摘要
目的探讨老年脑梗死与颈动脉粥样硬化的关系。方法选择60岁以上老年脑梗死患者100例(男58例,女42例)。经详细询问病史、生化检验、头颅CT/MRI及颅外段颈动脉超声检查。入选患者分为短暂性脑缺血发作组(TIA组,18例),腔隙性梗死组(腔梗组,24例)、脑血栓形成组(脑血栓组,58例)3组。选择同期住院和门诊非脑梗死患者40例为对照组。结果(1)颈动脉粥样硬化检出率为82%,颈动脉粥样硬化斑块检出率71%,其中TIA斑块检出率72%(13/18);腔隙性梗死组斑块检出率58%(14/24);脑血栓组斑块检出率76%(44/58);对照组斑块检出率25%(10/40)。TIA组、腔隙性梗死组和脑血栓形成组与对照组比较,差异有显著性(P<0.05)。(2)颈动脉内膜病变多发生在起始段的后壁及外侧壁;粥样硬化斑块以颈总动脉分叉处后壁即颈动脉膨大段多见,其次为颈总动脉、颈内动脉和颈外动脉的起始段,呈单发、多发,散在分布。斑块以扁平斑、软斑、硬斑较多见,溃疡斑块较少。(3)各组颈动脉狭窄程度比较腔隙性梗死组中轻度狭窄占75%(18/24),中度狭窄占20.8%(5/24),重度狭窄占4.2%(1/24);TIA组中轻度狭窄占55.6%(10/18),中度狭窄占33.3%(6/18),重度狭窄占11.1%(2/18);脑血栓组中轻度狭窄占36.2%(21/58),中度狭窄占48.3%(28/58),重度狭窄占15.5%(9/58)。TIA组、腔隙性梗死组、脑血栓组与对照组比较差异有显著性(P<0.05)。TIA组、腔隙性梗死组、脑血栓组狭窄程度组间比较差异亦具有显著性(P<0.05)。颈动脉轻度狭窄呈腔梗组>TIA组>脑血栓组趋势;中、重度狭窄呈脑血栓组>TIA组>腔梗组趋势。(4)老年脑梗死颈动脉粥样硬化患侧和健侧出现率比较患侧颈动脉粥样硬化斑块的出现率为70%,健侧为26%;患侧IMT增加的出现率76%,而健侧为34%,患侧与健侧两组数据比较差异有显著性(P<0.05)。结论颈动脉粥样硬化与老年脑梗死密切相关,超声多普勒检测颈动脉粥样硬化及斑块可预测老年脑梗死的发生。
Objective To investigate the relationship between cerebral infarction and carotid artherosclerosis in elderly. Methods 100 elderly patients above 60 were enrolled in this study （male 58, female 42）. They were asked for case history detailedly and checked through biochemistry, cerebral CT/MRI and supersound. They were divided into 3 groups： transient ischemlc attack group（TIA group, n = 18）, lacouna infarction group（ n = 24）, cerebral thrombosis group（ n = 58）.40 non-cerebral infarction patients were en- rolled as control. Results （ 1 ）Detection rate of carotid artheroselerosis was 82 %, detection rate of carotid artheroselerosis plaque is 71% .Of those detection rate of TIA plaque is 72% （13/18） ; detection rate of lacouna infarction plaque is 58% （14/24） ; detection rate of cerebral thrombosis plaque is 76 % （44/58） ; detection rate of control 25 % （10/40） o TIA group, lacouna infarction group, cerebral thrombosis group were significantly different from control group（ P 〈 0.05）. （2） Pathological changes of carotid endarterium mainly occurred on posterior and lateral wall of initial segment ; atherosclerotic plaque mainly occurred on posterior wall of common carotid artery crotch which is carotid artery intumescence, next on initial segment of common carotid artery, arterla carotid imema and arteria carotid externa, single, multiple and diffused distribution. Plaque was mainly fiat plaque, soft plaque and hard plaque, ulcer plaque was less. （3）Light degree srenosis, middle degree stenosis and severe stenosis of laeouna infarction accounted for 75% （18/ 24） ,20.8% （5/24）and 4.2% （1/24）, respectively; Light degree stenosis, middle degree stenosis and severe stenosis of TIA group accounted for 55.6%（10/18）,33.3% （6/18）and 11.1%（2/18）,respectively;Light degree stenosis,middle degree stenosis and severe stenosis of cerebral thrombosis group accounted for 36.2 % （ 21/58 ）, 48.3 % （ 28/58 ） and 15.5 % （ 9/58 ）, respectively. TIA group, lacouna infarction group,cerebral thrombosis group were significantly different from control group（ P 〈 0.05）. There was signitleantly-difference among TIA group, lacotma infarction group and cerebral thrombosis group （ P 〈 0.05）. Calorie artery light stenosis lacouna infarction group 〉 TIA group 〉 cerebral thrombosis group; middle and severe stenosis cerebral thrombosis group 〉 TIA group 〉 lacoana infarction. （4） Frequency of trouble side atherosclerotie plaque was 70% and that of uninjuried side was 26% ;frequency of trouble IMI increase was 76% ,and that of uninjuried side was 34%. There was significantly difference between trouble and uninjuried side（ P 〈 0.05）. Condusion The relationship between carotid artherosclerosis and elderly cerebral infarction is intimate. Super sound Doppler check for carotid artheroselerosis and plaque may be used to predict the oceurance of elderly cerebral infarction.
出处
《中国实验诊断学》
2008年第5期640-643,共4页
Chinese Journal of Laboratory Diagnosis
关键词
脑血管病
颈动脉粥样硬化
脑梗死
cerebrovascular disease
carotid artherosclerosis
cerebral infarciton
