摘要
目的探讨脑梗死再发的危险因素及其与颈动脉粥样硬化斑块之间的相关关系。方法将126例脑梗死患者分为初发组72例和再发组54例，对两组的年龄、生活习惯（吸烟史、饮酒史）、既往病史（包括糖尿病、冠心病、心房颤动、高血压病史）、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）以及高血压分级进行比较，颈动脉超声测量颈动脉内膜-中层厚度（IMT）及粥样硬化斑块的回声强度、数量、部位等，并对上述因素进行多因素非条件Logistic回归分析。结果再发组年龄、高血压病史、糖尿病病史、冠心病病史、心房颤动病史与初发组比较差异有统计学意义（P〈0．01或〈0．05）。再发组高血压分级明显高于初发组，差异有统计学意义（P〈0．01）。再发组颈总动脉、颈总动脉分叉部、颈内动脉IMT均明显高于初发组（P〈0．01）。初发组斑块检出例数为31例，占43．1％（31/72），总数为87个，平均（1．21±0．76）个，再发组斑块检出例数46例，占85．2％（46／54），总数为96个，平均（1．78±0．92）个；再发组斑块检出例数、平均斑块数量均明显高于初发组（P〈0．01）。再发组斑块中以软斑为多（占61．5％，59／96），初发组以硬斑为多（占60．9％，53／87），两组比较差异有统计学意义（P〈0．01）。多因素非条件Logistic回归分析显示，年龄、高血压分级、糖尿病病史、心房颤动病史、颈内动脉IMT、软斑数量是脑梗死再发的危险因素（OR值分别为1．315、2．435、1．072、2．131、3．024、5．162，P〈0．01或〈0．05）。结论年龄、高血压分级、糖尿病病史、心房颤动病史、颈内动脉IMT、软斑数量是导致脑梗死再发的危险因素，在监测血压、血糖等常规指标的同时观察颈动脉粥样硬化的部位、程度、斑块的性质可以对脑梗死的再发起到一定的预测作用。
Objective To investigate the risk factors of the recurrence of cerebral infarction and the correlation between carotid atherosclerotic plaque and the recurrent cerebral infarction. Methods One hundred and twenty-six patients with cerebral infarction were divided into primary group with 72 cases and recurrent group with 54 cases. The age,habits （smoking, alcohol consumption）,past medical history （including history of diabetes,coronary heart disease, atrial fibrillation and hypertension）,triglyceride （TG）, total cholesterol （TC）,high density ]ipoprotein cholesterol （HDL-C）,low density lipoprotein cholesterol （LDL-C） and high blood pressure level of the two groups were compared. The carotid intimamedia thickness （1MT）, and the echo intensity, quantity,location of atherosclerotic plaque were observed by neck ultrasound,and then these factors were analyzed by non-conditional Logistic regression analysis. Results Age,history of diabetes,coronary heart disease,atrial fibrillation and hypertension between recurrent group and primary group had significant differences （P 〈 0.01 or 〈 0.05 ）. High blood pressure level of the recurrent group was significantly higher than that of the primary group （P 〈 0.01 ）. While IMT of carotid artery, carotid bifurcation, internal carotid artery of the recurrent group were obviously higher than those of the primary group,respectively （P 〈0.01）. The number of cases detected having plaques in the primary group was 31,43.1% （31/72）,the total plaque number was 87,and average plaque number was 1.21 ＋ 0.76. These values in the recurrent group were 46,85.2% （46/54）,96,1.78 ＋ 0.92. The number of cases detected having plaques and average plaque number of the recurrent group were significantly higher than those in the primary group （P 〈 0.01 ）. There were more cases with soft plaque in the recurrent group （61.5% ,59/96）, while more hard plaque in the primary group （60.9% ,53/87）,and the difference was significant （P 〈0.01）. Non-conditional Logistic regression analysis showed that age,high blood pressure level,history of diabetes and atrial fibrillation,IMT of internal carotid artery,the number of soft plaque were the risk factors of the recurrence of cerebral infarction （OR = 1.315,2.435, 1.072,2.131,3.024,5.162, respectively,P 〈 0.01 or 〈 0.05）. Conclusions Age,high blood pressure level, history of diabetes and atrial fibrillation,IMT of internal carotid artery, the number of soft plaque are the risk factors of the recurrence of cerebral infarction. Observing the site and degree of carotid atherosclerosis, the characteristics of plaque besides monitoring blood pressure, blood glucose and other conventional indicators can have some predictive effect for the recurrence of cerebral infarction.
出处
《中国医师进修杂志》
2012年第16期8-11,共4页
Chinese Journal of Postgraduates of Medicine
关键词
颈动脉疾病
颈动脉狭窄
脑梗塞
Carotid artery diseases
Carotid stenosis
Brain infarction
