【摘要】 目的运用基于症状（symptoms）、狭窄（stenosis）、斑块（plaque）和颅内代偿（collateral compensation）的颈动脉新型分级体系SSPC的四维度评价方法 ，评价在颈动脉狭窄患者的预后判断及血运重建获益中的作用。方法 回顾性收集2013年1月至2017年12月复旦大学附属华山医院和复旦大学附属浦东医院诊断为颈动脉狭窄的945例患者资料。入组患者根据治疗方式分为血运重建组（514例）和最佳药物治疗组（best medical therapy,BMT）组（431例）。比较患者的基线情况、临床和病变特征、SSPC分级和随访5年的预后情况，利用Kaplan-Meier生存曲线分析计算患者免于卒中率。结果血运重建组患者中，10.3%被分类为SSPCⅡ级，41.4%为SSPCⅢ级，45.1%为SSPCⅣ级，而BMT组患者19.7%被分类为SSPCⅡ级，49.2%为SSPCⅢ级，13.2%为SSPCⅣ级。颈动脉SSPCⅢ级患者接受血运重建和BMT的5年卒中发生率分别为2.3%和5.1%，差异有统计学意义（P=0.023）。血运重建组5年免于卒中发生率为（94.1±1.1）%，而BMT组为（89.5±1.6）%，差异有统计学意义（P<0.001）。两组无症状颈动脉狭窄患者在免于卒中发生率方面差异无统计学意义（P=0.091），而在被分类为SSPCⅢ级的无症状患者中，血运重建和BMT之间的5年免于卒中发生率存在显著差异[（96.0±2.0）%比（89.1±2.4）%,P=0.041]。结论 颈动脉SSPC分级体系能够通过多维度的颈动脉狭窄卒中风险分层，以提供更合适的治疗策略，丰富颈动脉的治疗指征。更多还原

【Abstract】 Objective To use the four-dimensional evaluation method of the new carotid artery grading system based on symptoms, stenosis, plaque and collateral compensation(SSPC) to evaluate the prognosis and revascularization benefits for patients with carotid artery stenosis. Methods The clinical data of 945 patients diagnosed with carotid artery stenosis in Huashan Hospital Affiliated to Fudan University and Shanghai Pudong Hospital, Fudan University from January 2013 to December 2017 were collected retrospectively. The cohort were divided into the revascularization group(514 cases) and the best medical treatment(BMT) group(431 cases) according to treatment methods. Baseline conditions, clinical and lesion characteristics, SSPC grade and 5-year follow-up prognosis were compared, and Kaplan-Meier curve analysis was used to calculate the patients’ stroke survival rate. Results Among the patients in the revascularization group, 10.3% were categorized as SSPC grade Ⅱ, 41.4% as SSPC grade Ⅲ and 45.1% as SSPC grade Ⅳ, while 19.7% of the patients in the BMT group were categorized as SSPC gradeⅡ, 49.2% as SSPC grade Ⅲ and 13.2% as SSPC grade Ⅳ. The 5-year stroke incidence rates of patients with carotid SSPC grade Ⅲ who underwent revascularization and BMT were 2.3% and 5.1%, respectively, and the difference was statistically significant(P=0.023). The 5-year freedom from stroke rate in the revascularization group was(94.1±1.1)%, while that in the BMT group was(89.5 ±1.6)%. The difference was statistically significant(P<0.001). There was no statistically significant difference in freedom from stroke between the two groups of patients with asymptomatic carotid stenosis(P=0.091), whereas in asymptomatic patients classified as SSPC grade Ⅲ, there was a significant difference in the incidence of freedom from stroke [(96.0±2.0)% vs(89.1 ±2.4)%, P =0.041]. Conclusion The SSPC grading system for carotid artery can provide more appropriate treatment strategies and enrich carotid artery treatment indications through multi-dimensional carotid artery stenosis and stroke risk stratification.更多还原