末梢動脈閉塞と虚血性脳卒中との関連

Peripheral arterial disease(PAD) is associated with coronary artery disease(CAD) and stroke, but data on the relationship between PAD and acute ischemic stroke are lacking. Therefore, we investigated this relationship. A total of 101 patients were enrolled on admission to Harasanshin General Hospital(Fukuoka, Japan) with their first ischemic stroke. All 101 patients underwent　cranial CT and/or brain magnetic resonance imaging, duplex ultrasonography of the extracranial carotid arteries, and transthoracic echocardiography. The subjects were aged 41 to 92 years. PAD was present in 81/101 patients(80.2%), including 57/73(78.1%) with small artery occlusion, 11/13(84.6%) with large artery occlusion, and 13/15(86.7%) with cardiogenic 　embolism. In 42 of these 81 patients (51.9%), PAD was asymptomatic. Serum apoprotein A1 levels were significantly higher and the intima-media thickness was significantly greater in the patients with PAD than in those without PAD. The modified Rankin scale score was significantly higher　on admission in patients with PAD than in those without PAD. Stepwise logistic regression analysis revealed that the apoprotein A1 level and the modified Rankin　scale score on admission were strongly associated with the occurrence of stroke in　patients with PAD. Our results suggest that PAD is frequently associated with acute ischemic stroke. It may be important to perform screening for PAD in patients who have suffered an ischemic stroke.【目的】脳血管障害における末梢動脈閉塞(PAD)の関与を明らかにするために, 虚血性脳卒中を対象に末梢動脈閉塞合併率および動脈硬化の危険因子を検討した. 【方法】対象は平成14年7月から平成15年12月まで原三信病院救急外来に救急搬送された虚血性脳卒中と診断された70例(平均年齢71歳)である. NINDS(1990年)の分類に従ってラクナ脳梗塞(LAC), アテローム血栓性脳梗塞(ATI), 心原性脳梗塞(CE)に分けた. 採血, 心電図, 頭部CT, MRI・MRA, 超音波(頸動脈, 心 ,下肢動脈), 下肢造影MRA, フォルム(ABI/baPWV), ホルター心電図等の検査を施行. 下肢造影MRA, 下肢動脈エコーで閉塞あるいは有意狭窄を認め, かつABI<0.9, 動脈触知不良, 自覚症状のうち2つ以上を満たすものをPADと診断した. 【結果】PADの合併は, 70例(83.3％)と高率にみられ, 病型別では, LACで51例(72.8％), ATIで7例(10.0％), CEで12例(17.2％)であった. Fontaine分類では, I度が38例(58.5％), II度が29例(41．0％)でIII度が3例(0.5％)と, 半数以上がI度の無症候性のPADであった. ABIはPAD群で1.09±0.13と非PAD群(1.15±0.08)比較し, 低値傾向を示すも有意差は認めなかったが, baPWV, IMTはPAD群が非PAD群と比較し有意に高値を示した. 血清CRP, D-D, 及びTATでは有意差は認めなかったが, PAD群で高値を示し, HDL-CはPAD群が非PAD群と比較し有意に低値を示した. modified Rankin Scaleは入院時(3.21 vs 2.64)及び退院時(1.96 vs 1.78)のいずれもPAD群が高値傾向を示した. 【考察】虚血性脳卒中にPADを合併した場合, 機能予後や生命予後に悪影響を及ぼす可能性があり, PADを早期診断をすることが重要であると考えられた