缺血性脑卒中患者颈动脉粥样斑块发生与踝肱指数相关性研究

作者单位： 570311 海口，海南省人民医院超声科(李载红，杨炳昂，钟文津，张洁)；510630 广州，广州市第十二人民医院(刘移民)

缺血性脑卒中患者颈动脉粥样斑块发生与踝肱指数相关性研究

李载红杨炳昂钟文津张洁刘移民

【摘要】目的探讨缺血性脑卒中患者颈动脉粥样斑块发生与踝肱指数的相关性。方法对236例缺血性脑卒中患者(观察组)和260名健康人(对照组)应用彩色多普勒超声检测颈部血管内中膜厚度及斑块形成情况，使用多普勒超声仪测量踝肱指数，并分析踝肱指数与颈动脉粥样硬化的程度和稳定性的相关性。结果236例观察组患者中，检出颈动脉粥样硬化斑块183例(77.5%)，对照组为60例(23.1%)，缺血性脑卒中颈动脉粥样硬化斑块发生率明显高于对照组(P<0.01)。观察组22例踝肱指数异常，发生率为9.3%；对照组有6例踝肱指数异常，发生率为2.3%，2组比较差异有统计学意义(P<0.01)。缺血性脑卒中患者颈动脉内膜增厚组踝肱指数明显低于正常组，颈动脉内膜斑块形成组患者的踝肱指数明显低于增厚组(P<0.05)，颈动脉内膜不稳定斑块组踝肱指数明显低于稳定斑块组(P<0.05)。Logistic回归分析显示颈动脉粥样硬化斑块、踝肱指数与缺血性脑卒中明显相关(OR分别为1.118、0.054，P均<0.05)。结论颈动脉粥样硬化与缺血性脑卒中有关，踝肱指数可作为预测缺血性脑卒中发生的指标之一。

【关键词】缺血性脑卒中；颈动脉粥样硬化；踝肱指数

DOI：10.3969/g.issn.0253-9802.2015.07.013

通讯作者，刘移民

Abstract【】ObjectiveTo evaluate the relationship between carotid atherosclerosis and the ankle-brachial index in ischemic stroke patients. MethodsColor Doppler ultrasound examinations were performed in 236 ischemic stroke patients (study group) and 260 healthy volunteers (control group) to examine the carotid intima-media thickness and carotid atherosclerotic plaque formation. The ankle-brachial index (ABI) was measured using Doppler ultrasound. The correlation between the ABI and the extent and stability of carotid atherosclerotic plaques was assessed. ResultsAmong the 236 patients in the study group, 183 exhibited carotid atherosclerotic plaques, with an incidence rate of 77.5%, while 60 of the 260 volunteers in the control group exhibited carotid atherosclerotic plaques, resulting in an incidence rate of 23.1%. The incidence rate of atherosclerotic plaques was significantly higher in ischemic stroke patients compared with healthy volunteers (P<0.01). Among the ischemic stroke patients, 22 (9.3%) had an abnormal ABI, while six subjects in the control group (2.3%) had an ABI abnormality. The difference between the two groups was statistically significant (P<0.01). The ABI of the patients with a thickened carotid intima in the study group was remarkably lower than that of the normal control group, and the ABI of patients with plaques in the carotid intima was significantly lower than that of the patients with a thickened carotid intima (P<0.05). Furthermore, the ABI of patients with unstable plaques in the carotid intima was markedly lower than that of patients with stable plaques (P<0.05). Carotid atherosclerotic plaques and the ABI were correlated with ischemic stroke (OR=1.118 and 0.054, respectively, P<0.05). ConclusionsCarotid artery arteriosclerosis and, in particular, unstable plaques are closely associated with ischemic stroke. The ABI can be used as an indicator of risk for an ischemic stroke.

收稿日期：(2015-01-30)

Correlation between carotid atherosclerosis and ankle-brachial index in ischemic stroke patientsLiZaihong,YangBing’ang,ZhongWenjing,ZhangJie,LiuYimin.UltrasoundDivision,HainanProvincePeople’sHospital,Haikou570311,China

Correspondingauthor,LiuYimin

【Key words】Ischemic stroke; Carotid artery arteriosclerosis; Ankle-brachial index

脑卒中病死率和致残率较高，给患者的个人、家庭和社会带来了沉重的经济负担和精神压力。多项研究显示，缺血性脑卒中的发生与颈动脉粥样硬化斑块密切相关[1]。血管造影是诊断脑血管疾病的最佳手段，但由于其医疗费用高，且为有创检查，患者一般不愿接受[2]。与其相比，踝肱指数廉价、无创、操作简单，广泛用于心血管疾病的诊断及预后评估[3]。但踝肱指数与缺血性脑卒中的关系尚未定论。为此，本研究对236 例缺血性脑卒中住院患者进行颈动脉彩色多普勒超声(彩超)检查，并使用多普勒超声仪测量其踝肱指数变化，旨在探讨颈动脉粥样硬化斑块发生与踝肱指数的相关性，现报告如下。……