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目的分析一过性黑朦(amaurosis fugax,AmF)患者临床及颈动脉狭窄的特点,探讨其与脑梗死发生的关系。方法对34例一过性黑朦患者的临床资料进行分析,应用彩色多普照勒颈动脉超声及经颅多普勒超声(TCD)检查颈动脉硬化、狭窄及眼动脉血流方向情况。结果34例AmF患者中有25例(73.5%)以AmF为首发症状,29例(85.3%)为单眼AmF发作,左右两眼发病率无统计学差异(P>0.05),70.6%的患者在AmF发作后3个月内发生脑梗死。超声检查显示AmF患者患侧颈动脉内膜增厚伴斑块发生率(82.4%)高于对侧(29.4%,P<0.05)。颈动脉重度以上狭窄占91.2%,患侧颈内动脉狭窄或闭塞发生率(27例,79.4%)明显高于对侧(10例,29.4%,P<0.05)。TCD检查显示眼动脉侧支开放14例,无眼动脉侧支20例。眼动脉侧支开放组颈动脉中度以上狭窄发生率(92.9%)与侧支未开放组颈动脉狭窄发生率(70.0%)无明显差异(P>0.05)。经Logistic回归分析,有短暂性脑缺血病史(OR0.38,95%CI0.07~0.69,P=0.02<0.05)和颈动脉严重狭窄(OR0.33,95%CI0.08~0.58,P=0.01<0.05)是AmF发作后近期发生脑梗死的独立危险因素。结论AmF往往提示颈内动脉存在严重狭窄,严重的颈内动脉狭窄是引起AmF的主要原因。伴有短暂性脑缺血病史及颈动脉严重狭窄的AmF患者近期容易发生脑梗死。
Objective To analyze the clinical features of carotid artery stenosis in patients with amaurosis fugax (AmF) and to explore its relationship with the occurrence of cerebral infarction. Methods The clinical data of 34 patients with transient amaurosis were analyzed. The carotid atherosclerosis, stenosis and ophthalmic artery blood flow were examined by color Doppler echocardiography and transcranial Doppler echocardiography (TCD). Results AmF was the first symptom in 25 of 34 patients (73.5%) and 29 patients (85.3%) were unilateral AmF. The incidence of left and right eyes had no significant difference (P> 0.05), and 70.6% Cerebral infarction occurs within 3 months after the onset of AmF. Ultrasonography showed that the incidence of carotid intimal thickening with plaque in patients with AmF was higher (82.4%) than contralateral (29.4%, P <0.05). The stenosis of carotid artery was 91.2%. The incidence of occlusion or occlusion of internal carotid artery was significantly higher in 27 cases (79.4%) than in contralateral side (10 cases, 29.4%, P <0.05). TCD examination revealed 14 cases of lateral branch of ophthalmic artery and 20 cases without lateral branch of ophthalmic artery. There was no significant difference in the incidence of carotid artery stenosis (92.9%) and carotid artery stenosis (70.0%) in collaterals open group (P> 0.05). Logistic regression analysis showed that there was a history of transient ischemic attack (OR0.38, 95% CI0.07-0.69, P = 0.02 <0.05) and severe carotid stenosis (OR0.33, 95% CI0.08-0.58, P = 0.01 <0.05) was an independent risk factor for recent cerebral infarction after AmF attack. Conclusions AmF often prompts severe internal carotid artery stenosis. Severe carotid artery stenosis is the main cause of AmF. AmF patients with a history of transient ischemic attacks and severe carotid stenosis are susceptible to recent cerebral infarction.