急性卒中患者颈动脉粥样硬化程度与早期神经功能恶化的相关性研究
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摘要
目的研究急性卒中患者颈动脉粥样硬化程度与早期神经功能恶化(END)的相关性。方法选取收治的急性卒中患者98例(观察组)、健康对照组30例(对照组)为研究对象,对比2组颈动脉粥样硬化评分(CAS)、颈动脉彩超相关参数[斑块大小、厚度、数量及颈动脉内膜中层厚度(IMT)]、神经功能[美国国立卫生研究院神经功能缺损评分量表(NIHSS)、神经元特异性烯醇化酶(NSE)、S100β蛋白(S100β)],依据稳定性将观察组分为各亚组,分析斑块稳定性与神经功能缺损的关系。结果观察组CAS评分及斑块大小、厚度、数量、IMT高(大)于对照组(P<0.05);观察组NIHSS评分及血清NSE、S100β水平明显高于对照组(P<0.05);不稳定斑块、稳定斑块、无斑块的NIHSS评分及END发生率比较差异有统计学意义(P<0.05);Spearman相关性分析结果显示,急性卒中患者CAS评分、IMT与其NIHSS评分、END发生率呈正相关(P<0.05)。结论急性卒中患者颈动脉粥样硬化程度与其早期神经功能恶化有密切关系,随颈动脉粥样硬化程度增加,患者神经功能受损更严重,END发生率增加,应提高警惕。
Objective To investigate the correlation between the degree of carotid atherosclerosis and early neurological deterioration(END) in patients with acute stroke.Methods A total of 98 patients with acute stroke(observation group) who were admitted and treated in our hospital from January 2014 to January 2018 and 30 healthy subjects(control group) were enrolled in the study. The carotid atherosclerosis score(CAS),carotid artery color Doppler ultrasound related parameters including the size,thickness and quantity of plaque,carotid intima media thickness(IMT),and neurological function [National Institutes of Health Stroke Scale(NIHSS),neuron specific enolase(NSE),S100β protein(S100β)]were observed and compared between the two groups.According to the stability of plaque,the patients in observation group were divided into subgroups,and the relationship between plaque stability and neurological impairment was analyzed.Results The CAS scores,the size,thickness and number of plaques and IMT in observation group were significantly higher/larger than those in control group(P<0.05).The NIHSS scores and serum levels of NSE and S100β in observation group were significantly higher than those in control group(P<0.05).There were significant differences in the NIHSS scores and incidence rate of END among unstable plaque,stable plaque and non plaque(P<0.05).Spearman correlation analysis showed that CAS score and IMT were positively correlated with NIHSS scores and incidence rate of END in patients with acute stroke(P<0.05).Conclusion The degree of carotid atherosclerosis in patients with acute stroke is closely related to END.With the increase of the degree of carotid atherosclerosis,the damage of nerve function becomes more serious and the incidence rate of END is increased,it should be paid much attention to.
Objective To investigate the correlation between the degree of carotid atherosclerosis and early neurological deterioration(END) in patients with acute stroke.Methods A total of 98 patients with acute stroke(observation group) who were admitted and treated in our hospital from January 2014 to January 2018 and 30 healthy subjects(control group) were enrolled in the study. The carotid atherosclerosis score(CAS),carotid artery color Doppler ultrasound related parameters including the size,thickness and quantity of plaque,carotid intima media thickness(IMT),and neurological function [National Institutes of Health Stroke Scale(NIHSS),neuron specific enolase(NSE),S100β protein(S100β)]were observed and compared between the two groups.According to the stability of plaque,the patients in observation group were divided into subgroups,and the relationship between plaque stability and neurological impairment was analyzed.Results The CAS scores,the size,thickness and number of plaques and IMT in observation group were significantly higher/larger than those in control group(P<0.05).The NIHSS scores and serum levels of NSE and S100β in observation group were significantly higher than those in control group(P<0.05).There were significant differences in the NIHSS scores and incidence rate of END among unstable plaque,stable plaque and non plaque(P<0.05).Spearman correlation analysis showed that CAS score and IMT were positively correlated with NIHSS scores and incidence rate of END in patients with acute stroke(P<0.05).Conclusion The degree of carotid atherosclerosis in patients with acute stroke is closely related to END.With the increase of the degree of carotid atherosclerosis,the damage of nerve function becomes more serious and the incidence rate of END is increased,it should be paid much attention to.
引文
1 张作念,王志晔,倪梦园,等.急性缺血性卒中患者血清促炎性细胞因子水平与颈动脉粥样硬化斑块稳定性的相关性.实用临床医药杂志,2016,20:6-9.
2 曾庆范,卢红.急性脑梗死患者颈动脉粥样硬化斑块与IL-6及CRP的关系.中国实用神经疾病杂志,2016,19:17-19.
3 陈海云,何超明.血清ox-LDL、 Lp-PLA2水平与缺血性脑卒中患者动脉粥样硬化及神经功能缺损的相关性研究.卒中与神经疾病,2017,24:504-507.
4 钱保进,唐向阳,王雷,等.血清神经元特异性烯醇化酶淀粉样蛋白A及IL-6与动脉粥样硬化性卒中后神经损伤和预后关系.安徽医学,2017,38:1005-1008.
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6 Lee EJ,Choi KH,Ryu JS,el al.Stroke risk after coronary artery by pass graft surgery and extent of cerebral artery atherosclerosis.JAm Coll Cardiol,2011,57:1811-1818.
7 戢运建,况娥.老年2型糖尿病合并急性脑梗死患者血清IGF-1水平与神经功能及颈动脉斑块的关系.卒中与神经疾病,2016,23:322-325.
8 张俊,袁勇,朱本亮,等.脑动脉粥样硬化性脑血栓形成患者梗死体积和神经功能评分与多种危险因素的关系.卒中与神经疾病,2013,20:169-171.
9 黄宏亮,杨莉莉,黄崴,等.脑卒中患者血清PARK7、LPA和D-D水平与颈动脉粥样硬化及神经缺损程度的关系.疑难病杂志,2017,16:776-779,783.
10 秦润祥,武红斌,许海宁,等.瑞舒伐他汀对脑梗死合并颈动脉粥样硬化患者神经功能缺损及血清炎症因子水平的影响.中国实用医刊,2016,43:19-22.
11 习艳兵.急性脑梗塞患者血清MCP-1、VE-cadherin的水平与神经功能、颈动脉粥样硬化的相关性.海南医学院学报,2017,23:1272-1275.
12 汤永健,林燕,区开云.血清同型半胱氨酸水平与急性缺血性脑卒中患者颈动脉粥样硬化斑块稳定性及神经功能缺损程度的相关性研究.实用心脑肺血管病杂志,2016,24:56-57.
13 韩忠奎,夏元亮,锁六军,等.脑动脉粥样硬化评分与轻型缺血性卒中早期神经功能恶化的相关性研究.医学研究生学报,2016,29:1140-1143.
14 Seners P,Ture G,Oppenheim C,et al.Incidences,causes and predictors of neurological deterioration occurring within 24h following acute ischaemic stroke:a systematic review with pathophysiological implications.J Neurol Neurosurg Psychiatry,2015,86:87-94.
15 常霞.动脉粥样硬化血栓形成性脑梗死血清D二聚体与神经功能、脑梗死面积的关系.血栓与止血学,2017,23:981-982.
2 曾庆范,卢红.急性脑梗死患者颈动脉粥样硬化斑块与IL-6及CRP的关系.中国实用神经疾病杂志,2016,19:17-19.
3 陈海云,何超明.血清ox-LDL、 Lp-PLA2水平与缺血性脑卒中患者动脉粥样硬化及神经功能缺损的相关性研究.卒中与神经疾病,2017,24:504-507.
4 钱保进,唐向阳,王雷,等.血清神经元特异性烯醇化酶淀粉样蛋白A及IL-6与动脉粥样硬化性卒中后神经损伤和预后关系.安徽医学,2017,38:1005-1008.
5 中华医学会神经病学分会.各类脑血管病诊断要点.中华神经精神科杂志,1996,29:379.
6 Lee EJ,Choi KH,Ryu JS,el al.Stroke risk after coronary artery by pass graft surgery and extent of cerebral artery atherosclerosis.JAm Coll Cardiol,2011,57:1811-1818.
7 戢运建,况娥.老年2型糖尿病合并急性脑梗死患者血清IGF-1水平与神经功能及颈动脉斑块的关系.卒中与神经疾病,2016,23:322-325.
8 张俊,袁勇,朱本亮,等.脑动脉粥样硬化性脑血栓形成患者梗死体积和神经功能评分与多种危险因素的关系.卒中与神经疾病,2013,20:169-171.
9 黄宏亮,杨莉莉,黄崴,等.脑卒中患者血清PARK7、LPA和D-D水平与颈动脉粥样硬化及神经缺损程度的关系.疑难病杂志,2017,16:776-779,783.
10 秦润祥,武红斌,许海宁,等.瑞舒伐他汀对脑梗死合并颈动脉粥样硬化患者神经功能缺损及血清炎症因子水平的影响.中国实用医刊,2016,43:19-22.
11 习艳兵.急性脑梗塞患者血清MCP-1、VE-cadherin的水平与神经功能、颈动脉粥样硬化的相关性.海南医学院学报,2017,23:1272-1275.
12 汤永健,林燕,区开云.血清同型半胱氨酸水平与急性缺血性脑卒中患者颈动脉粥样硬化斑块稳定性及神经功能缺损程度的相关性研究.实用心脑肺血管病杂志,2016,24:56-57.
13 韩忠奎,夏元亮,锁六军,等.脑动脉粥样硬化评分与轻型缺血性卒中早期神经功能恶化的相关性研究.医学研究生学报,2016,29:1140-1143.
14 Seners P,Ture G,Oppenheim C,et al.Incidences,causes and predictors of neurological deterioration occurring within 24h following acute ischaemic stroke:a systematic review with pathophysiological implications.J Neurol Neurosurg Psychiatry,2015,86:87-94.
15 常霞.动脉粥样硬化血栓形成性脑梗死血清D二聚体与神经功能、脑梗死面积的关系.血栓与止血学,2017,23:981-982.
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