目的：探讨急性脑梗死患者神经功能缺损与颈动脉粥样硬化斑块的关系。方法：选择2015年8月至2019年12月期间在上海交通大学医学院附属瑞金医院就诊的急性脑梗死患者1 022例,根据美国国立卫生研究院卒中量表（National Institute of Health stroke scale,NIHSS）评分将患者分为轻症组（n=572）和中重症组（n=450）。同时根据颈动脉彩色多普勒超声仪检查结果,分为无斑块组（n=365）和有斑块组（n=657）;并按斑块数量分为单发斑块组（n=249）、双发斑块组（n=91）和多发斑块组（n=317）,按回声特点分为稳定斑块组（n=316）和不稳定斑块组（n=341）。分析各亚组在NIHSS评分轻症组和中重症组的发生率差异。结果：无斑块组中轻症患者占71.8%（262/365）,有斑块组中轻症患者占43.1%（283/657）,2组比较差异有统计学意义（χ²=57.604,P<0.01）。单发斑块、双发斑块和多发斑块组间中重症患者所占比例差异有统计学意义（χ²=9.979,P=0.007）,中重症组不稳定斑块患者比例（57.4%）高于轻症组（45.8%）（χ²=8.738,P=0.003）。多因素Logistic回归分析结果显示,与无斑块组对照,有斑块组NIHSS评分>3分可能性是原来的3.691倍。结论：急性脑梗死患者神经功能缺损严重性与颈动脉粥样硬化斑块发生率、斑块数量及性质有关。

Objective To investigate the relationship between the neurological deficit and carotid atherosclerotic plaque in patients with acute cerebral infarction(CI). Methods From August 2015 to December 2019, 1 022 patients with CI were selected from Ruijin Hospital. According to National Institute of Health stroke scale(NIHSS) score, the patients were divided into mild group(n=572) and moderate to severe group(n=450). Meanwhile, according to carotid color Doppler ultrasound, all patients were divided into non-carotid plaque group(n=365) and carotid plaque group(n=657). Furthermore, the carotid plaque group was divided into single plaque group(n=249), double plaque group(n=91) and multiple plaque group (n=317) based on the number of plaques, and according to the echo characteristics and the plaque stability, the plaque group was divided into stable plaque group (n=316) and unstable plaque group (n=341). The difference of the incidence of carotid plaque between the mild and moderate to severe group was analyzed. Results There were 71.8%(262/365) mild patients in the non-plaque group and 43.1%(283/657) mild patients in the plaque group. There was significant difference between the two groups（χ²=57.604, P<0.01）. There was significant difference in the proportion of moderate to severe patients among single plaque, double plaque and multiple plaque groups（χ²=57.604, P<0.01). The proportion of unstable plaque in the moderate to severe group（57.4%） was higher than that in the mild group(45.8%). Multivariate Logistic regression analysis showed that the possibility of NIHSS>3 in the plaque group was 3.691 times higher than that in non-plaque group. Conclusions The severity of neurological deficit in patients with acute cerebral infarction may be related to the incidence of carotid atherosclerotic plaques, the number and character of plaques.