉脂质、光滑斑块,(c)显示左侧侧脑室旁小片状急性脑梗塞,(d)显示左侧颈总动脉脂质斑块所致管腔轻度狭窄(黑箭头所示)

    Figure  3.  In the same patient: (a) and (b) show lipid and smooth plaques in the left common carotid artery, respectively; (c) shows small patchy acute cerebral infarction near the left lateral ventricle; and (d) shows mild stenosis of the left common carotid artery lumen due to lipid plaques (black arrow)

    图  4  为同一患者:(a)和(b)显示左侧颈动脉分叉处纤维斑块,(c)显示该患者DWI未见明显急性脑梗塞,(d)显示左侧颈动脉分叉处纤维斑块所致管腔中度狭窄(黑箭头所示)

    Figure  4.  In the same patient: (a) and (b) show fibrous plaques at the left carotid bifurcation, (c) shows no significant acute cerebral infarction on DWI, and (d) shows moderate stenosis of the lumen at the left carotid bifurcation due to fibrous plaques (black arrow)

    图  5  同一患者:(a)和(b)显示为左侧颈总动脉混合斑块、脂质成分为主,(c)显示左侧顶叶皮层下急性脑梗塞(黑箭头所示),(d)显示左侧颈总动脉混合斑块所致管腔中度狭窄(黑箭头所示)

    Figure  5.  In the same patient: (a) and (b) show mixed plaques in the left common carotid artery with a predominance of lipid components, (c) shows left parietal subcortical acute cerebral infarction (black arrow), and (d) shows moderate stenosis of the left common carotid artery lumen due to mixed plaques (black arrow)

    表  1  病例组与对照组一般临床资料和实验室指标比较

    Table  1.   Comparison of general clinical data and laboratory indicators between the case and control groups

    项目参数组别统计检验
    病例组(n=95)
    例数(%)或$\bar x \pm s$
    对照组(n=102)
    例数(%)或$\bar x \pm s$
     t/χ2  P
      性别   男71(81.4)83(74.7)1.2690.260
       女24(18.6)19(25.3)
      年龄/岁   <505(5.3)25(24.5)32.672<0.001
       50~6425(26.3)25(24.5)
       ≥6565(68.4)52(51.0)
      高血压*   是66(69.5)35(34.3)24.339<0.001
       否29(30.5)67(65.7)
      糖尿病   是26(27.4)17(16.7)3.3010.069
       否69(72.6)85(83.3)
      吸烟   是14(14.7)9(8.8)1.6680.197
       否81(85.3)93(91.2)
      饮酒   是13(13.7)7(6.9)2.5090.133
       否82(86.3)95(93.1)
        TC/(mmol/L)6.417±3.6815.050±2.4473.0470.002
        TG/(mmol/L)2.235±1.8491.742±1.5042.0430.042
        HDL/(mmol/L)1.241±0.3441.086±0.3023.3370.001
        LDL/(mmol/L)2.609±0.8372.385±0.9181.7890.075
        HCY/(umol/L)20.502±11.49516.614±9.592 2.5670.011
        CysC/(mg/L)1.143±0.2511.073±0.2451.9780.049
      HbA1c/%   正常47(49.5)81(79.4)19.372<0.001
       不正常48(50.5)21(20.6)
    下载: 导出CSV

    表  2  病例组与对照组颈动脉斑块检出情况和颈动脉管腔狭窄程度比较

    Table  2.   Comparison of the features of carotid plaques and carotid artery stenosis

    项目参数组别统计检验
    病例组(n=95)
    例数(%)或$\bar x \pm s$
    对照组(n=102)
    例数(%)或$\bar x \pm s$
    t/χ2P
      斑块类型*  无斑块14a(14.7)16a(15.7)28.109 <0.001
      钙化斑块17a(17.9)37a(36.3)
      脂质斑块46a(48.4)15b(14.7)
      纤维斑块13a(13.7)23a(22.5)
      混合斑块5a(5.3)11a(10.8)
      斑块表面形态*  无斑块14a(14.7)16a(15.7)9.1360.028
      光滑斑块34a(35.8)56b(54.9)
      不规则斑块30a(31.6)18b(17.6)
      溃疡斑块17a(17.9)12a(11.8)
      斑块数量/个*4.37±3.2523.00±2.3253.4150.001
      管腔狭窄程度  无狭窄15(15.8)16(15.7)1.1530.679
      轻度狭窄47(49.5)44(43.1)
      中度狭窄30(31.6)40(39.2)
      重度狭窄3(3.2)2(2.0)
     注:*表示P<0.05;a和b表示该因素在两组间经两两比较后存在统计学差异,字母相同则不存在统计学差异。
    下载: 导出CSV

    表  3  急性缺血性脑卒中发生的多因素相关Logistic回归分析

    Table  3.   Multivariate logistic regression analysis of the risk factors for acute ischemic stroke

    因素β$S_{\bar {\rm{x}}} $Wald χ2POR(95%CI)
      年龄/岁  <501.000
      50~651.2940.9461.8710.1713.647(0.571~23.281)
      ≥65*1.8920.7995.6000.0186.632(1.384~31.777)
      高血压*  否1.000
      是2.3410.50721.309<0.001 10.395(3.847~28.090)
          TC*0.1690.0764.9200.0271.184(1.020~1.375)
          HDL*1.8030.7975.1440.0246.067(1.272~28.940)
          HCY*0.0620.0237.1250.0081.064(1.017~1.114)
      脂质斑块*  否1.000
      是1.3280.4947.2170.0073.773(1.432~9.938)
     *为P<0.05,差异有统计学意义。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-03-03
  • 修回日期:  2022-04-27
  • 录用日期:  2022-05-17
  • 网络出版日期:  2022-06-30

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