老年人颈内动脉颅外段硬化性病变与脑缺血性疾病的关系

目的探讨老年患者颈内动脉（ＩＣＡ）颅外段硬化性狭窄度及斑块形态学类型与脑缺血症状的关系。方法将接受颈动脉Ｄｕｐｌｅｘ超声检查的１８８例老年患者分成脑缺血组、下肢动脉硬化性闭塞症（ＰＡＯＤ）组和脑缺血＋ＰＡＯＤ组进行分析。狭窄度分成５级，斑块类型分成４型。结果１８８例中，无双侧ＩＣＡ颅外段均重度狭窄者。３７６条血管中，轻度狭窄２５７条，中度８９条，重度２８条，闭塞２侧；有症状１５８条血管中，轻度狭窄９４条（占３６．６％）、中度４０条（４４．９％）及重度２２条（７８．６％）、闭塞２条，轻、中、重３组间比较，差异有显著性（Ｐ＜０．０１）。在２１３条（５６．６％）有超声测定斑块类型记录者中，脑缺血组、ＰＡＯＤ组及脑缺血＋ＰＡＯＤ组中ＩＣＡ颅外段重度狭窄发生率分别为１２．５％、８．３％和３７．５％。狭窄度与斑块类型比较，狭窄度与症状之间较斑块类型与症状之间关系更密切（Ｐ＜０．０１）。结论脑缺血患者中存在ＩＣＡ颅外段重度狭窄者，ＩＣＡ颅外段动脉硬化病变是脑缺血性疾病发生的危险因素

The relationship between ischaemic cerebrovascular disease and extracranial internal carotid artery atherosclerosis in old patients

Objective To study the relationship between the cerebral ischaemic symptoms and the degree of extracranial internal carotid stenosis and(or) the plaque morphology in old patients. Methods Based on clinical symptoms and CT or MRI, 188 old patients were divided into three patient groups as follows: Brain infarction or TIA group, peripheral arterial occlusive disease (PAOD) group and brain infarction or TIA PAOD group. A total of 376 internal carotid arteries (ICA) was scanned by Duplex ultrasonography. Five grades of stenosis degree and four plaque types were classified. Results In the 188 patients, there was no bilateral extracranial ICA of severe stenotic degree. Of the 376 vessels, 257 vessels showed light degree of stenosis (<30% caliber narrowed), 89 vessels with median degree of stenosis (30% 69%) and 28 vessels with severe degree of stenosis (70% 99%);of the 158 vessels in patients with symptom, there were 94 vessels (36 6%) of light degree, 40 vessels (44 9%) median degree and 22 vessels (78 6%)severe degrees( P <0 01). Plaque types were identified in 213 vessels . In the groups of brain infarction/TIA, PAOD and brain infarction or TIA PAOD,the prevalence of severe stenosis was 12 5%,8 5% and 37 5% respectively. To compare the stenotic degree with the plaque type, the relationship between stenotic degree and symptoms was much closer than that between the plaque type and symptoms. Conclusions In brain infarction or TIA patients with severe atherosclerotic stenosis of extracranial internal carotid arteries the carotid atherosclerotic plaque is a risk factor for ischaemic cerebrovascular disease.