颈动脉斑块超声特征与中老年患者缺血性脑卒中的关联性研究

孙丹丹; 陈怡静; 霍禹璇; 姜紫薇; 李玲玲; 李改

doi:10.3969/j.issn.2095-5227.2022.01.004

颈动脉斑块超声特征与中老年患者缺血性脑卒中的关联性研究

Correlation between ultrasonographic features of carotid artery plaque and ICS in middle-aged and elderly patients

摘要

摘要:
背景颈动脉粥样硬化斑块与缺血性脑卒中(ischemic cerebral stroke，ICS)的发生关系密切，超声检查是颈部血管疾病筛查的首选方式。
目的通过对中老年患者颈动脉斑块超声检测指标与ICS的相关性分析，以颈动脉斑块超声特征作为预警指标，简化临床评估路径，从而提高超声诊断价值和ICS筛查效率。
方法选取2017年9月- 2019年11月吉林医药学院附属医院诊治的≥45周岁的ICS患者为ICS组，采用随机抽样的方法抽取同时间段来院诊治的同年龄段非ICS患者作为对照组，对所有受试者进行颈动脉超声检查。
结果共收集资料完整的ICS组患者992例，对照组患者1 117例，两组年龄差异无统计学意义(P＞0.05)，ICS组男女性别比高于对照组(594/398 vs 493/624，P＜0.01)。超声结果显示，两组间斑块形成、斑块数目、回声、形态、颈动脉狭窄的差异有统计学意义(P均＜0.05)。ICS组伴颈动脉粥样硬化斑块形成的比例高于对照组(86.90% vs 69.92%， P＜0.01)。ICS组多发斑块、不均匀斑块、不规则斑块的比例高于对照组(95.71% vs 88.09%，51.62% vs 45.45%，24.13% vs 16.90%，P均＜0.05)。ICS组颈动脉狭窄的比例高于对照组(18.33% vs 11.91%，P＜0.01)。ICS组颈动脉重度狭窄或闭塞的比例高于对照组(3.71% vs 1.15%，2.09% vs 0.51%，P均＜0.01)。斑块超声特征指标与脑卒中的多因素logistic回归结果显示，斑块数目(OR=1.702)、斑块形态(OR=1.381)、颈动脉狭窄(OR=1.435)与中老年患者ICS的发生有关联性(P均＜0.05)。
结论对中老年患者进行ICS筛查时，颈动脉斑块是否形成是具有关联性的重要指标。在斑块超声特征的描述中，斑块数目、形态、是否造成颈动脉狭窄与ICS发生相关。ICS组颈动脉狭窄的比例更高、程度更重。

Abstract:
Background Carotid atherosclerotic plaque is closely related to the occurrence of ischemic cerebral stroke (ICS), and ultrasound is the predominant method for cervical vascular disease screening.
Objective To analyze the correlation between ultrasonic detection indicators of carotid artery plaque and ICS in middle-aged and elderly patients, so as to improve the value of ultrasonic diagnosis and the efficiency of ICS screening by using ultrasonographic features of carotid artery plaque as early warning indicators and simplifying the clinical evaluation path.
Methods The patients aged 45 years or older who were admitted to our hospital from September 2017 to November 2019 were collected for two groups, patients with ICS were included in the ICS group and patients without ICS were included in the control group.
Results Totally 992 patients were included in the ICS group and 1 117 patients in the control group. There was no statistical difference in age between the two groups (P＞0.05), and the proportion of male/female patients in the ICS group was higher than that in the control group (594/398 vs 493/624, P＜0.01). Ultrasound results showed that there were significant differences between the two groups in plaque formation, plaque number, echotexture, morphology and carotid artery stenosis (all P＜0.05). The ratio of patients with carotid atherosclerotic plaque in the ICS group was higher than that in the control group (86.90% vs 69.92%, P＜0.01). The ratios of multiple plaque, uneven plaque and irregular plaque in the ICS group were higher than that in the control group (95.71% vs 88.09%, 51.62% vs 45.45%, 24.13% vs 16.90%, all P＜0.05). The ratio of carotid artery stenosis in the ICS group was significantly higher than that in the control group (18.33% vs 11.91%, P＜0.01). The ratio of severe carotid artery stenosis or occlusion in the ICS group was also higher than that in the control group (3.71% vs 1.15%, 2.09% vs 0.51%, P＜0.01, respectively). Multivariate Logistic regression analysis showed that plaque number (OR=1.702), plaque morphology (OR=1.381) and carotid artery stenosis (OR=1.435) were correlated with the occurrence of ICS in middle-aged and elderly patients (all P＜0.05).
Conclusion Plaque formation in carotid artery is a relevant and important predictor of ICS in middle-aged and elderly patients. In the ultrasonic features of plaque, the number, morphology and whether the plaque caused carotid artery stenosis are related to the occurrence of this disease. The proportion and severity of carotid artery stenosis are higher in the ICS group.

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