脑梗死患者血脂水平与颈动脉粥样硬化CTA特征的相关性
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摘要
目的探讨脑梗死患者血脂水平与颈动脉粥样硬化CT血管造影(CTA)特征的相关性。方法搜集117例血脂异常的脑梗死患者及同期116例血脂正常的脑梗死患者。利用256层螺旋CT对其分别进行颈动脉CTA检查,观察颈动脉粥样硬化、狭窄程度及斑块性质的情况。利用统计学卡方检验比较血脂正常组和血脂异常组颈动脉粥样硬化发生率、粥样硬化斑块造成管腔的狭窄程度及粥样硬化斑块的性质的差异。同时根据血脂升高的程度进一步将血脂异常组分为血脂边缘性升高组与血脂升高组,利用统计学卡方检验比较两组颈动脉粥样硬化发生率、粥样硬化斑块造成管腔的狭窄程度及粥样硬化斑块性质的差异。结果血脂异常组颈动脉粥样硬化的发生率(χ~2=8.277,P=0.004)、颈动脉重度狭窄的发生率(χ~2=3.984,P=0.046)、颈动脉混合斑块(χ~2=8.650,P=0.003)及软斑块(χ~2=10.871,P=0.001)的发生率均高于血脂正常组,差异有统计学意义(P均<0.05)。血脂异常组与血脂正常组颈动脉轻中度狭窄的发生率(χ~2=0.002,P=0.964)无显著差异(P>0.05)。血脂异常组钙化斑块的发生率低于血脂正常组(χ~2=25.352,P=0.000),差异有统计学意义(P<0.05)。血脂边缘性升高组与血脂升高组在颈动脉粥样硬化的发生率(Fisher确切概率P=0.648)、轻中度狭窄的发生率(χ~2=0.109,P=0.741)、重度狭窄的发生率(χ~2=0.940,P=0.332)、钙化斑块的发生率(χ~2=0.285,P=0.593)、混合斑块的发生率(χ~2=0.006,P=0.937)及软斑块的发生率(χ~2=0.364,P=0.546)均无显著差异(P>0.05)。结论对于脑梗死患者,血脂发生边缘性升高时,其发生颈动脉粥样硬化、颈动脉中重度狭窄、混合斑块和软斑块的概率均高于血脂正常时,但与血脂升高时无差异。由此可见,当血脂发生边缘性升高时,即应当引起临床关注,积极控制血脂水平。
Objective To explore the relationship between the blood lipid level of patients with cerebral infarction and the CTA characteristics of carotid atherosclerotic plaque. Methods The author selected 117 cerebral infarction patients with dyslipidemia as a case group,and selected a control group,in the same period,including 116 cerebral infarction patients with the normal blood lipid. Using 256-slice spiral CT,patients were performed carotid artery angiography respectively and we observed the degree of carotid atherosclerosis and stenosis,as well as the nature of plaque.The author contrasted the ortholiposis group with the dyslipidemia group to analyze the discrepancy of the incidence rate of atherosclerosis,the narrow degree of lumen caused by atherosclerotic plaque and the nature of atherosclerotic plaque by chisquare test. Meanwhile,in line with the increased blood lipid,the dyslipidemia group was further divided into blood lipid marginal group and elevated blood lipid group by chisquare test. The difference mentioned above was analyzed through contrasting those two groups. Results The dyslipidemia group's incidence rates of carotid atherosclerosis( χ~2= 8. 277,P = 0. 004),severe stenosis in carotid artery( χ~2= 3. 984,P = 0. 046),carotid artery mixed plaque( χ~2= 8. 650,P = 0. 003) and fatty plaques( χ~2= 10. 871,P = 0. 001) were higher than the ortholiposis group. This difference had statistical significance( P < 0. 05). Comparing the dyslipidemia group with ortholiposis group,there was no distinct difference( P > 0. 05) in the incidence rate of mild-moderate stenosis of carotid artery( χ~2= 0. 002,P = 0. 964). Additionally,the dyslipidemia group 's incidence rate of calcified plaque( χ~2= 25. 352,P = 0. 000) was lower than the ortholiposis group's. The difference between them also possessed statistical significance( P < 0. 05). Afterwards,comparing blood lipid marginal group with elevated blood lipid group,there were no distinct difference( P > 0. 05) in incidence rates of carotid atherosclerosis( Fisher Exact P = 0. 648),mild-moderate stenosis of carotid artery( χ~2= 0. 109,P = 0. 741),severe stenosis( χ~2= 0. 940,P = 0. 332),calcified plaque( χ~2=0. 285,P = 0. 593),mixed plaque( χ~2= 0. 006,P = 0. 937) and fatty plaque( χ~2= 0. 364,P = 0. 546). Conclusion In patients with cerebral infarction,the risk of carotid atherosclerosis,severe carotid stenosis,mixed plaque and soft plaque is higher than that of normal blood lipids,but there is no difference when blood lipids rise. It can be seen that when the level of blood lipids rises,it warrants clinical attention and blood lipid levels should be actively controlled.
Objective To explore the relationship between the blood lipid level of patients with cerebral infarction and the CTA characteristics of carotid atherosclerotic plaque. Methods The author selected 117 cerebral infarction patients with dyslipidemia as a case group,and selected a control group,in the same period,including 116 cerebral infarction patients with the normal blood lipid. Using 256-slice spiral CT,patients were performed carotid artery angiography respectively and we observed the degree of carotid atherosclerosis and stenosis,as well as the nature of plaque.The author contrasted the ortholiposis group with the dyslipidemia group to analyze the discrepancy of the incidence rate of atherosclerosis,the narrow degree of lumen caused by atherosclerotic plaque and the nature of atherosclerotic plaque by chisquare test. Meanwhile,in line with the increased blood lipid,the dyslipidemia group was further divided into blood lipid marginal group and elevated blood lipid group by chisquare test. The difference mentioned above was analyzed through contrasting those two groups. Results The dyslipidemia group's incidence rates of carotid atherosclerosis( χ~2= 8. 277,P = 0. 004),severe stenosis in carotid artery( χ~2= 3. 984,P = 0. 046),carotid artery mixed plaque( χ~2= 8. 650,P = 0. 003) and fatty plaques( χ~2= 10. 871,P = 0. 001) were higher than the ortholiposis group. This difference had statistical significance( P < 0. 05). Comparing the dyslipidemia group with ortholiposis group,there was no distinct difference( P > 0. 05) in the incidence rate of mild-moderate stenosis of carotid artery( χ~2= 0. 002,P = 0. 964). Additionally,the dyslipidemia group 's incidence rate of calcified plaque( χ~2= 25. 352,P = 0. 000) was lower than the ortholiposis group's. The difference between them also possessed statistical significance( P < 0. 05). Afterwards,comparing blood lipid marginal group with elevated blood lipid group,there were no distinct difference( P > 0. 05) in incidence rates of carotid atherosclerosis( Fisher Exact P = 0. 648),mild-moderate stenosis of carotid artery( χ~2= 0. 109,P = 0. 741),severe stenosis( χ~2= 0. 940,P = 0. 332),calcified plaque( χ~2=0. 285,P = 0. 593),mixed plaque( χ~2= 0. 006,P = 0. 937) and fatty plaque( χ~2= 0. 364,P = 0. 546). Conclusion In patients with cerebral infarction,the risk of carotid atherosclerosis,severe carotid stenosis,mixed plaque and soft plaque is higher than that of normal blood lipids,but there is no difference when blood lipids rise. It can be seen that when the level of blood lipids rises,it warrants clinical attention and blood lipid levels should be actively controlled.
引文
1 张娟娟.颈动脉粥样硬化斑块与脑梗死的关系研究[J].实用心脑肺血管杂志,2011,19:788-789.
2 张斌,王影,王宝春.颈动脉粥样硬化斑块的彩色多普勒超声表现及其与脑梗死的关系研究[J].现代中西医结合杂志,2017,26:663-665.
3 黄晓云,王雪伟,郭卫红.脑梗死与血脂水平和颈动脉粥样硬化斑块的相关性及彩色多普勒超声的价值分析[J].中国实用神经疾杂志,2015,18:63-64.
4 葛伟 ,李源 ,袁华.老年缺血性脑血管病与颈动脉粥样硬化的相关性研究[J].中华物理医学与康复杂志,2002,5:34-36.
5 王耀,朱启云,李光布.74例脑梗塞患者颈动脉粥样硬化斑块和血脂分析[J].中华全科医学,2015,13:854-856.
6 汤颖,张珣,张荣伟.颈动脉狭窄程度及颈动脉粥样硬化斑块性质、部位与脑梗死的相关性研究[J].中国医药导报,2014,11:32-34.
7 Basili S,Loffredo L,Pastori D,et al.Carotid plaquedetection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular fibrillation:The ARAPACIS Study[J].Int J Cardiol 2017,231:143-149.
8 李太勇,姜辉,方烨,等. 老年脑梗死患者血尿酸水平与颈动脉硬化及颅内动脉血流动力学变化的相关性研究[J]. 浙江临床医学,2016,18:1046- 1048
9 Kim J,Song TJ,Song D,et al. Serum alkaline phosphatase andphosphate in cerebral atherosclerosis and functional outcomes aftercerebral infarction[J].Stroke,2013,25:90-93
10 刘春香,丁海娟,吕婷,等.颈动脉粥样硬化与血脂水平的相关性分析[J].中国临床保健杂志,2014,17:48-50.
11 Lei CY,Wu B,Liu M,et al. Risk factors and clinical outcomes associated with intracranial and extracranial atherosclerotic stenosis acute ischemic stroke[J]. J Stroke Cerebrovasc Dis,2013,9:24.
12 Jiang SZ,Liu R,Han B. Relevance analysis of health behaviors and influencing factors for detection rate of carotid atherosclerotic plaque[J]. Zhonghua yi xue za zhi,2014,94:1785-1787.
13 徐利权.颈动脉粥样硬化与脑梗死的关系研究[J].中国现代医药杂志,2011,13:64-65.
14 史新秀.缺血性脑血管病颈动脉斑块特征与血脂的相关研究[D].吉林大学,2012.
15 Takatsu H, Fujiwara H. Mechanism of acute coronary syndrome studied with coronary srteriograms[J].Nippon Rinsho,1998,56:2527-2531.
16 Nguyen KT,Clark CD,Chancellor TJ,et al. Carotid geometryeffects on blood flow and on risk for vascular disease [J]. JBiomechanics,2008,41:11-19.
17 张晶,关欣,王伟,陈孟英,梁蓉.血脂代谢与颈动脉粥样硬化不稳定性斑块的相关性[J].中国动脉硬化杂志,2012,20:833-836.
18 中国成人血脂异常防治指南制定联合委员会(2007).中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35:390-419. (收稿:2017-09-17 修回:2017-10-07)
2 张斌,王影,王宝春.颈动脉粥样硬化斑块的彩色多普勒超声表现及其与脑梗死的关系研究[J].现代中西医结合杂志,2017,26:663-665.
3 黄晓云,王雪伟,郭卫红.脑梗死与血脂水平和颈动脉粥样硬化斑块的相关性及彩色多普勒超声的价值分析[J].中国实用神经疾杂志,2015,18:63-64.
4 葛伟 ,李源 ,袁华.老年缺血性脑血管病与颈动脉粥样硬化的相关性研究[J].中华物理医学与康复杂志,2002,5:34-36.
5 王耀,朱启云,李光布.74例脑梗塞患者颈动脉粥样硬化斑块和血脂分析[J].中华全科医学,2015,13:854-856.
6 汤颖,张珣,张荣伟.颈动脉狭窄程度及颈动脉粥样硬化斑块性质、部位与脑梗死的相关性研究[J].中国医药导报,2014,11:32-34.
7 Basili S,Loffredo L,Pastori D,et al.Carotid plaquedetection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular fibrillation:The ARAPACIS Study[J].Int J Cardiol 2017,231:143-149.
8 李太勇,姜辉,方烨,等. 老年脑梗死患者血尿酸水平与颈动脉硬化及颅内动脉血流动力学变化的相关性研究[J]. 浙江临床医学,2016,18:1046- 1048
9 Kim J,Song TJ,Song D,et al. Serum alkaline phosphatase andphosphate in cerebral atherosclerosis and functional outcomes aftercerebral infarction[J].Stroke,2013,25:90-93
10 刘春香,丁海娟,吕婷,等.颈动脉粥样硬化与血脂水平的相关性分析[J].中国临床保健杂志,2014,17:48-50.
11 Lei CY,Wu B,Liu M,et al. Risk factors and clinical outcomes associated with intracranial and extracranial atherosclerotic stenosis acute ischemic stroke[J]. J Stroke Cerebrovasc Dis,2013,9:24.
12 Jiang SZ,Liu R,Han B. Relevance analysis of health behaviors and influencing factors for detection rate of carotid atherosclerotic plaque[J]. Zhonghua yi xue za zhi,2014,94:1785-1787.
13 徐利权.颈动脉粥样硬化与脑梗死的关系研究[J].中国现代医药杂志,2011,13:64-65.
14 史新秀.缺血性脑血管病颈动脉斑块特征与血脂的相关研究[D].吉林大学,2012.
15 Takatsu H, Fujiwara H. Mechanism of acute coronary syndrome studied with coronary srteriograms[J].Nippon Rinsho,1998,56:2527-2531.
16 Nguyen KT,Clark CD,Chancellor TJ,et al. Carotid geometryeffects on blood flow and on risk for vascular disease [J]. JBiomechanics,2008,41:11-19.
17 张晶,关欣,王伟,陈孟英,梁蓉.血脂代谢与颈动脉粥样硬化不稳定性斑块的相关性[J].中国动脉硬化杂志,2012,20:833-836.
18 中国成人血脂异常防治指南制定联合委员会(2007).中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35:390-419. (收稿:2017-09-17 修回:2017-10-07)
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