| Objective:Clinical studies have found that internal carotid artery stenosis or occlusion is associated with hypertension,diabetes,smoking,drinking and other cerebrovascular risk factors,as well as abnormal biochemical indicators such as blood lipid,homocysteine and uric acid.Patients with severe stenosis or occlusion of internal carotid artery may have severe neurological deficits,transient ischemic attack or no clinical symptoms.It is speculated that the degree of neurological deficits may be connected with related risk factors,biochemical indicators and the degree of the establishment of collateral circulation.The purpose of this study is to explore the influence factors and the characteristics of the collateral circulation of the degree of neurological deficits in research objects that are selected with severe stenosis or occlusion of unilateral internal carotid artery,on the basis of the risk factors and biochemical indicators related to internal carotid artery stenosis or occlusion reported in previous studies,so as to reduce,delay,or alleviate the occurrence of neurological deficits through primary and secondary prevention of controllable factors.Methods:The inpatients with severe stenosis or occlusion of unilateral internal carotid artery diagnosed by digital subtraction angiography(DSA)in the Department of Neurology of the first hospital of Jilin University were selected as the research objects for retrospective study.According to the NIHSS score during DSA examination,the research objects were divided into three groups: no neurological deficits,mild neurological deficits and moderate to severe neurological deficits.The following data was collected:(1)The general clinical data such as age,gender,the history of cerebrovascular disease,hypertension,diabetes,coronary heart disease,smoking and drinking;(2)The biochemical indicators such as fasting blood glucose,triglyceride,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,uric acid,homocysteine,platelet count,fibrinogen and hematocrit;(3)The cerebrovascular factors such as the location of severe stenosis or occlusion of internal carotid artery and the type and degree of collateral circulation opening.The differences of the above factors among the groups were compared and analyzed,and the independent risk factors affecting the degree of neurological deficits were screened by statistical methods.Statistical analysis was completed by SPSS 26.0 software,P<0.05 was statistically significant,multiple logistic regression analysis was used to screen independent risk factors.Results:1.A total of 210 patients were included in this study,including93 patients with no neurological deficits,66 patients with mild neurological deficits,and 51 patients with moderate to severe neurological deficits.There were 161 males and 49 females,male:female = 3.29:1,with an average age of 57.9±9.68 years.The results of statistical analysis of general clinical data showed that:(1)Systolic blood pressure at admission(P=0.021)and history of type 2diabetes mellitus(P=0.039)had statistically significant differences among the three groups;(2)Gender(P=0.609),age(P=0.505),the history of cerebrovascular disease(P=0.422),the history of hypertension(P=0.150),diastolic blood pressure at admission(P=0.594),the history of atrial fibrillation(P=0.365),the history of ischemic heart disease(P=0.293),smoking without quitting(P=0.901),smoking with quitting(P=0.985),no smoking(P=0.935),average number of daily cigarettes(P=0.675),smoking duration(P=0.984),smoking index(P=0.841),drinking without quitting(P=0.849),drinking with quitting(P=0.711),no drinking(P=0.980),average daily alcohol consumption(P=0.308),drinking duration(P=0.478)and drinking index(P=298)had no significant differences among the three groups.2.The statistical analysis of biochemical indicators showed that:(1)Neutrophil-to-lymphocyte ratio(P=0.049),Apo B(P=0.012),Apo B/A1ratio(P=0.047),fasting blood glucose(P=0.000)and serum creatinine(P=0.009)were significantly different among the three groups;(2)White blood cell(P=0.271),neutrophil(P=0.065),lymphocyte(P=0.114),red blood cell(P=0.864),PLT(P=0.480),hemoglobin(P=0.427),hematocrit(P=0.411),fibrinogen(P=0.348),triglyceride(P=0.322),total cholesterol(P=0.814),high density lipoprotein cholesterol(P=0.531),low density lipoprotein cholesterol(P=0.788),Apo A1(P=0.581),homocysteine(P=0.999),uric acid(P=0.804),Hb Ac1(P=0.087)and blood urea nitrogen(P=0.145)had no significant differences among the three groups.3.The results of statistical analysis of the severe stenosis or occlusion sites of the internal carotid artery showed that:(1)C1segment was the most common site among different neurological deficits,followed by C6 and C7 segments,and other sites were rare as the initial stenosis sites.The incidence of C1 segment was 76.3% in no neurological deficits group,71.2% in mild neurological deficits group and 84.3% in moderate to severe neurological deficits group;the incidence of C6 segment was 4.3% in no neurological deficits group,16.7% in mild neurological deficits group and 5.9% in moderate to severe neurological deficits group;the incidence of C7 segment was 15.1% in no neurological deficits group,7.6% in mild neurological deficits group and 5.9% in moderate to severe neurological deficits group respectively.(2)There was significant differences in severe stenosis or occlusion of C6segment(P=0.017)among the three groups,while there were no significant differences in other segments among the three groups.4.The results of statistical analysis on the types and degree of collateral circulation opening showed that:(1)The opening rates of various collateral circulation types in no neurological deficits group from high to low were anterior communicating artery(59.1%),posterior communicating artery(51.6%),leptomeningeal anastomoses(36.6%)and ophthalmic artery(12.9%);the opening rates in mild neurological deficits group from high to low were anterior communicating artery(63.6%),posterior communicating artery(54.5%),leptomeningeal anastomoses(45.5%)and ophthalmic artery(15.2%);the opening rates in moderate to severe neurological deficits group from high to low were anterior communicating artery(54.9%),leptomeningeal anastomoses(49.0%),posterior communicating artery(41.2%)and ophthalmic artery(31.4%).(2)The incidence of the degree of various collateral circulation openness in no neurological deficits group from high to low were primary collateral circulation(38.7%),primary+secondary collateral circulation(37.6%),no collateral circulation(18.3%)and secondary collateral circulation(5.4%);the incidence in mild neurological deficits group from high to low were primary+secondary collateral circulation(42.4%),primary collateral circulation(40.9%),no collateral circulation(9.1%)and secondary collateral circulation(7.6%);the incidence in moderate to severe neurological deficits group from high to low were primary+secondary collateral circulation(47.1%),primary collateral circulation(21.6%),no collateral circulation(21.6%)and secondary collateral circulation(9.8%).(3)The median number of collateral circulation in the three groups was 2,and the difference was not statistically significant(P=0.526).(4)Ophthalmic artery opening(P=0.017)was significantly different among the three groups,and the other factors were not significantly different among the three groups.5.The general clinical data,biochemical indicators,the severe stenosis or occlusion sites of internal carotid artery and the types and degree of collateral circulation opening that had significant differences among the three groups were compared between any two groups,and the results showed that:(1)Fasting blood glucose(P=0.021),the history of type 2 diabetes mellitus(P=0.011)and severe stenosis or occlusion of C6 segment(P=0.009)had significant differences between no neurological deficits group and mild neurological deficits group;(2)Systolic blood pressure at admission(P=0.026),neutrophil-tolymphocyte ratio(P=0.049),fasting blood glucose(P=0.000),serum creatinine(P=0.007)and ophthalmic artery opening(P=0.007)had significant differences between no neurological deficits group and moderate to severe neurological deficits group;(3)Apo B(P=0.010),Apo B/A1 ratio(P=0.045)and the ophthalmic artery opening(P=0.036)had significant differences between mild neurological deficits group and moderate to severe neurological deficits group.6.Multiple logistic regression analysis showed that between mild neurological deficits group and no neurological deficits group,patients with severe stenosis or occlusion of C6 segment of internal carotid artery(OR=4.765,P=0.015)were easier to suffer mild neurological deficits;Between moderate to severe neurological deficits group and no neurological deficits group,neutrophil-to-lymphocyte ratio(OR=1.414,P=0.007)and fasting blood glucose(OR=1.370,P=0.006)were the independent risk factors,and serum creatinine(OR=0.972,P=0.039)was the independent protection factor.Conclusions:1.Patients with severe stenosis or occlusion of C6 segment of internal carotid artery were easier to suffer mild neurological deficits.Neutrophil-to-lymphocyte ratio and fasting blood glucose were the independent risk factors,and serum creatinine was the independent protection factor,of the degree of neurological deficits in patients with severe stenosis or occlusion of internal carotid artery.Systolic blood pressure at admission,the history of type 2 diabetes,Apo B,Apo B/A1 ratio and ophthalmic artery opening were associated with the degree of neurological deficits in patients with severe stenosis or occlusion of internal carotid artery.Early intervention and treatment of controllable factors,especially independent risk factors,can reduce,delay or alleviate the occurrence of neurological deficits.2.The opening of primary collateral circulation has a certain protective effect on severe stenosis or occlusion of internal carotid artery,which can prevent the occurrence of moderate to severe neurological deficits;The opening of secondary collateral circulation is a sign of poor opening of collateral circulation and an adverse factor of the occurrence of neurological deficits in severe stenosis or occlusion of internal carotid artery. |
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