斯里兰卡缺血性脑卒中患者队列中颈动脉狭窄的患病率及相关因素。
Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients.
机构信息
Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka.
Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
出版信息
BMC Neurol. 2021 Oct 4;21(1):385. doi: 10.1186/s12883-021-02415-1.
BACKGROUND
Large artery atherosclerotic disease is an important cause of stroke, accounting for 15-46% of ischaemic strokes in population-based studies. Therefore, current guidelines from west recommend urgent carotid imaging in all ischaemic strokes or transient ischaemic attacks and referral for carotid endarterectomy. However, the clinical features and epidemiology of stroke in Asians are different from those in Caucasians and therefore the applicability of these recommendations to Asians is controversial. Data on the prevalence of carotid artery stenosis (CAS) among South Asian stroke patients is limited. Therefore, we sought to determine the prevalence and associated factors of significant CAS in a cohort of Sri Lankan patients with ischaemic stroke.
METHODS
We prospectively studied all ischaemic stroke patients who underwent carotid doppler ultrasonography admitted to the stroke unit of a Sri Lankan tertiary care hospital over 5 years. We defined carotid stenosis as low (< 50%), moderate (50-69%) or severe (70-99%) or total-occlusion (100%) by North American Symptomatic Trial Collaborators (NASCET) criteria. We identified the factors associated with CAS ≥ 50% and ≥ 70% by stepwise multiple logistic regression analysis.
RESULTS
A total of 550 ischaemic stroke patients (326 (59.3%) male, mean age was 58.9 ± 10.2 years) had carotid doppler ultrasonography. Of them, 528 (96.0%) had low-grade, 12 (2.2%) moderate and 7 (1.3%) severe stenosis and 3 (0.5%) had total occlusion. On multivariate logistic regression, age was associated with CAS ≥ 50% (OR 1.12, p = 0.001) and CAS ≥ 70% (OR 1.14, p = 0.016), but none of the other vascular risk factors studied (sex, hypertension, diabetes mellitus, smoking, past history of TIA, stroke or ischemic heart disease) showed significant associations.
CONCLUSIONS
Carotid stenosis is a minor cause of ischemic stroke in Sri Lankans compared to western populations with only 4.0% having CAS ≥ 50 and 3.5% eligible for carotid endarterectomy. Our findings have implications for the management of acute strokes in Sri Lanka.
背景
大动脉粥样硬化性疾病是中风的一个重要病因，在基于人群的研究中占缺血性中风的 15-46%。因此，目前西方的指南建议对所有缺血性中风或短暂性脑缺血发作的患者进行紧急颈动脉成像，并转介行颈动脉内膜切除术。然而，亚洲人的中风临床特征和流行病学与白种人不同，因此这些建议对亚洲人的适用性存在争议。南亚中风患者颈动脉狭窄（CAS）患病率的数据有限。因此，我们旨在确定斯里兰卡缺血性中风患者队列中显著 CAS 的患病率和相关因素。
方法
我们前瞻性研究了 5 年内在斯里兰卡一家三级护理医院中风病房住院并接受颈动脉多普勒超声检查的所有缺血性中风患者。我们根据北美症状性试验协作组（NASCET）标准将颈动脉狭窄定义为低（<50%）、中（50-69%）或重度（70-99%）或完全闭塞（100%）。我们通过逐步多元逻辑回归分析确定与 CAS≥50%和≥70%相关的因素。
结果
共纳入 550 例缺血性中风患者（326 例（59.3%）为男性，平均年龄为 58.9±10.2 岁）进行了颈动脉多普勒超声检查。其中，528 例（96.0%）为低级别狭窄，12 例（2.2%）为中度狭窄，7 例（1.3%）为重度狭窄，3 例（0.5%）为完全闭塞。多元逻辑回归显示，年龄与 CAS≥50%（OR 1.12，p=0.001）和 CAS≥70%（OR 1.14，p=0.016）相关，但我们研究的其他血管危险因素（性别、高血压、糖尿病、吸烟、短暂性脑缺血发作史、中风或缺血性心脏病史）均无显著相关性。
结论
与西方人群相比，颈动脉狭窄是斯里兰卡缺血性中风的一个次要病因，只有 4.0%的患者存在 CAS≥50%，3.5%的患者适合行颈动脉内膜切除术。我们的研究结果对斯里兰卡急性中风的治疗管理具有启示意义。
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