摘要： 研究背景 中青年脑梗死患者呈逐年增加趋势，病因尚不明确。通过对中青年腔隙性脑梗死患者血清尿酸、超敏C-反应蛋白水平及颈动脉内-中膜厚度（IMT）的测定，探讨血清尿酸、超敏C-反应蛋白与颈动脉粥样硬化程度的相关性。方法 采用经颅多普勒超声分别测量186 例诊断明确的腔隙性脑梗死患者舒张末期颈总动脉远端、颈总动脉分叉处和颈内动脉近端内-中膜厚度；以1.00 mm ≤ IMT< 1.20 mm为颈动脉内-中膜增厚，存在突入血管腔回声结构或突入血管腔血流异常缺损或局部IMT ≥1.20 mm为颈动脉粥样硬化斑块形成；并分析血清尿酸、超敏C-反应蛋白水平与颈动脉粥样硬化程度间的相关性。结果 腔隙性脑梗死组患者血清尿酸、超敏C-反应蛋白水平及内-中膜厚度均高于正常对照组（P = 0.000），颈动脉内-中膜增厚组、粥样硬化斑块形成组与颈动脉内膜正常组之间差异有统计学意义（均 P < 0.01 ）；血清尿酸和超敏C-反应蛋白水平与内-中膜厚度呈线性正相关关系（r = 0.923，P =0.000；r = 0.955，P = 0.008）。结论 血清尿酸和超敏C-反应蛋白参与了粥样硬化斑块的形成，并在不伴高血压等危险因素的腔隙性脑梗死首次发病机制中起重要作用。

关键词: 脑梗死；动脉硬化；颈动脉；尿酸；C反应蛋白质；超声检查, 多普勒

Abstract: Background Nowadays, clinical practice shows that the number of patients with cerebral infarction increases year by year in young and middle-aged adults with unclear causes. This paper aims to investigate the correlation between the level of serum uric acid (UA), high-sensitivity C-reactive protein (hsCRP) and the degree of carotid atherosclerosis by detecting the level of UA, hsCRP and carotid intima-media thickness (IMT) in young and middle-aged patients with lacunar infarct. Methods By using Holland Philips HT-11 color Doppler ultrasonic diagnostic apparatus with linear type probe and 7.50MHz frequency, IMT of end-diastolic distal and bifurcation of arteria carotis communis and proximal internal carotid artery were measured respectively on 186 patients with definitely diagnosed lacunar infarct. As a result, average values were taken as the IMT values. IMT < 1.00 mm was regarded as negative result and 1.00 mm ≤IMT < 1.20 mm was thickening of carotid artery intima. Carotid artery plaque formation was regarded with echo structure existing in the lumen or abnormal blood flow deficits into the lumen, or local IMT ≥1.20 mm at vertical and horizontal scan. At the same time, the levels of UA and hsCRP were detected, and correlation analysis was made between them and IMT. Results The values of UA, hsCRP and IMT in the case group were higher than that in the control group (P = 0.000). The differences among the case subgroups including IMT thickening group, plaque formation group and IMT normal group were statistically significant (P < 0.01, for all). There was linear correlation between the levels of UA, hsCRP and IMT ( r = 0.923, P = 0.000; r = 0.955, P = 0.008). Conclusion UA and hsCRP involve in the formation of atherosclerosis plaque and play an important role in the first-onset lacunar infarct patients without hypertension and other risk factors.

Key words: Brain infarction, Arteriosclerosis, Carotid arteries, Uric acid, C-reactive protein, Ultrasonography, Doppler