Palomäki H, Kaste M, Raininko R, Salonen O, Juvela S, Sarna S
Department of Neurology, University of Helsinki, Finland.
Stroke. 1993 Jul;24(7):970-5. doi: 10.1161/01.str.24.7.970.
Our purpose was to study potential determinants of the presence and the severity of cervical atherosclerosis in patients with transient ischemic attack or minor ischemic stroke.
Two hundred ninety-four patients up to 60 years of age were included in this cross-sectional study. The male to female ratio was 171/123. Atherosclerosis was defined as the presence of any visible atherosclerotic lesion in anteroposterior or left oblique views of cervical arteries in aortic arch angiograms. The severity of atherosclerosis was assessed using three scores, which were computed separately for the total thickness and length of all plaques as well as for the percent stenosis of the vessels.
Atherosclerosis was present in 180 patients (61.2%). In a multiple stepwise logistic regression analysis, age, serum triglycerides, smoking history for more than 20 years, arterial hypertension (defined as systolic or diastolic blood pressure values at least 150 or 100 mm Hg, respectively, or the use of antihypertensive medication), regular light alcohol consumption (inversely), and body mass index (marginal inverse association) were independent determinants of the presence of atherosclerosis; the respective odds ratios were 1.1/1 y, 1.8/1 mmol/L, 3.3, 2.4, 0.3, and 0.9/1 kg/m2. In multiple linear regression models, age was associated positively and the ratio of high density lipoprotein to total cholesterol was associated negatively with the severity of atherosclerosis regardless of the scoring method, whereas current smoking and female sex were predictors only of the percent stenosis and the length of the lesions. Arterial hypertension showed a significant association only with the length of the lesions.
Age, cigarette smoking, and arterial hypertension contribute substantially to atherosclerosis in cervical arteries, but this study also confirms the independent associations of lipid or lipoprotein variables with atherosclerotic disease. An independent inverse association of regular light consumption of alcohol with cervical atherosclerosis was also observed.
我们的目的是研究短暂性脑缺血发作或轻度缺血性卒中患者颈部动脉粥样硬化存在情况及严重程度的潜在决定因素。
本横断面研究纳入了294例60岁及以下患者。男女比例为171/123。动脉粥样硬化定义为主动脉弓血管造影中颈总动脉前后位或左斜位可见任何动脉粥样硬化病变。使用三个评分评估动脉粥样硬化的严重程度，分别针对所有斑块的总厚度和长度以及血管的狭窄百分比进行计算。
180例患者（61.2%）存在动脉粥样硬化。在多步逐步逻辑回归分析中，年龄、血清甘油三酯、20年以上吸烟史、动脉高血压（定义为收缩压或舒张压分别至少为150或100 mmHg，或使用抗高血压药物）、规律少量饮酒（呈负相关）和体重指数（边缘负相关）是动脉粥样硬化存在的独立决定因素；相应的比值比分别为1.1/每1岁、1.8/每1 mmol/L、3.3、2.4、0.3和0.9/每1 kg/m²。在多元线性回归模型中，无论采用何种评分方法，年龄与动脉粥样硬化严重程度呈正相关，高密度脂蛋白与总胆固醇的比值与动脉粥样硬化严重程度呈负相关，而当前吸烟和女性仅为病变狭窄百分比和长度的预测因素。动脉高血压仅与病变长度有显著关联。
年龄、吸烟和动脉高血压在很大程度上导致颈部动脉粥样硬化，但本研究也证实了脂质或脂蛋白变量与动脉粥样硬化疾病的独立关联。还观察到规律少量饮酒与颈部动脉粥样硬化存在独立的负相关。
