汤颖等

[摘要] 目的 探讨颈动脉狭窄程度以及颈动脉粥样硬化斑块性质、部位与脑梗死的相关性。 方法 选取2013年4月～2014年1月急性脑梗死患者100例设为观察组，同时选取100例同期就诊非急性脑梗死患者设为对照组。所有患者行头颈动脉联合CTA检查，观察颈动脉狭窄程度以及斑块分布部位，并用斑块分析软件分析颈动脉狭窄程度及斑块性质。 结果 观察组颈动脉无狭窄，中、重度狭窄及闭塞较对照组增高（25.2%，28.0%，15.5%，11.1%比54.0%，15.2%，6.8%，3.0%）（P < 0.05）；观察组斑块检出率高于对照组（74.8%比46.0%，P < 0.01）；观察组不稳定斑块比例高于稳定斑块（83.9%比38.0%）（P < 0.05），对照组稳定斑块比例高于不稳定斑块（62.0%比16.1%）（P < 0.05）；观察组混合斑块和软斑块发生率明显高于对照组（P < 0.01），对照组纤维斑块及钙化斑块发生率明显高于观察组（P < 0.01）。 结论 颈动脉狭窄程度以及颈动脉粥样硬化斑块性质与急性脑梗死的发生具有明确的相关性，而颈动脉斑块部位与急性脑梗死发生无明显相关。

[关键词] 颈动脉狭窄；颈动脉斑块；不稳定斑块；脑梗死

[中图分类号] R543.4 [文献标识码] A [文章编号] 1673-7210（2014）09（a）-0032-04

[Abstract] Objective To investigate the relationship between the degree of carotid stenosis as well as the character of atherosclerotic plaque and cerebral infarction. Methods From April 2013 to January 2014， totally 100 acute cerebral infarction patients were studied as the observation group. Meanwhile， 100 cases who were not acute cerebral infarction were selected as the control group. Carotid artery of all were examined by carotid artery CTA to observe the degree of carotid stenosis and to judge plaque characters as well as their location. Then they were measured by plaque analysis software. Results The number of no stenosis， mild and severe stenosis and occlusion in observation group was higher than those in control group （25.2%， 28.0%， 15.5%， 11.1% vs 54.0%， 15.2%， 6.8%， 3.0%， respectively） （P < 0.05）； compared with control group， plaque detection rate was high （74.8% vs 46.0%） （P < 0.01）； in observation group， the occurrence of unstable plaque was higher than stable plaque （83.9% vs 38.0%） （P < 0.05）， in control group， the occurrence of stable plaque was higher than unstable plaque （62.0% vs 16.1%） （P < 0.05）； the incidence of mixed plaques and soft plaques in observation group was significantly higher than those of control group （P < 0.01）， the incidence of fibrous plaques and calcified plaques in control group was significantly higher than those of observation group （P < 0.01）. Conclusion The degree of carotid stenosis as well as the characters of atherosclerotic plaques are associated with acute cerebral infarction and there is no correlation between atherosclerotic plaques location and acute cerebral infarction

[Key words] Carotid plaque； Carotid stenosis； Unstable plaque； Infarction

数据显示我国脑卒中发生率正以每年8.7%的速率上升，我国缺血性卒中年复发率高达17.7%，发病者中约30%的患者死亡，70%的生存者有偏瘫、失语等功能障碍[1]。20%～30%的缺血性脑卒中与颈动脉狭窄有关。根据发病机制及病理分析，颈动脉狭窄是缺血性脑血管病的重要原因及危险因素，与脑梗死的发生、发展及梗死部位密切相关。多次大规模临床试验证实，颈动脉的狭窄程度是预测脑血管病时间发生的主要因素，但是颈动脉狭窄程度和同侧脑梗死的发生率和严重程度并不完全一致。近年来的研究结果显示造成急性脑血管病发生的另一主要原因是不稳定性斑块[2]。因此，斑块的稳定性同颈动脉狭窄一样具有预测缺血性脑血管病的意义。

头颈动脉联合CT血管造影（CT angiography，CTA）为近几年来在临床上无创性判断动脉粥样硬化斑块以及血管狭窄程度的一种良好方法，因其存在较高的时间以及空间分辨率、强大的后处理功能以及更长的解剖覆盖范围而被临床广泛应用，并且能够运用血管减影技术使成像质量得到近一步提高。……