颈动脉狭窄程度及血浆髓过氧化物酶水平对缺血性脑卒中的影响
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摘要
目的:分析不同颈动脉狭窄程度、不同血浆髓过氧化物酶(myeoloperoxidase,MPO)水平对狭窄侧颈动脉供血区发生缺血性脑卒中的影响。方法:对颈部血管彩色超声证实的120例单侧颈动脉狭窄病变行头颅CT扫描,以明确每个病例狭窄侧颈动脉供血区中有无梗死灶。将病例分为MPO水平升高组(n=57)和正常组(n=63),分析两组中梗死灶发生率的差异。根据颈部血管彩色超声检查测量值计算狭窄程度,将上述病例按狭窄程度又分为≤50%组(n=68)、51%~69%组(n=36)和≥70%组(n=16),分析狭窄程度与病变同侧梗死灶发生率的关系,同时分析相同狭窄程度时不同MPO水平与梗死灶发生率的关系。结果:MPO升高组57例中,有梗死灶的患者为43例,占75.43%;MPO正常组63例中,有梗死灶者33例,占52.38%;两组间梗死灶的发生率差异有统计学意义(P<0.05)。狭窄程度≤50%组、51%~69%组和≥70%组梗死灶的发生率分别为63.23%,63.89%和62.50%,三组间差异无统计学意义(P>0.05)。颈动脉狭窄程度≤50%组的68例中,MPO升高32例,正常36例,分别有26例(26/32,81.25%)和17例(17/36,47.22%)发生梗死灶,梗死灶的发生率差异有统计学意义(P<0.05)。结论:在颈动脉狭窄病例中,MPO升高组在狭窄侧颈动脉供血区发生缺血性脑卒中的风险较MPO正常组更大,而颈动脉狭窄程度与缺血性脑卒中无明显关系。
Objective:To explore the ef ect of carotid stenosis degree and plasma level of myeoloperoxidase(MPO) on the occurrence of cerebral ischemic stroke.Methods:A total of 120 patients with carotid stenosis coni rmed by carotid artery ultrasound were included.Computer tomography scan was performed to identify if there was infarction in all patients.These patients were divided into a high MPO group(n=57) and a normal MPO group (n=63) according to the plasma MPO level,and the incidence of cerebral infarction was compared in the 2 groups.Meanwhile,all patients were also divided into 3 groups according to the degree of carotid stenosis:the low degree of stenosis group(≤50%,n=68),the medium degree of stenosis group(51%-69%,n=36) and the high degree of stenosis group(≥70%,n=16).The correlation between the carotid stenosis degree and the incidence of ipsilateral cerebral infarction was analyzed.If the carotid stenosis degree was same,the relationship between the plasma MPO levels and the incidence of cerebral infarction was determined.Results:In 57 patients of the high MPO group,43 patients suf ered infarction(75.43%),while in the 63 patients of the normal MPO group,only 33 displayed infarction(52.38%).The difference between these two groups was significant(P<0.05).The incidences of cerebral infarction were 63.23%,63.89%,and 62.50% in the low,medium and high degree of stenosis group,respectively.The difference among these three groups was not significant(P>0.05).In the 68 patients of the low degree of stenosis group,the MPO level was increased in 32 patients and normal in 36 patients.Among them,26 patients(26/32,81.25%) and 17 patients(17/36,47.22%) showed infarction,respectively,with signii cant dif erence(P<0.05).Conclusion:In the patients with carotid stenosis,the risk of cerebral ischemic stroke in patients with elevated MPO level was higher than that with the normal MPO level.However,there was no significant correlation between the carotid stenosis degree and the occurrence of cerebral ischemic stroke.
Objective:To explore the ef ect of carotid stenosis degree and plasma level of myeoloperoxidase(MPO) on the occurrence of cerebral ischemic stroke.Methods:A total of 120 patients with carotid stenosis coni rmed by carotid artery ultrasound were included.Computer tomography scan was performed to identify if there was infarction in all patients.These patients were divided into a high MPO group(n=57) and a normal MPO group (n=63) according to the plasma MPO level,and the incidence of cerebral infarction was compared in the 2 groups.Meanwhile,all patients were also divided into 3 groups according to the degree of carotid stenosis:the low degree of stenosis group(≤50%,n=68),the medium degree of stenosis group(51%-69%,n=36) and the high degree of stenosis group(≥70%,n=16).The correlation between the carotid stenosis degree and the incidence of ipsilateral cerebral infarction was analyzed.If the carotid stenosis degree was same,the relationship between the plasma MPO levels and the incidence of cerebral infarction was determined.Results:In 57 patients of the high MPO group,43 patients suf ered infarction(75.43%),while in the 63 patients of the normal MPO group,only 33 displayed infarction(52.38%).The difference between these two groups was significant(P<0.05).The incidences of cerebral infarction were 63.23%,63.89%,and 62.50% in the low,medium and high degree of stenosis group,respectively.The difference among these three groups was not significant(P>0.05).In the 68 patients of the low degree of stenosis group,the MPO level was increased in 32 patients and normal in 36 patients.Among them,26 patients(26/32,81.25%) and 17 patients(17/36,47.22%) showed infarction,respectively,with signii cant dif erence(P<0.05).Conclusion:In the patients with carotid stenosis,the risk of cerebral ischemic stroke in patients with elevated MPO level was higher than that with the normal MPO level.However,there was no significant correlation between the carotid stenosis degree and the occurrence of cerebral ischemic stroke.
引文
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9 .贾伟,陈光辉.颈动脉粥样硬化易损性斑块的检测方法[J].国际脑血管病杂志,2006,14(2):132-135.JIA Wei,CHEN Guanghui.Detection method of vulnerability carotid atherosclerotic plaques[J].International Journal of Cerebrovascular Diseases,2006,14(2):132-135.
10 .Klebanoff SJ.Myeloperoxidase:friend and foe[J].J Leukoc Biol,2005,77(5):598-625.
11 .Brennan ML,Penn MS,Van Lente F,et al.Prognostic value of myeloperoxidase in patients with chest pain[J].N Engl J Med,2003,349(17):1595-1604.
12 .Sporcatte R,Rey HC,Rangel FO,et al.Predictive value of myeloperoxidase to identify high risk patients admitted to the hospital with acute chest pain[J].Arq Bras Cardiol,2007,89(6):377-384.
2 .韩锟,贾宁,闵连秋.脑梗死患者血清髓过氧化物酶和妊娠相关血浆蛋白A与颈动脉易损斑块的相关性[J].中国动脉硬化杂志,2012,20(6):561-563.HAN Kun,JIA Ning,MIN Lianqiu.Cerebral infarction patients serum myeloperoxidase and pregnancy associated plasma protein A and the correlation of carotid vulnerable plaques[J].Chinese Journal of Arteriosclerosis,2012,20(6):561-563.
3 .中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南.2010[J].中华神经科杂志,2010,43(2):146-153.Neurology Branch of Chinese Medical Association Cardiovascular Epidemiology Group Guidance of Diagnosis and Treatment of Acute Ischemic Stroke Group.China's Guidelines of Diagnosis and Treatment of Acute Ischemic Stroke,2010[J].Chinese Journal of Neurology,2010,43(2):146-153.
4 .中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南.2012[J].中华神经科杂志,2012,43(2):154-160.Neurology Branch of Chinese Medical Association Cardiovascular Epidemiology Group from Ischemic Stroke Secondary Prevention Guide.China Ischemic Stroke and transient Ischemic Attack Secondary Prevention Guide.2012[J].Chinese Journal of Neuroloy,2012,43(2):154-160.
5 .Muir KW,Weir CJ,Arwan WD,et al.C-reactive protein and outcome after ischemic stroke[J].Stroke,1999,30(2):981-985.
6 .Redgrave JN,Lover JK,Gallagher PJ,et a1.Histological assessment of 52 symptomatic carotid plaquesin relation to the nature and timing of ischemic symptoms:the Oxford plaque study[J].Circulation,2006,113(19):2320-2328.
7 .Gao TL,Zhang Z,Yu W,et al.A therosclerotic carotid vulnerable plaque and subsequent stroke:A high-resolution MRI study[J].Cerebrovasc Dis,2009,27(4):345-352.
8 .Inzitari D,Eliasziw M,Gates P,et al.The causes and risk of stroke in patients with asymptomatic intimal-carotid-artery stenosis.North American Symptom Carotid Endarterectomy Trial Collaborators[J].N Engl J Med,2000,342(23):1693-1700.
9 .贾伟,陈光辉.颈动脉粥样硬化易损性斑块的检测方法[J].国际脑血管病杂志,2006,14(2):132-135.JIA Wei,CHEN Guanghui.Detection method of vulnerability carotid atherosclerotic plaques[J].International Journal of Cerebrovascular Diseases,2006,14(2):132-135.
10 .Klebanoff SJ.Myeloperoxidase:friend and foe[J].J Leukoc Biol,2005,77(5):598-625.
11 .Brennan ML,Penn MS,Van Lente F,et al.Prognostic value of myeloperoxidase in patients with chest pain[J].N Engl J Med,2003,349(17):1595-1604.
12 .Sporcatte R,Rey HC,Rangel FO,et al.Predictive value of myeloperoxidase to identify high risk patients admitted to the hospital with acute chest pain[J].Arq Bras Cardiol,2007,89(6):377-384.