妊娠期高血压和子痫前期患者颈总动脉内中膜厚度与弹性相关性研究

目的：本研究旨在探讨妊娠期高血压和子痫前期患者颈总动脉内中膜厚度（IMT）与弹性的相关性。方法：妊娠期高血压组32例,子痫前期组26例,同期正常妊娠者40例作为对照组。应用内中膜分析技术（QIMT）和动脉僵硬度分析技术（QAS）对所有受检者右侧颈总动脉进行检查。获得颈总动脉的IMT、顺应性系数（CC）、扩张性系数（DC）和僵硬度系数（β）。结果：妊娠期高血压组、子痫前期组和对照组的β差异有统计学意义（P<0.05）,对照组<妊娠期高血压组<子痫前期组。妊娠期高血压组、子痫前期组和对照组的CC、DC两项指标差异有统计学意义（P<0.05）,对照组>妊娠期高血压组>子痫前期组。子痫前期组的IMT高于妊娠期高血压组和对照组,差异有统计学意义（P<0.05）,妊娠期高血压组和对照组的IMT差异无统计学意义（P>0.05）。妊娠期高血压和子痫前期患者的IMT与β呈明显正相关（r=0.86,P=0.000）,与CC、DC呈明显负相关（r=－0.81,r=－0.76,P=0.000）。结论：妊娠期高血压和子痫前期患者的颈总动脉的弹性已发生明显改变,且子痫前期患者颈总动脉的IMT也发生明显改变。妊娠期高血压和子痫前期患者颈总动脉的IMT与弹性存在明显相关性。     

超声造影评价颈总动脉内中膜厚度的研究

目的 探讨超声造影在颈总动脉前、后壁内中膜厚度(IMT)测定中的应用价值.方法 在二维和超声造影模式下,观察颈总动脉前、后壁内中膜显示清晰程度,分别测量颈总动脉内径,前、后壁IMT值.结果 造影后颈总动脉前壁内中膜显示满意率有明显提高(P＜0.01);造影前、后颈总动脉后壁内中膜显示满意率没有明显差异(P＞0.05);造影后颈总动脉内径值大于造影前颈总动脉内径值(P＜0.05);造影后前壁IMT值大于造影前前壁IMT值(P＜0.01);造影后后壁IMT值小于造影前后壁IMT值(P＜0.01).结论 超声造影可以明显提高颈总动脉前壁内中膜显示满意率.     

高脂血症与颈总动脉内中膜厚度的相关研究

目的探讨脑梗塞患者高脂血症与颈总动脉内中膜厚度（IMT）之间关系。方法随机选择不同程度脑梗塞患者219例,常规进行血脂三项指标（TCH、TG、LDL）检查,根据结果将其分成三组,组1：血脂三项指标均正常。组2：血脂三项指标中有任意二项不同程度增高。组3：血脂三项指标均明显增高。然后分别行彩色多普勒超声检测和颈总动脉内中膜厚度及是否有斑块形成,最后用统计学多种方法分析高脂血症与IMT厚度及动脉硬化斑块之间关系。结果219例脑梗塞患者中,组1（50例）,IMT≤1．0,斑块形成2例。组2（81例）．1．0〈IMT≤1．3,斑块形成57例,组3（88例）,IMT≥1.3,全部患者均有斑块形成。结论高脂血症是致颈总动脉内中膜增厚的主要因素,是斑块形成的基础,是诱发心脑血管疾病的根源。     

超声回声跟踪技术联合高频超声评价血脂对类风湿性关节炎颈总动脉病变的影响

目的 探讨超声回声跟踪(ET)技术联合高频超声评价不同血脂水平的类风湿性关节炎(RA)患者颈动脉病变的价值.方法 选取47例符合2010年ACR/EULAR新分类标准的RA患者,根据血脂水平分为高血脂组20例和血脂旨正常组27例.应用高频超声及ET技术对RA高血脂组、RA正常组及47例健康成人(对照组)进行双侧颈总动脉内-中膜厚度(IMT)、动脉斑块情况及动脉血管压力-应变弹性系数(Eρ)及硬度指数(β)僵硬度参数的测量.结果 RA高血脂组颈总动脉IMT异常及斑块发生率均高于RA血脂正常组及对照组(均P＜0.05);而RA血脂正常组与对照组间IMT异常及斑块发生率均无明显差异.RA高血脂组颈总动脉僵硬度参数Eρ及β均高于RA血脂正常组及对照组(均P＜0.05),而RA血脂正常组颈总动脉Eρ及β亦明显高于对照组(P＜0.05).Eρ、β均与IMT呈正相关,其相关系数r分别为0.679及0.706(均P＜0.001).结论 高频超声及ET技术均能够准确反映不同血脂水平对RA患者颈总动脉IMT、斑块发生率及僵硬度的影响,为临床中RA患者动脉粥样硬化的早期诊断提供了新方法.     

彩色多普勒超声评价颈总动脉壁厚度及血管阻力指数与代谢综合征患者急性心肌梗死发生的关系

目的应用彩色多普勒超声评价颈总动脉壁厚度及血管阻力在预测代谢综合征(MS)患者急性心肌梗死(AMI)发生中的作用。方法 102例MS患者中合并AMI者57例,未合并AMI者45例。彩色多普勒超声观察颈总动脉(CCA)内膜-中层厚度(IMT)、外膜厚度(AT)及阻力指数(RI),分析评价上述指标与MS患者AMI发生的关系及与其他AMI危险因素间的相关性。结果 MS合并AMI组较MS未合并AMI组IMT和AT显著升高(P<0.01,P<0.05),且与AMI发生密切相关(P<0.01,P<0.05);AMI组IMT及AT阳性率高于RI(P<0.001),非AMI组IMT阳性率高于AT及RI(P<0.005)。AMI组IMT与收缩压、餐后2h血糖及血清纤维蛋白原(FIB)水平呈正相关(r=0.830,r=0.835,r=0.753,P均<0.001),与高密度脂蛋白胆固醇水平(HDL-C)呈负相关(r=-0.840,P<0.001);AT与FIB呈正相关(r=0.828,P<0.001),与HDL-C呈负相关(r=-0.798,P<0.001);RI与HDL-C呈负相关(r=-0.671,P<0.001)。结论同时测量MS患者CCA的IMT及AT可提高早期预测AMI的准确性,为及时采取防治措施提供了超声学依据。     

颈总动脉中膜厚度与脑梗死之间关系的研究

近几年来脑血管病的发病有逐年增高的趋势,而缺血性脑血管疾病占脑血管病的80％～85％,其发病率高,致残率高,严重地影响着中老年人的身体健康。许多研究表明,大部分缺血性脑血管病的病因是由于颅外段动脉狭窄而不是颅内段动脉的直接狭窄造成的。颈部血管超声的应用就很好的解决了通过对颈动脉硬化的动态观察,对分析脑梗死形成的原因有很大的作用。颈动脉硬化出现的内-中膜增厚及动脉粥样硬化斑块的形成是造成脑血管供血不足甚至是脑梗死的常见病因。本研究应用彩色多普勒超声诊断仪检测颈动脉内-中膜厚度（intima-media thickness,IMT）探讨IMT与脑梗死之间的关系。     

高频超声评价原发性高血压患者肱动脉内皮功能及颈动脉内中膜厚度

目的：高频超声评价原发性高血压（EH）患者肱动脉内皮功能、颈动脉内中膜厚度,并观察斑块发生率。方法：将102例EH患者按病程分为2组,病程<5年为A组,病程>5年为B组,正常对照组52例,用高频超声测量反应性充血时肱动脉内皮依赖性舒张功能（EDD）及颈动脉内中膜厚度（IMT）,观察斑块情况,并检查血清总胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）。结果：A组EDD低于对照组（P<0.01）,B组TC、TG、LDL及IMT、斑块发生率均高于A组及对照组,而EDD减低（P<0.05）,A组斑块发生率高于对照组（P<0.05）,并且斑块发生率为软斑>混合斑>硬斑,B组中IMT与LDL、病程呈正相关（r=0.631,P<0．01;r=0.646,P<0．01）,EDD与LDL、病程、IMT呈负相关（r=-0.681,P<0．05;r=-0.591,P<0．05;r=-0.673,P<0．05）。结论：EDD技术能方便、快捷、无创评价EH患者早期血管内皮功能的变化,LDL升高、IMT增厚与病程延长及EDD降低关系密切,这些结果提示随着病程的延长,LDL升高,动脉内皮功能逐渐减退,进一步导致IMT增厚,动脉粥样硬化逐渐加重,斑块发生率为软斑>混合斑>硬斑。EDD可以作为EH患者独立预测因子。     

颈总动脉内中膜增厚患者低壁面剪应力分布的探讨

目的 采用血流剪应力可视化定量分析软件,分别测定健康人和内中膜增厚患者的颈总动脉壁面剪应力(wall shear stress,WSS),分析WSS的空间分布规律.方法 提取50例健康人(健康组)和50例内中膜增厚患者(增厚组)颈总动脉彩色多普勒血流图像DICOM文件,运用血流剪应力可视化定量分析软件绘制颈总动脉WSS二维空间分布图、三维空间分布图和WSS数据,进行图像和数据分析.结果 健康组WSS的变化范围在4～14 dyn/cm2之间(1 dyn=10 5N),增厚组WSS的变化范围在2～6dyn/cm2之间.增厚组WSS平均值[(2.87±0.59)dyn/cm2]显著低于健康组[(6.91±1.20)dyn/cm2],差异具有统计学意义(t=17.828,P=0.000).结论 内中膜增厚患者颈总动脉局部产生了低WSS区,说明局部血流动力学的改变引起的WSS降低与颈总动脉内中膜增厚有关.     

射频数据处理技术定量评价健康人颈总动脉内-中膜厚度和血管弹性的研究

目的 应用高频超声射频数据处理(ultrasound radio-frequency data,RF-data)技术定量检测健康人颈总动脉内-中膜厚度(intima-media thickness,IMT)和血管弹性,确定相关参数的正常值范围.方法 对160例健康人根据年龄分为4组(30～39岁,40～49岁,50～59岁,60～69岁),每组40例,男性20例,女性20例;RF-data技术获取健康者双侧颈总动脉IMT、颈总动脉扩张性(CD)、单点脉搏波传播速度(PWVβ)、僵硬度(β),并分析各参数之间及与年龄、性别的关系.结果 ①IMT、PWVβ和β与年龄呈显著正相关,CD与年龄负相关;IMT、CD、PWVβ和β与性别相关性不显著;②IMT与PWVβ、β呈显著正相关,而与CD相关性不显著;PWVβ与β显著正相关,而与CD显著负相关;③随着年龄的增加,IMT亦随之增高(P＜0.05).在30～39岁、40～49岁组中,随年龄增加PWVβ增高,而CD减低明显(P＜0.05);50～59岁组PWVβ和β增高显著(P＜0.05);在60～69岁组,随年龄增加CD、PWVβ、β差异无统计学意义.④CD、PWVβ和β的正常值在60～69岁组分别为(329.39±102.06)μm、(7.22±1.91)m/s和10.04±4.91,而在＜60岁者随年龄不同而异.结论 RF-data技术能够准确检测颈总动脉IMT和血管弹性,根据年龄确立正常值范围,为临床定量评估血管性能提供新的手段.     

高血压患者颈总动脉壁面剪应力与颈动脉内-中膜厚度的关系

目的探讨高血压患者颈总动脉壁面剪应力（WSS）与颈总动脉内中膜厚度（IMT）的关系及其WSS的分布。方法选取42例健康者（对照组）和83例高血压患者颈动脉的彩色多普勒血流图像,其中高血压患者依颈总动脉IMT分为IMT正常组（33例）和IMT增厚组（50例）,采用血流WSS可视化定量分析软件绘制颈总动脉WSS三维空间分布图,分析高血压患者颈总动脉WSS的空间分布特点。结果高血压组无论IMT是否增厚,其颈总动脉WSS均比对照组低,差异有统计学意义（P〈0.05）。IMT增厚组颈总动脉WSS较IMT正常组低[（2.87±0.59）dynes/cm2 vs.（4.26±1.18）dynes/cm2,P〈0.05]。高血压患者IMT增厚组中IMT与WSS呈负相关（r=-0.76）。结论高血压患者在IMT增厚前颈总动脉WSS已开始下降,WSS可成为动脉粥样硬化早期病变的监测指标。     

Measurement of intima-media thickness of common carotid arteries with high-resolution B-mode ultrasonography: inter- and intra-observer variability

High-resolution B-mode ultrasonography enables quantitative measurement of the thickness of the intima-media layer of superficial large arteries noninvasively. We investigated the inter- and intra-observer variability of this measurement in the common carotid arteries in 10 randomly selected men. The maximal right and left carotid intima-media thickness (IMT) was measured with calipers during the scanning from frozen images by four observers in a blinded fashion. Three observers also repeated the scanning and the measurements twice with a week's intervals, with no knowledge of the previous readings. The inter-observer coefficient of variation (CV) was 10.5%. The intra-observer CV (mean of right and left CCA) was 5.4-5.8% for the three observers who carried out the measurements three times. The mean absolute difference between the first and third measurement was 0.087 mm. The intra-observer variation accounted for only 4% of the total measurement variability, 96% being attributable to inter-observer variation. These data show that most of the measurement variability in ultrasonographic B-mode IMT measurements is due to differences between observers, whereas the within-observer variability over time appears proportionately very small.     

Factors affecting intima-media thickness in carotid arteries in diabetes mellitus of the young

The aim of the work was to measure intima-media thickness IMT), study lipid and carbohydrate metabolism and factors contributing to the development of vascular complications in type 1 and 2 diabetes mellitus (DM) of the young. It included 63 patients aged 18-40 years (40 with DM1 and 13 with DM2). Glycated hemoglobin was measured on a AzSYM immunoenzyme analyzer, lipid metabolism studied using a Cobas Integra 400 Plus analyzer, and IMT estimated based on the ultrasound technique (Volision--750 Exert with 10 MHz sensors). Patients with DM of the young showed higher IMT values than age-matched healthy subjects. IMT tended to increase after the age of 33 years and with duration of DM. DM did not cause a decrease of blood HDL levels. Smoking had negative effect on the vascular wall in DM patients.     

应用QIMT及QAS技术对中青年高血脂患者颈总动脉结构和功能的评估

目的 探讨超声射频信号血管内中膜分析(QIMT)技术及血管硬度定量分析(QAS)技术评价中青年高血脂患者颈总动脉内-中膜厚度(IMT)和血管弹性改变及血脂与血管弹性的关系.方法 分别获取70例高血脂组患者颈总动脉IMT和颈总动脉血管僵硬度参数:脉搏波传播速度(PWV)、僵硬度(β)、顺应性系数(CC),并与健康对照组进行对比分析.结果 高血脂组颈总动脉IMT、PWW、β高于对照组,CC低于对照组,差异有统计学意义(P<0.05),IMT、PWV及β数与总胆固醇呈正相关,相关系数分别为0.8102、0.8401及0.9492(P<0.001);CC与总胆同醇呈负相关,相关系数为-0.9391(P<0.001).结论 QIMT及QAs技术能够自动、实时、准确检测高血脂患者颈总动脉IMT和血管弹性的变化,可为临床评价动脉结构和功能提供较为准确的定量指标.     

The influence of obesity on the assessment of carotid intima-media thickness

BACKGROUND.: The assessment of carotid intima-media thickness (CIMT) may improve cardiovascular risk prediction. The optimal protocol for CIMT measurement is unclear. CIMT may be measured in the common carotid artery (CCA), carotid bifurcation (CB), and internal carotid artery (ICA), but measurements from CB and ICA are more difficult to obtain. We studied the influence of body mass index (BMI) and atheroma plaques on the capacity to obtain CIMT measurements at different carotid sites. METHODS.: Using an automatic system, CIMT was measured in 700 subjects aged 45-75, in the near and far walls of CCA, CB, and ICA bilaterally. The presence of atheroma plaques, BMI and vascular risk factors were recorded. RESULTS.: CIMT measurements in CCA were possible in all except one subject. It was not possible to obtain CIMT measurements at CB or ICA in 24.1% of normal weight and 58.8% of obese subjects. The likelihood of obtaining CIMT measurement at all carotid sites decreased as the BMI increased. Atheroma plaques in a carotid segment did not preclude CIMT measurement at this site. CONCLUSIONS.: CIMT measurements in distal carotid segments are more challenging in obese subjects. Measuring CIMT at CCA remains feasible in obese subjects and should be the primary endpoint in these subjects. Nevertheless, CB and ICA measurements, when feasible, would improve risk classification. ? 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:479-485, 2012.     

颈动脉内中膜厚度和血流剪切力的相关性研究

目的:探讨颈动脉内中膜厚度(IMT)和血流剪切力的关系。资料和方法:采用高分辨力声像仪测量20例健康人颈动脉内中膜厚度,其中男10例,女10例,平均年龄(34.3±10.6)岁。同时测量该处血管的血流剪切力(τm),具体计算公式:τm=η×4×VmFD。通过直线相关分析判定内中膜厚度和血流剪切力的关系。结果:20例健康人平均内中膜厚度为(0.68±0.06)mm,相应的平均血流剪切力为(12.2±3.4)dynesFcm2,二者呈明显负相关(y=0.8174-0.0117xr,=-0.67)。结论:本研究表明颈动脉内中膜厚度和血流剪切力呈负相关,证实血流剪切力可影响颈动脉内中膜厚度的变化,对预测早期动脉粥样硬化有一定意义。     

Calcium distribution in the vessel wall and intima-media thickness of the human carotid arteries

Increased common carotid artery (CCA) intima-media thickness (IMT) measured by B-mode ultrasound is an early marker of the atherosclerotic process. Arterial calcification is not clearly understood. Using the particle-induced X-ray emission (PIXE) method, we have looked for the location in the artery wall where calcium accumulated in the early phase of atherosclerosis. Twelve segments of CCAs of deceased stroke patients were investigated. In-vivo, carotid duplex ultrasound was performed with bilateral CCA IMT measurement at plaque-free sections. During autopsy, segments of carotid arteries were collected and filled under pressure with a stained histologic embedding material. The frozen arteries were cut into 60-microm-thick slices. Calcium distribution maps from the segments of arteries were determined by PIXE method. IMT measured by ultrasound and calcium distribution maps measured by PIXE were compared. In our cross-sectional study, using the PIXE analysis and ultrasound images, we could demonstrate early calcium accumulation in the media layer. Our results have also shown a significant relationship between calcium content of distributional maps measured by PIXE analysis and corresponding IMT on B-mode ultrasound images of human CCAs.     

颈总动脉内膜中膜厚度与脑梗死复发的关系

目的:探讨颈总动脉内膜中膜厚度(CCA-IMT)与脑梗死复发的关系。方法:连续收集急性脑梗死住院患者265例,通过颈动脉彩超检查CCA-IMT,随访观察有无脑梗死复发。结果:随访12个月内,265例脑梗死患者中有25例(9.4%)复发脑梗死,复发与无复发脑梗死患者间总胆固醇、低密度脂蛋白胆固醇、空腹血糖和CCA-IMT水平差异有显著性(P<0.05)。把两组间存在显著差异的指标引入Logistic回归方程,结果显示CCA-IMT是脑梗死复发的独立危险因素。结论:CCA-IMT是脑梗死复发的独立危险因素。