| Background and objective:Cerebral infarction accounts for the common disability and death in the elderly,and recurrent cerebral infarction has a poorer prognosis. Extracranial carotid atherosclerosis is considered to be an important cause and risk factor of ischemic cerebral infarction.The stable carotid plaques not easily rupture and result in clinical symptoms, And the vulnerable plaques come to ruptured and lead to cerebral infarction,even without severe stenosisFully realizing the relationship between carotid plaque and cerebral infarction, knowing the cerebral infarction recurrent risk factors well , taking appropriate intervention measures,all the above measures are of great significance on controling the recurrence of cerebral infarction.At present higher resolution ultrasound examination can recognize the features of carotid vulnerable plaques very well and had broad scope of application on ischemic stroke.This clinical trial identified risk factors of recurrent cerebral infarction,analysed the characteristic of atherosclerotic carotid plaque of patients with recurrent and initial cerebral infarction using Color Doppler Ultrasonography,and evaluated their predictive value for secondary prevention,for the prupose of offering reference for ischemic cerebrovascular disease prevention.Methods:Retrospective analysis was conducted on a total of 105 consecutive patients hospitalized for ischemic stroke between the age of 45～86 years old in the Second Affiliated Hospital,Shantou university,Department of Neurology,from October 2009 to March 2010,including 30 patients with recurrent cerebral infarction (recurrent group),75 patients survived from first stroke (initial group). All cases were diagnosed according to cerebrovascular diagnostic criteria revised and identified by CT/MRI scan.All patients underwent Color Doppler Ultrasonography.Data were collected prospectively and assigned the values respectively. All data were analyzed by statistical packages for statistical analysis 18.0,chi-square test was used to compare the categorical data,and t-test was used to compare the measurement data.The unconditional logistic regression analysis was used to analyze the main risk factors for recurrent cerebral infarction.Results:1. The unconditional Logistic regression analysis turned out that the independent risk factors of recurrent cerebral infarction are hypertension (p < 0.01, OR = 4.746, 95% CI 1.612-13.979) and carotid vulnerable plaque (p < 0.01, OR = 4.237, 95% CI 1.440-12.469). Also diabetes mellitus is an important risk factor.2. There was 25 patients (83.3%)with carotid plaques in 30 cases of recurrent group, including 23 patients (76.7%) carrying vulnerable plaques ,the mean IMT was (1.06±0.15)mm; There was 45 cases (60.0%)with carotid plaques in 75 cases of initate group, including 40 cases(53.3%) carrying vulnerable plaques ,the mean IMT was (0.95±0.19)mm; Comparison between the two groups are statistically significant (p < 0.05).3. The fibrinogen in vulnerable plaque group had a level of(4.94±1.46)mg/L ,and the average intima-media thickness was 1.05±0.15mm. Comparison between vulnerable group and stable group are statistically significant (p < 0.05).4. There was 15 patients (50.0%) with artery stenosis in the recurrent group,all of them were moderate and moderate above narrow; There was 12 cases (16.0%) with artery stenosis in the initate group ,10 cases patients were moderate and moderate above narrow (13.3%); Comparison between the two groups are statistically significant (p < 0.01).5. Patients in the recurrent group can be divided into narrow group and no narrow groups both in 15 cases.There were 12 cases(80.0%) with higher level of low density lipoprotein ,13 men(86.7%) in narrow group,and its average age was 68.8±8.33 years old.The three aspects were higher than no narrow group. Comparison between the two groups are significant (p < 0.05). Conclusion:1. The risk factors of cerebral infarction recurrence are:hypertension , arotid vulnerable plaques,dibetes milletus..2. Atherosclerosis is generally worse at the patients with recurrent cerebral infarction.(1) Carotid vulnerable plaque is one of the independent risk factors of cerebral infarction recurrent;the thicken of carotid intima-media thickness, fibrinogen involves in formation of atherosclerotic vulnerable plaque.(2) Serious carotid artery stenosis caused more cerebral infarction recurrence.3. Carotid ultrasonography detection can timely assess the characteristic of carotid plaques,indirectly find out functional status and cerebral blood supply, provide the auxiliary basis for clinical and prognosis assessment . So it has important value of clinical application. |
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