脑梗死患者颈动脉斑块及其稳定性

探讨脑梗死患者颈动脉粥样硬化病变特点及其与脑梗死之间的关系 ,寻找不稳定性颈动脉斑块的血清标志物。通过对 12 0例定位于颈内动脉系统的动脉粥样硬化性脑梗死患者进行颈动脉超声检查 ,根据颈动脉超声结果分为软斑组、硬斑组和无斑块组 ,对符合入选标准的 84例患者于入院 3周后 ,用酶联免疫吸附测定法测定血清基质金属蛋白酶 9水平。结果发现 ,颈动脉粥样硬化斑块检出率为 72 .5 % (87例 ) ,颈动脉重度狭窄发生率为 4 .17%。梗死侧颈动脉软斑发生率 (32 .9% )高于非梗死侧 (16 .9% ) ,软斑组和硬斑组基质金属蛋白酶 9水平均明显高于无斑块组 ,而软斑组基质金属蛋白酶 9水平又高于硬斑组 (P <0 .0 5 )。结果提示 ,缺血性脑卒中患者颈动脉粥样硬化病变特点可能以斑块居多 ,而重度狭窄发生率较低 ,软斑为脑梗死重要危险因素 ,基质金属蛋白酶 9可能是不稳定性粥样斑块的一个潜在的血清标志物。

Carotid Plaques and Its Stability in Cerebral Infarction Patients

Aim To assess the character of carotid atherosclerosis in patients with cerebral infarction and the relationship with serum matrix metalloproteinase-9 (MMP-9). Methods The duplex ultrasonography was performed in the carotid arteries of all the 120 patients with cerebral infarction located in arteriae carotis interna system. 84 patients were included and were divided into soft plaque group, hard plaque group and nonplaque group. Serum MMP-9 levels were determined by enzyme-linked immunosorbent assay in blood samples obtained 3 weeks later after hospitalization. Results Carotid plaques were found in 87 (72.5%)patients, the prevalence of severe lumen stenosis was 4.17%. The incidence of soft plaque in the side of cerebral infarction were higher than that of non-infarction. Serum MMP-9 levels were significantly higher in soft plaque group than those in the hard plaque and non-plaque group (P<0.05). Conclusions Most of the carotid artery lesion are plaques other than severe stenosis, which may be the character of carotid atherosclerosis of Chinese stroke patients. Soft plaque is an important risk factor of stroke in our study. MMP-9 may be a potential clinical marker of unstable plaque.