摘要： 目的 分析天津市城市社区脑卒中高危人群颈动脉粥样硬化特点，以为颈部血管超声在脑卒中防控中发挥更大作用提供启示。方法 采用整群抽样方法对天津市4 个城市社区956 名脑卒中高危人群进行颈部血管超声筛查，包括双侧颈总动脉、颈内动脉、颈外动脉、椎动脉、锁骨下动脉和无名动脉，记录颈动脉内-中膜厚度，粥样硬化斑块形成及其部位、大小，管腔狭窄或闭塞，以及血流频谱特征。分析不同性别、年龄受试者颈动脉粥样硬化特点。结果（1）颈动脉粥样硬化检出率为71.55%（684/956），且男性高于女性（79.08%对65.87%；χ² = 20.067，P = 0.000）。（2）颈动脉粥样硬化以斑块形成最常见，占81.58%（558/684），其次为内-中膜增厚（13.01%，89/684），中至重度狭窄或闭塞少见（5.41%，37/684），其中男性颈动脉内-中膜增厚比例低于女性（7.08%对18.38%；χ² = 19.269，P = 0.000）、斑块形成比例高于女性（86.46%对77.16%；χ² = 9.824，P = 0.002）。颈动脉粥样硬化程度中位评分为1.79 分，且男性高于女性［1.98（0.70，3.26）分对1.52（0.20，2.84）分；Z = 2.304，P = 0.042］。颈动脉斑块最多见于颈动脉球部（36.61%），其次为锁骨下动脉（22.18%）。颈动脉狭窄表现为颈内动脉狭窄（30 名）、椎动脉狭窄（4 名）、椎动脉闭塞（3 名），其中锁骨下动脉盗血综合征10 名。（3）颈动脉粥样硬化检出率随年龄的增长而明显增加（χ² = 212.067，P = 0.000），其中< 70岁者颈动脉内-中膜增厚检出率高于≥ 70岁者（10.68%对6.03%；χ² = 5.101，P = 0.024），≥ 60 岁者颈动脉斑块（72.26%对28.99%；χ² = 64.850，P = 0.000）和中至重度狭窄或闭塞（5.24%对0.98%；χ² = 10.174，P = 0.001）检出率均高于< 60 岁者。结论 天津市城市社区脑卒中高危人群具有较高的颈动脉粥样硬化检出率，男性高于女性，且随着年龄的增长而显著增加。颈部血管超声用于脑卒中高危人群筛查简便无创、准确可靠，是脑卒中预防与控制的有效措施。

关键词: 卒中, 危险因素, 颈动脉, 超声检查, 多普勒, 彩色, 天津

Abstract: Objective  To investigate the features of carotid atherosclerosis in a population at high risk of stroke in urban communities of Tianjin, so as to provide inspiration for carotid ultrasonography to play a greater role in the prevention and control of stroke.  Methods  A total of 956 residents at high risk of stroke were selected from 4 urban communities in Tianjin using cluster random sampling method. Doppler ultrasound screening was performed in bilateral common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), vertebral artery (VA), subclavian artery (SCA) and innominate artery of the population. The intima-media thickness (IMT), atherosclerotic plaque formation and its location and size, vascular stenosis or occlusion, and flow spectrum were detected. The results and features of carotid ultrasound screening were analyzed and compared among different gender and age groups.  Results  1) The detection rate of carotid atherosclerosis was 71.55% (684/956), and the detection rate in males was significantly higher than that in females (79.08% vs 65.87%; χ² = 20.067, P = 0.000). 2) Among the population with carotid atherosclerosis, the most common manifestation was the formation of atherosclerotic plaques (81.58%, 558/684), secondly intima-media thickening (13.01%, 89/684), followed by moderate to severe stenosis or occlusion (5.41%, 37/684). The proportion of intima-media thickening in males was lower than that in females (7.08% vs 18.38%; χ² = 19.269, P = 0.000). The proportion of carotid atherosclerotic plaque formation in males was higher than that in females (86.46% vs 77.16%; χ² = 9.824, P = 0.002). The median rating of carotid atherosclerosis was 1.79, with males higher than females [1.98 (0.70, 3.26) vs 1.52 (0.20, 2.84); Z = 2.304, P = 0.042]. The site of plaque formation was most commonly located in carotid bulb (36.61%), secondly SCA (22.18%). Of the type of carotid stenosis, ICA stenosis was detected in 30 cases, VA stenosis in 4 cases, VA occlusion in 3 cases, and subclavian steal syndrome (SSS) in 10 cases. 3) The detection rate of carotid atherosclerosis increased with age (χ² = 212.067, P = 0.000). The detection rate of intima-media thickening in the population aged less than 70 years was higher than that aged over 70 years (10.68% vs 6.03% ; χ² = 5.101, P = 0.024). The detection rate of carotid atherosclerotic plaque of the population aged over 60 years was significantly higher than that aged less than 60 years (72.26% vs 28.99%; χ² = 64.850, P = 0.000). Similarly, the detection rate of moderate to severe stenosis or occlusion in the population aged over 60 years was significantly higher than that aged less than 60 years (5.24% vs 0.98%; χ² = 10.174, P = 0.001). Conclusions  The incidence of carotid atherosclerosis in the population at high risk of stroke is high in urban communities of Tianjin, and the incidence of males is higher than that of females, increasing with age. It is an simple, non-invasive, accurate, reliable, and effective measure to prevent stroke by using carotid artery ultrasound screening in the population at high risk of stroke.

Key words: Stroke, Risk factors, Carotid arteries, Ultrasonography, Doppler, color, Tianjin