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目的研究不同临床和影像学亚型脑梗死发生颈动脉斑块的差异。方法选取2008年2月至2011年2月在南京大学医学院附属鼓楼医院神经内科住院治疗的251例缺血性脑血管病患者根据头颅磁共振结果分为脑梗死和非脑梗死组并以后者作为对照,根据超声检查颈动脉内膜-中膜厚度以确定颈动脉斑块的有无。比较脑梗死组和对照组颈动脉斑块的阳性率,并进一步分析其在各临床和影像学分型中的差异。Logistic回归分析颈动脉斑块与脑梗死临床和影像学亚型间的相关性。结果脑梗死组斑块阳性率为74.2%(135/182),对照组为56.5%(39/69),差异有统计学意义(P<0.05)。脑梗死组内,按临床分型斑块发生率由高向低的次序为部分前循环梗死(PA-CI)、腔隙性脑梗死、后循环梗死、完全前循环梗死,其中PACI(83.8%)较对照组明显升高(P<0.05)。按影像学分型斑块发生率由高向低的次序是放射冠梗死、前循环皮质梗死、基底节区梗死、后循环梗死,其中放射冠梗死(85.2%)、皮质梗死(75.4%)明显高于对照组。颈动脉斑块与PACI的P值和OR(95%CI)分别为0.01,2.576(1.251～5.307)。结论临床和影像学亚型对于脑梗死患者颈动脉斑块的发生具有一定的预测作用。
Objective To study the differences of carotid plaques in different clinical and imaging subtypes of cerebral infarction. Methods From February 2008 to February 2011, 251 patients with ischemic cerebrovascular disease hospitalized in Department of Neurology, Drum Tower Hospital Affiliated to Medical College of Nanjing University were divided into cerebral infarction and non-cerebral infarction group according to the results of head magnetic resonance As a control, carotid intima-media thickness was examined by ultrasound to determine the presence or absence of carotid plaque. The positive rates of carotid plaque in cerebral infarction group and control group were compared, and their differences in clinical and imaging types were further analyzed. Logistic regression analysis of the correlation between carotid plaque and clinical and imaging subtypes of cerebral infarction. Results The positive rate of plaque was 74.2% (135/182) in cerebral infarction group and 56.5% (39/69) in control group, the difference was statistically significant (P <0.05). In the cerebral infarction group, according to the order of high-to-low clinical classification of plaque, partial anterior circulation infarction (PA-CI), lacunar infarction, posterior circulation infarction and complete anterior circulation infarction, PACI (83.8% ) Than the control group was significantly higher (P <0.05). According to the imaging type, the incidence of genital plaques from high to low was in the order of radiation crown infarction, anterior circulation cortical infarction, basal ganglia infarction and posterior circulation infarction. Incidence of coronary crown infarction (85.2%) and cortical infarction (75.4%) were significantly higher In the control group. P value and OR (95% CI) of carotid artery plaque and PACI were 0.01 and 2.576 (1.251 ~ 5.307) respectively. Conclusion Clinical and imaging subtypes have some predictive value for the occurrence of carotid plaque in patients with cerebral infarction.