摘要
目的探讨颈动脉重度粥样硬化性狭窄患者颈动脉重构指数(CRI)、斑块声学特征及血流动力学变化对其发生临床缺血症状的预测价值。方法回顾性连续纳入2016年1月至2019年1月因单侧颈动脉重度粥样硬化性狭窄(狭窄率70%~99%)在首都医科大学宣武医院神经外科、血管外科拟接受手术治疗并符合纳排标准的患者185例。根据有无临床缺血症状,将185例患者分为症状组(104例)和无症状组(81例),比较两组患者一般资料、CRI、斑块声学特征及血流动力学参数的差异,排除参数共线性后进一步行多因素Logistic回归分析。拟通过受试者工作特征(ROC)曲线及曲线下面积(AUC),分析CRI用于预测发生临床缺血事件的诊断价值。结果(1)症状组与无症状组患者年龄及脑血管病相关危险因素的差异均无统计学意义(均P>0.05),症状组男性比例高于无症状组,组间差异有统计学意义[92.3%(96/104)比80.2%(65/81),P<0.05]。(2)症状组颈动脉狭窄远段收缩期峰值流速[50.0(28.3,62.8)cm/s比60.0(44.5,74.5)cm/s]、舒张期末流速[23.0(14.0,30.0)cm/s比29.0(21.5,33.5)cm/s]、患侧大脑中动脉收缩期峰值流速[(74±21)cm/s比(85±21)cm/s]、大脑中动脉舒张期末流速[(39±11)cm/s比(42±10)cm/s]均低于无症状组,症状组颈动脉狭窄段与狭窄远段收缩期峰值流速的比值[10.3(6.1,16.6)比7.2(5.0,11.8)]、CRI[1.82(1.65,2.08)比1.64(1.51,1.80)]、低回声斑块发生率[83.7%(87/104)比37.0%(30/81)]及溃疡型斑块发生率[27.9%(29/104)比7.4%(6/81)]均高于无症状组,组间差异均有统计学意义(均P<0.05)。(3)多因素Logistic回归分析结果显示,CRI越大(OR=12.43,95%CI:2.85~54.25,P<0.01)、溃疡型斑块(OR=4.04,95%CI:1.40~11.62,P<0.05)及低回声斑块(OR=5.54,95%CI:2.65~11.58,P<0.01)是颈动脉重度狭窄患者发生临床缺血性事件的独立危险因素。(4)经ROC曲线分析,CRI=1.74是预测颈动脉重度狭窄患者发生临床缺血症状的最佳截断值(AUC
Objective To investigate the predictive value of carotid remodeling index(CRI),plaque characteristics,and hemodynamic changes in patients with severe carotid atherosclerotic stenosis.Methods A total of 185 continuous patients with unilateral severe carotid artery atherosclerotic stenosis who underwent surgical treatment were enrolled retrospectively in the Department of Neurosurgery and Vascular Surgery of Xuanwu Hospital,Capital Medical University from January 2016 to January 2019.According to the clinical symptoms,patients were divided into the symptom group(104 cases)and the asymptomatic group(81 cases).The general clinical data,CRI,echo characteristics of plaque,and hemodynamic parameters were compared between the two groups.Multivariate logistic regression analysis was performed after excluding the collinearity of parameters.The value of CRI for predicting clinical ischemic events was analyzed through the receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results(1)There were no significant differences in age and risk factors of cerebrovascular disease between the two groups(all P>0.05).However,the rate of male patients was significantly higher in the symptom group compared with the asymptomatic group(92.3%[96/104]vs.80.2%[65/81),P<0.05).(2)There were lower in the peak systolic velocity(PSV)of the distal internal carotid artery(50.0[28.3,62.8]cm/s vs.60.0[44.5,74.5]cm/s,P<0.01),the end-diastolic velocity(EDV)of the distal internal carotid artery(23.0[14.0,30.0]cm/s vs.29.0[21.5,33.5]cm/s,P<0.01),the PSV of the ipsilateral middle cerebral artery([74±21]cm/s vs.[85±21]cm/s,P<0.01),and the EDV of the ipsilateral middle cerebral artery([39±11]cm/s vs.[42±10]cm/s,P<0.05)in the symptom group compared with the asymptomatic group.There were higher in the ratio of PSV at the stenosis lesion of the internal carotid artery to the distal internal carotid artery(PSV prox/PSV dist,10.3[6.1,16.6]vs.7.2[5.0,11.8]),CRI(1.82[1.65,2.08]vs.1.64[1.51,1.80]),hypoechoic plaques(83.7%[87/104]vs.37.0%[
作者
赵越
刘玉梅
华扬
刘然
李娜
凌晨
Zhao Yue;Liu Yumei;Hua Yang;Liu Ran;Li Na;Ling Chen(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2020年第6期285-290,共6页
Chinese Journal of Cerebrovascular Diseases
基金
首都卫生发展科研专项(首发2018-2-2011)。
