社区脑卒中高危人群颈动脉粥样硬化与缺血性脑卒中的关系
Association between carotid atherosclerosis and ischemic stroke in the population with a high risk for stroke

摘要：目的 在社区脑卒中高危人群中，研究颈动脉粥样硬化与缺血性脑卒中的关系。方法 2012年西安市雁塔区“脑卒中高危人群筛查和干预项目”发现的脑卒中高危人群，进行颈动脉超声检查，4年后进行电话随访。χ2检验、方差分析、多因素COX回归模型等分析颈动脉粥样硬化与缺血性脑卒中的关系。结果 774例脑卒中高危人群，4年后随访到735人，排除拒绝调查17人，行颈动脉支架成形术4人，发生脑出血4人，纳入统计分析710人，年龄45-98岁(平均59.75岁±9.58岁)，男性282人(39.7%)。随访期间发生缺血性脑卒中50人。颈动脉粥样硬化组缺血性脑卒中发生率高于非颈动脉粥样硬化组(13.1% vs. 5.2%，P<0.001)。K-M生存分析显示，非颈动脉粥样硬化组的生存时间较颈动脉粥样硬化组长。多因素COX比例风险模型回归分析显示，年龄、既往脑卒中病史、冠心病家族史、糖尿病家族史、服用降糖药物、服用降脂药物、高密度脂蛋白异常和颈动脉粥样硬化与缺血性脑卒中发生明显相关。颈动脉粥样硬化是影响缺血性脑卒中的独立因素(HR=2.529，95% CI： 1.150～5.563, P=0.029)。结论 社区脑卒中高危人群合并颈动脉粥样硬化时，缺血性脑卒中的风险明显增加。
ABSTRACT: Objective To investigate the relationship between carotid atherosclerosis and ischemic stroke in the population with a high risk for stroke from Yanta District, Xi’an. Methods The subjects were selected from Screening and Prevention Program of Stroke in Yanta District, Xi’an, in 2012. All of them received carotid ultrasound examination and were followed up by telephone 4 years later. Chi-square test, analysis of variance, and multivariate cox regression model analysis were performed to investigate the correlation between carotid atherosclerosis and ischemic stroke. Results A total of 774 subjects met the inclusion criteria, and 4 years later 39 lost to follow-up, 17 refused to be investigated, 4 patients underwent carotid artery stenting, and 4 patients had cerebral hemorrhage, Finally, 710 patients were included in the analysis, and the age was 45-98 years (59.75 years ±9.58 years) with males being 282 (39.7%). During the follow-up, 50 participants were diagnosed as having ischemic stroke. The incidence of ischemic stroke in the carotid atherosclerosis group was higher than that in the non-atherosclerosis group (13.1% vs. 5.2%, P<0.001). K-M survival analysis showed that the survival time in the non-carotid atherosclerosis group was longer than that in the carotid atherosclerosis group. Multivariable Cox regression analysis showed that age, history of stroke, family history of coronary heart disease or diabetes, medication on hypoglycemics and lipid-lowering drugs, abnormal level of high-density lipoprotein and carotid atherosclerosis were significantly associated with ischemic stroke. It also showed that carotid atherosclerosis was an independent factor for ischemic stroke (HR=2.529, 95% CI: 1.150-5.563, P=0.029). Conclusion Carotid atherosclerosis in the population with a high risk for stroke significantly increases the risk of ischemic stroke