摘要
目的 探讨脑梗死患者颈动脉超声诊断价值及脑梗死患者危险因素评价,为临床防治提供一些参考与思路。方法 收集2020-01-01-2022-12-31天津市中医药研究院附属医院收治的185例脑梗死患者及199例非脑梗死患者的临床资料,分析颈动脉超声数据、临床资料和实验室检查结果,比较2组患者的颈动脉斑块情况[内-中膜厚度(IMT)、斑块最大厚度、斑块数量、狭窄程度、累及部位、斑块性质和斑块稳定性],对2组患者临床生化指标[总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、尿素(UR)、尿酸(UA)、肌酐(CR)、纤维蛋白原(FIB)、血糖、白蛋白、球蛋白、白球蛋白比(A/G)、血小板数目(PLT)、钙离子浓度(Ca2+)]和基础病史(糖尿病、冠心病、高血压、吸烟、饮酒、收缩压、年龄)等情况进行单因素及多因素分析。结果 脑梗死组与非脑梗死组患者在IMT(t=8.595,P<0.001)、斑块数量(t=4.085,P<0.001)、斑块最大厚度(t=4.071,P<0.001)、斑块性质(均P<0.05)和狭窄程度(Z=-9.118,P<0.001)方面差异有统计学意义。临床与生化指标单因素分析结果显示,2组患者高血压(χ^(2)=40.741,P<0.001)、冠心病(χ^(2)=33.463,P<0.001)、糖尿病(χ^(2)=13.019,P<0.001)、吸烟(χ^(2)=21.675,P<0.001)、饮酒(χ^(2)=20.251,P<0.001)、斑块检出(χ^(2)=78.911,P<0.001)、年龄(t=-9.064,P<0.001)、HDL-C(t=4.395,P<0.001)、LDL-C(t=2.846,P=0.005)、TC(t=4.077,P<0.001)、收缩压(t=-6.220,P<0.001)、白蛋白(t=2.273,P=0.024)和血糖(t=-3.963,P<0.001)差异有统计学意义;2组患者TG、FIB、UA、UR、CR、PLT、Ca2+、球蛋白、A/G比较,差异无统计学意义,均P>0.05。多因素分析结果显示,高龄(OR=1.064,95%CI为1.034~1.095,P<0.001)、高血压(OR=2.474,95%CI为1.119~5.472,P=0.025)、吸烟(OR=2.258,95%CI为1.099~4.638,P=0.027)、高血糖(OR=1.141,95%CI为1.009~1.290,P=0.035)和斑块形成(OR=2.725,95%CI为1.478~5.022,P=0.001)是脑梗死的独立危险因素,HDL-C(OR=0.377,95%CI为0.154~0.927,P=0.034)是脑梗死的保护因素。结论 脑梗死受年龄、高血压、吸烟、高血糖、血脂异常和颈部斑块等因素影响,颈动脉超声检查对于诊断颈动脉斑块的形成及判断斑块特征十分关键,应该重视上述生化指标以及颈动脉超声结果,积极干预防治脑梗死。
Objective To explore the value of carotid ultrasound in patients with cerebral infarction and the evaluation of risk factors in patients with cerebral infarction,so as to provide some references and ideas for clinical prevention and treat-ment.Methods Clinical data of 185patients with cerebral infarction and 199non cerebral infarction patients admitted to the Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine from January 1,2020to December 31,2022 were collected.We compared the condition of carotid artery plaques between two groups of patients,including intima-media thickness(IMT),maximum plaque thickness,number of plaques,degree of stenosis,affected site,plaque nature,and plaque stability.We conducted univariate and multivariate analysis on clinical biochemical indicators[total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),urea(UR),uric acid(UA),creatinine(CR),fibrinogen(FIB),glucose,albumin,globulin,albumin/glbulin ratio(A/G),platelet(PLT),calcium ion concentration(Ca 2+)]and basic medical history(diabetes,coronary heart disease,hy-pertension,smoking,alcohol consumption,systolic blood pressure,age)of two groups of patients.Results There were statistically significant differences in IMT(t=8.595,P<0.001),plaque number(t=4.085,P<0.001),maximum plaque thickness(t=4.071,P<0.001),plaque nature(all P<0.05),and stenosis degree(Z=-9.118,P<0.001)between the cerebral infarction group and the non cerebral infarction group.The single factor analysis results of clinical biochemical indicators showed that hypertension(χ^(2)=40.741,P<0.001),coronary heart disease(χ^(2)=33.463,P<0.001),diabetes(χ^(2)=13.019,P<0.001),smoking(χ^(2)=21.675,P<0.001),alcohol consumption(χ^(2)=22.51,P<0.001),plaque detection(χ^(2)=78.911,P<0.001),age(t=-9.064,P<0.001),HDL-C(t=4.395,P<0.001),LDL-C(t=2.846,P=0.005),TC(t=4.077,P<0.001),systolic blood pressure(t=-6.220,P<0.001),albumin(t=2.273,P=0.024),and glucose(t=-3.963,P<0.001)showed statistically significant differences between the two groups.There were no statistically significant differences in TG,FIB,UA,UR,CR,PLT,Ca 2+,globulin,A/G be-tween the two groups of patients,all P>0.05.The results of multivariate analysis showed that older age(OR=1.064,95%CI was 1.034-1.095,P<0.001),hypertension(OR=2.474,95%CI was 1.119-5.472,P=0.025),smoking(OR=2.258,95%CI was 1.099-4.638,P=0.027),hyperglycemia(OR=1.141,95%CI was 1.009-1.290,P=0.035),and plaque formation(OR=2.725,95%CI was 1.478-5.022,P=0.001)were independent risk factors for cerebral infarction,HDL-C(OR=0.377,95%CI was 0.154-0.927,P=0.034)was a protective factor for cerebral in-farction.Conclusions Cerebral infarction is affected by age,hypertension,smoking,hyperglycemia,dyslipidemia,neck plaques and other factors.Carotid artery ultrasound examination is very important for diagnosing the formation of carotid artery plaques and judging the characteristics of plaques.We should pay attention to the above biochemical indicators and carotid artery ultrasound results,and actively prevent and treat cerebral infarction.
作者
王金颖
张蕊
杨明铭
WANG Jinying;ZHANG Rui;YANG Mingming(Department of Functional Examination,Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine,Tianjin 300120,China)
出处
《社区医学杂志》
CAS
2023年第19期1000-1005,共6页
Journal Of Community Medicine
关键词
脑梗死
颈动脉超声
斑块
血生化
cerebral infarction
carotid artery ultrasound
plaques
blood biochemistry
