脑卒中高危人群无症状颈动脉斑块易损性与实验室指标的关系及对脑血管缺血事件发生的影响

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摘要目的探讨脑卒中高危人群无症状颈动脉斑块易损性与实验室指标的关系及对脑血管缺血事件发生的影响。方法回顾性分析2017年6月至2020年6月在东莞市松山湖中心医院行脑卒中筛查确定为高危人群且合并无症状颈动脉斑块的120 例患者临床资料，根据颈动脉超声结果将所有脑卒中高危人群分为稳定性斑块组（n=71）及易损斑块组（n=49）。比较两组的基础资料、实验室指标水平，分析脑卒中高危人群发生脑血管缺血事件的危险因素。结果稳定性斑块组与易损斑块组的外周血空腹血糖（FPG）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、同型半胱氨酸（Hcy）水平比较，差异无统计学意义（P＞0.05）。易损斑块组患者的外周血低密度脂蛋白胆固醇（LDL-C）、胱抑素C（CysC）水平高于稳定性斑块组患者，差异有统计学意义（P＜0.05）。单因素分析结果显示，脑血管缺血事件组和非脑血管缺血事件组患者的性别、年龄、体重指数及FPG、TC、TG、HDL-C、Hcy 水平比较，差异无统计学意义（P＞0.05）；斑块性质与LDL-C、CysC 水平比较，差异有统计学意义（P＜0.05）。多因素分析结果显示，易损斑块（β=1.784，OR=2.546，95%CI=1.734～2.996）、LDL-C 水平较高（β=1.695，OR=2.198，95%CI=1.453～2.760）、CysC 水平较高（β=1.564，OR=1.754，95%CI=1.176～2.488）是脑卒中高危人群脑血管缺血事件发生的危险因素（P＜0.05）。结论脑卒中高危人群合并易损性无症状颈动脉斑块，LDL-C、CysC 水平异常增高，且是后续脑血管缺血事件发生的独立危险因素。

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关键词 ：脑卒中高危人群, 无症状颈动脉斑块, 易损性, 脑血管缺血事件

Abstract：Objective To investigate the relationship between vulnerability of asymptomatic carotid artery plaque, laboratory indicators and influence on the occurrence of cerebrovascular ischemic events in high-risk patients with stroke.Methods The clinical data of 120 patients with asymptomatic carotid plaque who underwent stroke screening in Dongguan Songshan Lake Central Hospital from June 2017 to June 2020 were retrospectively reviewed. According to the results of carotid ultrasound, all patients with high risk of stroke were divided into stable plaque group (n=71) and vulnerable plaque group (n=49). The basic data and laboratory index levels of the two groups were compared, and the risk factors of cerebral ischemic events in the high-risk population of stroke were analyzed. Results There were no significant differences in levels of fasting blood glucose (FPG), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and homocysteine (Hcy) in peripheral blood between stable plaque group and vulnerable plaque group (P>0.05). The levels of low-density lipoprotein cholesterol (LDL-C) and cystatin C (CysC) in peripheral blood in vulnerable plaque group were higher than those in stable plaque group, and the differences were statistically significant (P<0.05). Univariate analysis showed that there were no significant differences in gender, age, body mass index, FPG, TC, TG, HDL-C and Hcy between two groups (P>0.05). There were statistically significant differences in plaque properties, LDL-C and CysC levels (P<0.05). Multivariate analysis showed that the levels of vulnerable plaques(β=1.784, OR=2.546, 95%CI=1.734-2.996), LDL-C (β=1.695, OR=2.198, 95%CI=1.453-2.760) and CysC (β=1.564,OR=1.754, 95%CI=1.176-2.488) were independent risk factors for cerebral ischemic events in high-risk stroke population (P<0.05). Conclusion Patients at high risk of stroke complicates with vulnerable asymptomatic carotid artery plaque have abnormal levels of LDL-C and CysC, which are independent risk factors for subsequent cerebral ischemic events.

Key words： People at high risk of stroke Asymptomatic carotid plaque Vulnerability Cerebrovascular ischemic event

基金资助:广东省东莞市社会科技发展（一般）项目（20195 0715024096）

引用本文:

胡斌彬；罗成宏；陆伟恒；刘群. 脑卒中高危人群无症状颈动脉斑块易损性与实验室指标的关系及对脑血管缺血事件发生的影响[J]. 中国当代医药, 2022, 29(8): 25-28.
HU Binbin LUO Chenghong LU Weiheng LIU Qun. Relationship between vulnerability of asymptomatic carotid artery plaque,laboratory indicators and its influence on the occurrence of cerebrovascular ischemic events in patients at high risk of stroke. 中国当代医药, 2022, 29(8): 25-28.

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https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2022/V29/I8/25

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