目的 探讨阿托伐他汀钙对颈动脉粥样硬化患者血管内皮的保护作用。 方法 选取2010年10月－2011年8月颈动脉粥样硬化患者80例，随机分为治疗组和对照组。对照组给予阿司匹林肠溶片0.1 g，早饭后口服1次；治疗组在此基础上给予阿托伐他汀钙20 mg，每晚口服1次，10个月为1个疗程。分别在治疗前后进行颈动脉彩色多普勒超声检测颈动脉中膜厚度及颈动脉粥样硬化斑块面积，测定甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、一氧化氮（NO）、血管内皮素-1（ET-1）水平。两组患者在1个疗程治疗结束后停药12周，测定TG、TCH、LDL-C、HDL-C、NO、ET-1水平。 结果 与治疗前比较，治疗组患者的TG、TC、LDL-C、ET-1水平显著降低，HDL-C、NO水平显著升高（P＜0.01）。颈动脉中膜厚度和颈动脉粥样硬化斑块面积明显变小（P＜0.05）。对照组无明显变化。治疗组停药12周后与停药时比较，TG、TC、LDL-C、ET-1水平显著升高，HDL-C、NO水平明显降低（P ＜0.05）。对照组无明显变化。 结论 阿托伐他汀钙能显著改善颈动脉粥样硬化斑块患者的血管内皮功能、血脂水平，稳定颈动脉粥样硬化斑块，促进斑块逆转，且需要长期坚持服用。
Objective To explore the risk factors of carotid artery atherosclerotic plaque in ischemic stroke patients. Methods One hundred and forty-eight patients with ischemic stoke were allocated into two groups by ultrasonographic testing (80 with plaque and 68 without plaque). The carotid artery acoustic densitometry (IMT), blood pressure, blood glucose , blood lipid, fibriongen (FIB), c-reactive protein (CRP) were tested. First, single variable analysis was conducted and then multivariate non-condition stepwise logistic model analysis was conducted. Results Carotid IMT, age , total cholesterol (TC), low density lipoprotein (LDL)-CH, FIB, CRP level and the incidence of hypertension and diabetes were significantly higher in ischemic stroke patients with carotid artery plaques than patients without plaques (P≤0.05); Multiple logistic regression analysis showed the most important risk factors of plaques were CRP (OR=3.546, P=0.035) and FIB (OR=1.074, P=0.012) level. Conclusion The main risk factors of carotid atherosclerosis plaque are almost the same as atherosclerosis, such as age , hypertension ,diabetes, hyperlipidemia , high FIB and CRP level and increase in carotid IMT. CRP and FIB may play a crucial role in the development of carotid artery atherosclerosis plaque.
目的:探讨老年人颈动脉粥样硬化临床特点及其相关危险因素。方法:收集符合纳入标准的住院老年患者临床资料,颈动脉多普勒检测颈总动脉内中膜厚度(IMT)、斑块有无及性质、管腔狭窄程度。结果:(1)老年人群颈总动脉IMT异常者占50.53％;颈动脉斑块阳性者占78.7％;颈动脉狭窄者占20％,以轻度狭窄为主。(2)颈动脉斑块好发部位依次是左颈总分叉、左颈总动脉、右颈总动脉、右颈总分叉、颈动脉窦、左颈内动脉、右颈内动脉、右颈外动脉、左颈外动脉。(3)颈动脉斑块阳性人群合并高血压 心肌梗塞 脑血管意外和心脑血管事件率增加。(4)颈动脉IMT异常组较IMT正常组年龄、收缩压、甘油三酯,合并脑血管事件和心脑血管事件明显增加,同时颈总动脉IMT增厚伴颈动脉斑块阳性率、管腔狭窄率及斑块累及部位增加。结论:老年患者颈动脉粥样硬化的发病率高,斑块好发于颈动脉分叉、颈总动脉、颈内动脉,并以左侧常见。颈总动脉IMT异常组合并脑血管事件和心脑血管事件率明显增加,颈总动脉IMT增厚增加颈动脉斑块和管腔狭窄的发生率。
Objective To systematically review the correlation between obstructive sleep apnea syndrome (OSAS) and the incidence of carotid atherosclerosis. Methods PubMed, EMbase, CNKI, WanFang Data, CBM, and VIP databases were electronically searched to collect studies on the correlation between OSAS and carotid atherosclerosis and carotid intima-media thickness (CIMT) from inception to August 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 16.0 software and RevMan 5.3 software. Results A total of 32 studies, including 2 915 patients were included. The results of the meta-analysis showed a higher incidence of carotid atherosclerotic plaque in OSAS patients than in the control group (OR=5.56, 95%CI 0.27 to 8.38, P<0.000 01); subgroup analysis revealed that, compared with the control group, patients who were male (OR=5.38, 95%CI 2.79 to 10.38, P<0.000 01) or had mild-to-moderate OSAS (OR=3.9, 95%CI 1.66 to 9.15, P=0.002) or severe OSAS (OR=19.86, 95%CI 6.49 to 60.82, P<0.000 01) had a higher risk of carotid atherosclerosis. The CIMT of the OSAS group was significantly higher than that of the control group (SMD=1.24, 95%CI 0.97 to 1.51, P<0.000 01). There was a positive correlation between the apnea hypopnea index (AHI) and CIMT in OSAS patients (r=0.52, 95%CI 0.44 to 0.60, <0.000 1), and the CIMT increased with OSAS severity. Conclusion OSAS is associated with a high incidence of carotid atherosclerotic plaque that is highly correlated with CIMT, which increases with an increase in the AHI. These findings are required to be verified in prospective high-quality studies to overcome the limitations of quantity and quality of studies included in this systematic review.