彩色多普勒超声诊断颈动脉粥样硬化斑块病人与血脂改变的相关性分析

目的 探讨彩色多普勒超声诊断颈动脉粥样硬化斑块与病人血脂改变的相关性。方法 研究100例彩色多普勒超声诊断颈动脉粥样硬化斑块病人的斑块特点、血液动力学改变及病人血脂分析。结果 超声检查100例颈动脉粥样硬化斑块好发于分叉部，有颈动脉粥样硬化斑块的病人血液生化检查甘油三脂升高42例，占42％，总胆固醇（CHOL）升高31例，占31％。结论 彩色多普勒超声诊断颈动脉粥样硬化斑块及对心脑血管疾病临床诊断有重要价值。     

小剂量阿托伐他汀钙对血脂及颈动脉斑块的影响

目的观察小剂量阿托伐他汀钙(10 mg/d)对无症状颈动脉斑块患者血脂及斑块的影响。方法选取2008年10月—2010年10月在我科住院患者78例,经颈动脉彩超证实有颈动脉斑块,分别于治疗前、治疗后3、6、12个月测定血脂及颈动脉斑块情况,并观察终点事件及不良反应情况。结果治疗3个月起血胆固醇、低密度脂蛋白、三酰甘油明显降低,6个月起高密度脂蛋白明显升高,与治疗前比较差异有统计学意义(P<0.01或0.05)。斑块面积从治疗6个月起,较治疗前明显减少,至治疗12个月与治疗前比较,差异有统计学意义(P<0.05)。治疗后斑块总数有减少趋势,稳定斑块逐渐增多,不稳定斑块逐渐减少,但与治疗前比较,差异无统计学意义(P均>0.05)。治疗过程中未发生严重副反应。结论 10 mg/d阿托伐他汀钙能够显著改善无症状颈动脉斑块患者血脂及颈动脉硬化的程度。     

颈动脉粥样斑块与脑梗塞的关系

目的研究颈动脉粥样斑块性状和部位与脑梗塞的关系.材料和方法回顾性分析86例脑梗塞彩色多普勒超声检测颈动脉相关数据.结果本组颈动脉粥样斑块发生率为82.6%.双侧颈动脉受累及一条血管多个斑块及各型斑块并存多见,颈总动脉(CCA)分叉处发生率最高.高血压合并脑梗塞组舒张末期血流速度(EVD)较正常人组明显下降(P＜0.05).颈动脉IMT及粥样斑块指数与脑梗塞相关因素呈正相关,软斑及合并溃疡的混合斑是脑梗塞主要的栓子来源之一.结论颈动脉超声能显示动脉粥样斑块的相关物理特性,对脑梗塞的疗效观察与预测具有十分重要的意义.     

彩色多普勒超声诊断颈动脉斑块171例分析

脑血管疾病是我国当前中老年人群的常见病、多发病,严重者极易引起脑卒中,甚至危及生命。众所周知,动脉粥样硬化是引起脑血管疾病的重要原因之一。因此,早期发现动脉硬化,尽早对危险因素进行有效干     

脑梗死患者颈动脉狭窄和粥样硬化斑块的超声研究

目的:探讨脑梗死与颈动脉粥样硬化斑块和颈动脉狭窄的关系,以期为脑梗死的临床早期防治提供客观依据.方法:分析我院138例脑梗死患者的颈动脉彩色多普勒超声检查结果,另选取138例同期住院或门诊非脑梗死患者作为对照.比较研究两组颈动脉斑块性质和颈动脉狭窄程度.结果:梗死组合并糖尿病、高血压、高脂血症、冠心病的患者明显多于对照组.梗死组出现多个颈动脉斑块的病例数明显多于对照组,且颈动脉不稳定斑块,如脂质性软斑、扁平斑和溃疡性斑块均明显多于对照组(P＜0.05).梗死组双侧和单侧颈动脉管腔狭窄明显多于对照组,且梗死组颈动脉中度和重度狭窄明显增多(P＜0.05).结论:颈动脉不稳定斑块和中重度狭窄是脑梗死的重要危险因素.     

颈动脉斑块患者血液流变学指标变化探讨

颈动脉斑块形成是动脉硬化的明显特征,可作为观察全身动脉硬化病变的窗口。近年来,颈动脉斑块发病率越来越高,有关这方面的文献报道也较多。颈动脉位置表浅、运动较少,又是动脉粥样硬化的好发部位,故此处的粥样斑块比较容易检测。本研究随机抽取了2005年12月～2007年10月我院住院患者249例,分析其颈动脉病变的超声检查结果与血液流变学指标,探讨颈动脉硬化、斑块形成与血液黏度的相关性。     

超声检查颈动脉内中膜厚度及斑块与缺血性脑卒中的相关性分析

目的 探讨分析超声检查颈动脉内中膜厚度(IMT)及斑块与缺血性脑卒中的相关性.方法 此次研究,选择我院2020年1月至12月期间,收治的50例缺血性脑卒中患者,纳为研究组,并选择同一时间本院非心脑血管疾病志愿者50例,纳为对照组,对两组进行超声检查,并对检查结果进行对比和分析.结果 研究组患者IMT增厚率、以及斑块形成...     

颈动脉粥样硬化患者斑块稳定性与血脂水平的相关性研究

目的观察不同类型颈动脉粥样硬化斑块患者血脂水平的变化及与斑块稳定性的相关性。方法70例伴有颈动脉粥样斑块的患者根据超声斑块形态分为易损斑块（vulnerable plaque,VP）组30例和稳定斑块（stable plaque,SP）组40例,另选50例无斑块者（NCP）为对照组,分别测定血脂水平的含量。结果与无斑块组比较,有斑块组血总胆固醇（TC）、低密度脂蛋白（LDL-C）较无斑块组显著增高,有显著差异（P〈0.05）;与稳定斑块组比较,易损斑块组血总胆固醇（TC）、低密度脂蛋白（LDL-C）明显增高,有显著差异（P〈0.05）。结论血总胆固醇（TC）、低密度脂蛋白（LDL-C）在颈动脉粥样硬化患者中有明显变化,血总胆固醇（TC）、低密度脂蛋白（LDL-C）与患者斑块稳定性相关。     

彩色多普勒超声对脑梗死患者颈动脉粥样硬化斑块诊断价值

目的探讨彩色多普勒超声对脑梗死患者颈动脉粥样硬化斑块的临床诊断价值。方法选取自2015年6月至2016年6月青海福利慈善医院收治的50例脑梗死患者纳入梗死组,另选同期健康体检者50名纳入对照组,应用彩色多普勒超声检查两组的颈动脉粥样硬化斑块、颈动脉狭窄、左颈动脉内膜-中层厚度(IMT)、各段动脉的峰值流速(PSV)、舒末流速(EDV)及阻力指数(RI)的变化情况。结果梗死组和对照组的斑块检出率分别为68%和32%,两组比较,差异有统计学意义(P<0.01)。梗死组颈动脉粥样硬化斑块的类型主要为软斑和混合斑,对照组主要以硬斑多见。梗死组颈动脉狭窄共33例,其中,轻度狭窄20例、中度狭窄10例、重度狭窄3例;对照组颈动脉狭窄共10例,其中,轻度狭窄9例,中度狭窄1例。梗死组左侧、右侧的IMT均显著高于对照组,两组比较,差异有统计学意义(P<0.05)。梗死组的血流参数PSV、EDV、RI均明显低于对照组,两组比较,差异有统计学意义(P<0.05)。结论彩色多普勒超声检测脑梗死患者颈动脉粥样硬化斑块,可以直接显示其血管内膜厚度、粥样斑块的类型、管腔狭窄程度等,为脑梗死的诊断和治疗提供依据。     

彩色多普勒超声对颈动脉粥样硬化斑块的诊断价值及临床研究

颈动脉粥样硬化病变常可导致脑部供血异常,是引起缺血性脑病的重要原因,粥样斑块或血栓的脱落则引起脑梗死,严重者可引起脑卒中.二维彩色多普勒超声不仅能够较为准确地判断颈动脉狭窄的程度和范围,而且可以判断斑块的形态、性质以及血流动力学改变,为临床医生提供治疗依据.     

超声造影成像技术评价脑梗死患者颈动脉斑块新生血管与血脂的相关性

目的探讨超声造影成像技术评价急性脑梗死患者颈动脉斑块内新生血管及其与血脂指标的关系。方法选取急性脑梗死伴颈动脉粥样斑块的住院患者106例(脑梗死组),无临床脑梗死表现的颈动脉粥样斑块患者40例(非脑梗死组),经超声造影检查获得斑块的造影参数并进行定量分析,检测两组患者血脂指标包括:三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)并进行比较。结果脑梗死组超声造影增强率为81.1%,明显高于非脑梗死组的40.0%(P<0.01),峰值强度比值(P)、曲线下面积(AUC)明显高于非脑梗死组,达峰时间(Tp)小于非脑梗死组(P<0.05)。两组血脂指标中TG、TC、LDL有统计学差异(P<0.05)。两组中,有增强病例LDL指标均高于无增强病例(P<0.05)。脑梗死组血脂指标与超声造影参数的相关性分析显示,TG与P、Tp、AUC、平均渡越时间(MTT)均明显相关(P<0.01),LDL与P、AUC明显相关(P<0.01),与Tp、MTT无明显相关(P>0.05),TC、HDL与超声造影参数无明显相关(P>0.05)。结论超声造影能方便地检测斑块内新生血管并进行定量分析,可以灵敏、客观地反映斑块的稳定性,对客观地预测和评价脑梗死的发生具有重要的临床价值。     

颈动脉易损斑块与颈动脉支架置入术后30天不良事件的相关性

目的探讨颈动脉易损斑块与颈动脉支架置入（CAS）术后30 d不良事件的相关性。 方法回顾性分析57例接受CAS的患者临床资料,分为稳定斑块组（A组,19例）及易损斑块组（B组,38例）,比较两组的基本资料及术后30 d发生不良事件的情况,多因素Logistic回归分析斑块稳定性与术后30天不良事件的关系。 结果57例患者术后30 d发生不良事件10例（17.54%）,其中稳定斑块组1例,易损斑块组9例,其中缺血性脑血管事件（短暂性脑缺血发作、脑梗塞）4例（7.01%）。术后严重不良事件3例（3/57,5.26%）均为B组患者,其中急性脑梗塞2例,颈动脉溃疡斑块破裂渗血1例。多因素Logistic回归分析显示：年龄≥65岁（OR=18.789,95%CI =1.648～214.220,P=0.018）、易损斑块（OR=21.806,95%CI= 1.278～372.177,P=0.033）及应用开环型支架（OR=14.645,95%CI= 1.407～152.417,P=0.025）为CAS术后30 d发生不良事件的危险因素。 结论CAS术后30 d不良事件发生率较高与易损斑块有关。     

肺炎衣原体、幽门螺杆菌及C反应蛋白与颈动脉粥样硬化斑块稳定性的相关性研究

组(P<0.01),不稳定性CAP组两种抗体的阳性率及hs-CRP水平均显著高于稳定性CAP组(P<0.01);混合感染(两种抗体均阳性)者不稳定性CAP的发病率明显高于单独感染(仅一种抗体阳性)者(P<0.01),单独感染者不稳定性CAP的发病率明显高于无感染者(P<0.01),且hs-CRP水平随病原体感染种类的增加而增高(P<0.05).结论 CAP患者CP和HP的感染率较正常人高,混合感染者不稳定CAP的发病率较单独感染高,hs-CRP水平与病原体感染种类的多少相关.     

MR plaque imaging of the carotid artery

Atherosclerotic carotid plaque represents a major cause of cerebral ischemia. The detection of vulnerable plaque is important for preventing future cardiovascular events. The key factors in advanced plaque that are most likely to lead to patient complications are the condition of the fibrous cap, the size of the necrotic core and hemorrhage, and the extent of inflammatory activity within the plaque. Magnetic resonance (MR) imaging has excellent soft tissue contrast and can allow for a more accurate and objective estimation of carotid wall morphology and plaque composition. Recent advances in MR imaging techniques have permitted serial monitoring of atherosclerotic disease evolution and the identification of intraplaque risk factors for accelerated progression. The purpose of this review article is to review the current state of techniques of carotid wall MR imaging and the characterization of plaque components and surface morphology with MR imaging, and to describe the clinical practice of carotid wall MR imaging for the determination of treatment plan.     

Relationship between intracranial internal carotid artery calcification and enlarged cerebral perivascular space

Purpose

The association between intracranial internal carotid artery (IICA) calcification and lacunes, white matter hyperintensity (WMH), and cerebral microbleeds (CMBs) has been well researched. However, enlarged cerebral perivascular space (PVS) has not yet been reported to correlate with intracranial internal carotid artery calcification. Therefore, the primary aim of this study was to investigate the relationship between IICA calcification and enlarged PVS.

Methods

A total of 189 patients with ischemic stroke in the middle cerebral artery territory who presented within 7 days of ictus from 2012 to 2015 were enrolled respectively. All patients were required to have undergone head computed tomography, magnetic resonance imaging, susceptibility-weighted magnetic resonance imaging, magnetic resonance angiography, or computed tomography angiography. Clinical characteristics were recorded. IICA calcification and enlarged PVS were semi-quantitatively evaluated, and the presence of lacunes, WMH, and CMBs was recorded.

Results

Of the 189 patients, 63.5% were male. Mean age of the patients was 68.6 ± 12.2 years. There were 104 patients with IICA calcification. Age, diabetes mellitus, lacunes, and white matter hyperintensity were significantly associated with IICA calcification (P < 0.05). Multivariate logistic regression analysis showed that age, diabetes mellitus, and lacunes were independent predictors of IICA calcification (P < 0.05). A lower risk of IICA calcification was found in patients with a higher enlarged PVS score (P = 0.004).

Conclusion

Higher enlarged PVS scores were associated with a lesser degree of IICA calcification. There appears to be a relationship between reduced risk of IICA calcification and enlarged PVS.

     

Agreement between multi-detector-row CT angiography and US-ECD in quantification of carotid artery stenosis and plaque characterization

Purpose

The purpose of this work was to evaluate the agreement between ultra-sound echo-color Doppler (US-ECD) and multi-detector-row CT angiography (MDCTA) in the quantification of carotid artery stenosis as well as plaque characterization.

Materials and methods

From January 2012 to January 2013 forty-five patients who underwent both MDCTA and US-ECD for the study of carotid arteries, were evaluated (33 males, 12 females; age range 43–70 years; mean age of 59.6 years). For all subjects the following parameters were analyzed: stenosis degree by using the NASCET method, plaque morphology (regular versus irregular), type of the plaque (fatty, mixed and calcified) and presence of ulcerations. Statistical analysis was performed to calculate concordance between the two techniques employed.

Results

The agreement observed in the quantification of carotid artery stenosis was 94.4% with a kappa value of 0.9306 (95% confidence interval of 0.8612–1.0). In the definition of the type of plaque, the observed agreements were 91.1% and the kappa value was 0.8815 (95% confidence interval: 0.7920–0.9709). In the definition of plaque ulceration, the observed agreements were 88.4% but the kappa value was only 0.325 (95% confidence interval: 0.201–0.449). Agreement observed in the evaluation of plaque morphology was 78.3% with a kappa value of 0.513 (95% confidence interval: 0.452–0.574).

Conclusion

We observed a good agreement between US-ECD and MDCTA in the quantification of carotid artery stenosis and the assessment of plaque type. There was, however, a poor agreement in the evaluation of plaque ulceration. The use of US-ECD and MDCTA provides different results in the evaluation of plaque. Our results suggest that information derived from US-ECD should be always critically compared with other diagnostic techniques.     

2型糖尿病患者血清IGF-1水平与颈动脉粥样斑块的相关性研究

目的探讨2型糖尿病(T2DM)患者血清胰岛素样生长因子-1(IGF-1)水平与双侧颈动脉粥样硬化斑块的相关性。方法应用超声检测186例患者双侧颈动脉内膜-中膜厚度,根据超声检查结果将其分为:(1)A组(颈动脉粥样硬化斑块阳性的T2DM患者)96例;(2)B组(颈动脉粥样硬化斑块阴性的T2DM患者)90例。并采用免疫放射分析法检测两组患者的血清IGF-1水平。结果 A组患者的血清IGF-1水平与B组比较显著降低,差异有显著统计学意义(P<0.01);T2DM患者血清IGF-1水平与双侧颈动脉粥样斑块的程度呈显著负相关(r=0.649,P<0.01)。结论 IGF-1参与了T2DM大血管病变的发生、发展,IGF-1水平与颈动脉粥样斑块程度密切相关。     

MR imaging in carotid artery atherosclerosis plaque characterization.

AIM: To evaluate the potential role of carotid artery atherosclerosis plaque magnetic resonance (MR) microimaging as magnetic resonance imaging (MRI) marker, ex vivo MR images were acquired at optimized parameters on 9.4T Bruker animal imager for occluded tissue resected by carotid endarterectomy (CEA) and corresponding histopathological analysis was made. METHODS AND MATERIALS: For imaging, CEA tissues of size 2-6 cm long and 0.5-1.5 cm wide, were transferred to 15 ml co-polymer laboratory culture tubes containing either 10% formalin in phosphate buffered saline (PBS) or in 50% glycerol in PBS. Imaging protocol was set at TE=30 ms, TR=1.5 s, matrix size=265 x 512, NEX=128, slice thickness=1 mm and in-plane resolution=0.1 mm for total sample size 2.5 cm. Soon after imaging done, carotid artery tissues were cut into 5-mm segments and processed for histological section for successive 5-micrometer slices. To compare morphology of 5 mum thin CEA section with that of 1 mm MR slices, registration was obtained between histologic sections and MR slices. Contrast and magnetic resonance relaxation characteristics were analyzed. RESULTS: Total carotid artery area computed by MR imaging was correlated with areas determined from histologic sections (r(2)=0.989, p=0.0001). For the lumen area, the correlation between MR images and histologic area was (r(2)=0.942, p=0.0001). Relaxation times and T(2) parametric images of different plaque components were determinant for contrast resolution. Scan parameters were optimized for fibrous cap and atheroma. Scan parameters were characteristic for comparison at 1.5T and 9.4T MR imagers. CONCLUSION: The observed correlation validated MR microimaging to assess morphological features of carotid artery plaques and contrast resolution highlighted the potential of in vivo MR imaging as non-invasive MRI marker to monitor carotid artery plaque morphometry and plaque composition.     

颈动脉硬化斑块与脑梗死的相关性研究

目的 :探讨超声检测到的颈动脉硬化斑块与脑梗死的相关性。方法 :收集超声检查的120例脑梗死患者和同期住院的120例非脑梗死患者,对2组患者颈动脉内中-膜厚度、斑块检出率、斑块特性及分布情况、颈动脉狭窄率等结果进行对比分析。结果:脑梗死组内-中膜局限性增厚检出率显著高于非梗死组(90.8%vs.61.7%,P0.001);脑梗死组颈动脉硬化斑块检出率高于非脑梗死组(68.3%vs.56.7%,P0.05);脑梗死组颈动脉管腔狭窄率≥50%的患者高于非脑梗死组(89.2%vs.35.0%,P0.001)。脑梗死组斑块以软斑为主,非脑梗死组以硬斑为主;脑梗死组软斑检出率高于非脑梗死组(58.5%vs.36.8%,P0.05)。结论:颈动脉粥样硬化是脑梗死的重要危险因素,超声评估颈动脉粥样硬化对预测脑梗死的发生有一定价值。