摘要
目的:探讨颈动脉狭窄≤50%的颈动脉斑块患者的MRI斑块特征及临床因素与发生缺血性脑卒中的关系。方法:选取2014年9月—2016年2月超声筛选颈动脉狭窄≤50%的颈动脉斑块患者43例,所有患者行核磁共振黑血成像检查,分析MRI斑块特征及其他危险因素与缺血性脑卒中的关系。结果:43例患者的颈动脉斑块狭窄程度5%~50%,随访时间1.9~19.4个月。随访期间发现脑梗死患者共4例。单因素与多因素Logistic回归分析结果显示,仅MRI的斑块内出血与缺血性脑卒中的发生有明显关系(OR=297.797,95%CI=2.638~33620,P=0.018),而其他斑块特征及临床因素均无明显关系(均P>0.05)。Kaplan-Meier生存分析显示,有斑块内出血者较无斑块内出血者的中位无脑卒中时间明显缩短(14.3个月vs. 18.6个月,P=0.001);有冠心病者较无冠心病者的中位无脑卒中时间也明显缩短(12.1个月vs. 18.7个月,P=0.029);Cox回归分析显示,斑块内出血(HR=18.2,95%CI=2.7~123.3,P=0.003)及冠心病(HR=27.4,95%CI=1.6~464.3,P=0.022)是缺血性脑卒中发生的独立危险因素。结论:在颈动脉狭窄≤50%的颈动脉斑块患者中,斑块内出血与冠心病是缺血性卒中的发生密切相关。
Objective: To investigate the relations of carotid plaque characteristics of MRI and clinical factors with ischemic stroke in patients with carotid artery stenosis≤50%. Methods: From September 2014 to February 2016, a total of 43 patients with carotid artery stenosis ≤50% were selected by ultrasound screening. All patients underwent the black-blood MRI examination. The relations of the plaque MRI characteristics and other risk factors with ischemic stroke were analyzed.Results: In the 43 patients, the degree of carotid artery stenosis ranged from 5% to 50%, and the follow-up time ranged from 1.9 to 19.4 months. During the follow-up period, ipsilateral ischemic stroke occurred in 4 patients. The results of univariate and multivariate Logistic regression analysis showed that only the intra-plaque hemorrhage(IPH) was significantly associated with ischemic stroke(OR=297.797, 95% CI=2.638–33620, P=0.018), while other MRI features and clinical factors were irrelevant to ischemic stroke(all P>0.05). Kaplan-Meier survival analysis showed that the mean ischemic stroke-free time in patients with IPH was significantly shorter than that in patients without IPH(14.3 months vs. 18.6 months, P=0.001), and in patients with coronary heart disease(CHD) was significantly shorter than that in patients without CHD(12.1 months vs. 18.7 months, P=0.029); Cox regression analysis showed that IPH(HR=18.2, 95% CI=2.7–123.3, P=0.003) and CHD(HR=27.4; 95% CI=1.6–464.3; P=0.022) were independent risk factors for ischemic stroke.Conclusion: In patients with carotid artery stenosis ≤50%, IPH and CHD are closely associated with the occurrence of ischemic stroke.
引文
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