劲动脉颅外段病变与缺血性脑卒中OCSP分型的关系

发布时间：2018-09-03 17:23

【摘要】：目的探讨颈动脉颅外段病变与牛津郡社区卒中项目（OCSP）分型的关系。为缺血性脑卒中的个体化治疗及二级预防提供新的切入点和参考依据。方法本研究选取2010年2月至2011年11月在郑州大学第一附属医院神经内科住院的急性缺血性脑卒中患者160例。所有患者发病一周内入院，为首次发病或再次发病但此前无神经功能缺损。按照牛津郡社区卒中项目（OCSP）的分型标准根据临床表现对所有缺血性脑卒中患者进行脑梗死亚型分型，并分为A、B、C三组。A组包括完全前循环脑梗死（TACI）9例和部分前循环脑梗死（PACI）67例，共76例；B组包括后循环脑梗死患者(POCI)40例；44例腔隙性脑梗死(LACI)患者归入C组。通过彩色多普勒超声观察所有缺血性脑卒中患者颈动脉颅外段动脉粥样硬化病变的特点，记录颈动脉颅外段狭窄程度，颈动脉粥样硬化斑块的发生部位、形态、回声强度、质地等情况，并对所得数据在各组间进行比较分析。采用SPSS17.0软件进行统计学分析。结果 1．160例缺血性脑卒中患者中，颈动脉粥样硬化斑块检出率为68.1%，颈动脉中度及中度以上狭窄发生率为12.5%。 2．A组颈动脉粥样硬化斑块检出率为77.6%、不稳定斑块检出率为59.1%，高于B组和C组（P0.05）。B组与C组比较差异无统计学意义（P0.05）。 3．颈动脉粥样硬化斑块好发于颈总动脉分叉处，，A、B、C三组比较差异无统计学意义（P0.05）。 4．160例缺血性脑卒中患者中，共检出299枚动脉粥样硬化斑块。A组患者检出的不稳定斑块数目明显多于B组（P0.01）、C组(P0.05)。B组与C组比较差异无统计学意义（P0.05）。 5．A组检出四个及以上动脉粥样硬化斑块的有24例（31.6%）高于B组和C组，（P0.05）。B组与C组比较差异无统计学意义（P0.05）。 6．A、B、C三组颈动脉狭窄发生率分别为59.2%、42.5%、43.2%，三组比较差异无统计学意义（P0.05）。颈动脉中度及中度以上狭窄发生率A组为22.4%高于B组的2.5%（P0.01）和C组的4.5％（P0.05）。B组与C组比较差异无统计学意义（P0.05）。结论 1．缺血性脑卒中患者颈动脉颅外段粥样硬化病变的特点为动脉粥样硬化斑块发生率高，而严重狭窄发生率相对较低。 2．OCSP分型不同亚型的颈动脉颅外段动脉粥样硬化病变特点不同。OCSP分型各亚型中，颈动脉粥样硬化斑块，尤其是不稳定斑块与PACI和TACI的发生有一定相关性； 3．OCSP分型对严重颈动脉颅外段狭窄有一定预测价值，PACI和TACI患者可能存在严重的颈动脉颅外段狭窄。
[Abstract]:Objective to investigate the relationship between extracranial carotid artery disease and (OCSP) classification of Oxfordshire community stroke project. To provide a new entry point and reference for individualized treatment and secondary prevention of ischemic stroke. Methods from February 2010 to November 2011, 160 patients with acute ischemic stroke were enrolled in Department of Neurology, first affiliated Hospital of Zhengzhou University. All patients were admitted to hospital within one week of onset. According to the (OCSP) classification criteria of Oxfordshire Community Stroke Project, all ischemic stroke patients were subdivided into three groups according to their clinical manifestations. Group A was divided into three groups, including 9 patients with complete anterior circulation cerebral infarction (TACI) and 67 patients with partial anterior circulation infarction (PACI). A total of 76 patients in Group B included 40 patients with posterior circulatory cerebral infarction (POCI) and 44 patients with lacunar infarction (LACI). The characteristics of extracranial carotid artery atherosclerosis in all patients with ischemic stroke were observed by color Doppler ultrasound. The degree of extracranial carotid artery stenosis, the location, morphology and echo intensity of carotid atherosclerotic plaque were recorded. Texture and so on, and the data in each group were compared and analyzed. SPSS17.0 software was used for statistical analysis. Results among 1.160 patients with ischemic stroke, The detection rate of carotid atherosclerotic plaque and carotid artery stenosis were 68.1 and 12.5 respectively. 2. In group A, the detection rate of carotid atherosclerotic plaque was 77.6, and the detection rate of unstable plaque was 59.1, which was higher than that in group B and C. (P0.05). There was no significant difference between group B and group C (P0.05). 3. There was no significant difference among the three groups in carotid atherosclerotic plaques at the common carotid artery bifurcation (P0.05). Among 4.160 patients with ischemic stroke, there was no significant difference among the three groups (P0.05). A total of 299 atherosclerotic plaques were detected in group A. the number of unstable plaques detected in group A was significantly higher than that in group B (P0.01). There was no significant difference between group B and group C. there was no significant difference between group B and group C. 5. Group A detected four or more atherosclerotic plaques. 24 cases (31.6%) of sclerosing plaque were higher than B group and C group (P0.05). There was no significant difference between group B and C (P0.05). 6. The incidence of carotid artery stenosis in group C was 59.2% (P 0.05). There was no significant difference among the three groups (P0.05). The incidence of moderate and moderate carotid artery stenosis in group A was 22.4% higher than that in group B (2.5%, P0.01) and group C (4.5%, P0.05). There was no significant difference between group B and group C (P0.05). Conclusion 1. The characteristics of extracranial carotid atherosclerosis in patients with ischemic stroke are the high incidence of atherosclerotic plaques. However, the incidence of severe stenosis was relatively low. There were different characteristics of extracranial carotid atherosclerotic lesions in different subtypes of 2.OCSP. In particular, unstable plaques were associated with the occurrence of PACI and TACI, and 3.OCSP classification was a predictor of severe extracranial carotid stenosis. PACI-and TACI patients may have severe extracranial carotid stenosis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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