脑梗死与颈动脉粥样硬化斑块的相关性分析

目的探讨脑梗死与颈动脉粥样硬化斑块的相关性。方法对55例脑梗死病人进行颈动脉彩色多普勒超声检查,观察其斑块的部位、性质以及粥样硬化斑块的回声强度、部位、数目等。结果脑梗死病人颈动脉粥样硬化斑块检出率为85.5%;斑块的好发部位为颈总动脉分叉处、颈总动脉主干;复发性脑梗死病人颈动脉粥样硬化斑块检出率达100.0%;脑梗死病人的颈动脉粥样硬化斑块多为不稳定性斑块。结论脑梗死的发生与颈动脉粥样硬化斑块密切相关,不稳定性斑块是引起脑梗死的主要危险因素之一。     

颈动脉粥样硬化斑块与脑梗死的关系研究

目的探讨颈动脉粥样硬化斑块与脑梗死的关系。方法对246例脑梗死患者（脑梗死组）和218例非脑梗死患者（非脑梗死组）行颈动脉彩色多普勒超声仪检查,分析入组者年龄、性别、伴发疾病与颈动脉粥样硬化斑块发生率的关系,观察不同等级的斑块在各组中的分布。结果高龄、伴有高血压、糖尿病、高胆固醇症者颈动脉粥样硬化斑块的发生率明显增高;脑梗死组颈动脉粥样硬化斑块的发生率较非脑梗死组明显增加;有斑块组脑梗死发生率显著高于无斑块组。结论颈动脉粥样硬化斑块的形成与高龄、高血压、糖尿病、高胆固醇症等因素有关,颈动脉粥样硬化斑块是脑梗死的危险因素之一。     

脑梗死与颈动脉粥样硬化斑块的相关性分析

目的 探讨脑梗死与颈动脉粥样硬化斑块的相关性.方法 采用超声对47例脑梗死患者进行检查.观察其斑块的部位、性质、动脉管腔内径,并与39例对照组颈动脉粥样硬化斑块检出情况进行比较.结果 脑梗死组患者的颈动脉粥样硬化斑块多为不稳定性斑块,多以颈总动脉分又处居多,且与血脂水平相关(P<0.05).结论 脑梗死的发生与颈动脉粥样硬化斑块密切相关,颈动脉粥样硬化斑块的性质、分布与血脂水平有关,通过超声检查可以早期发现斑块的形成,对防止脑梗死的发生有非常重要的意义.     

彩超下颈动脉粥样硬化斑块与脑梗死的相关性分析

目的探讨彩超下颈动脉粥样硬化斑块与脑梗死的相关性。方法对70例脑梗死病人进行颈动脉彩色多普勒超声检查,观察颈动脉狭窄程度及斑块情况,并与非脑梗死患者进行比较。结果脑梗死病人颈动脉粥样硬化斑块检出率为82.9%,硬化斑块主要为溃疡斑和软斑,斑块的好发部位为颈总动脉分叉处。结论脑梗死发病与颈动脉粥样硬化斑块相关,不稳定性斑块是主要危险因素。     

颈动脉粥样硬化斑块与脑梗死关系的探讨

目的探讨颈动脉粥样斑块与脑梗死发生的关系。方法应用彩色多普勒超声对48例陈旧脑梗死患者检查颈动脉血流及粥样硬化(CAS)斑块形成情况,并与30名健康志愿者作为对照。观察两组研究对象血管狭窄和附壁粥样硬化斑块情况。结果48例脑梗死患者中,有颈动脉粥样硬化斑块者40例,占83．3%；对照组颈动脉管壁增厚及斑块形成10例,占33．3%,二者比较差异有非常显著性意义(P＜0．01)。结论脑梗死与颈动脉粥样硬化斑块有着密切关系,颈动脉彩色多普勒超声检查对颈动脉粥样硬化及斑块的检出有助于对脑梗死的预测和防治。     

超声检测颈动脉粥样斑块对脑梗死的预测和评价作用

目的研究脑梗死患者颈动脉粥样斑块的分布特点及超声类型及其在预测及评价脑梗死中的作用。方法对56例脑梗死患者（脑梗死组）和50例非脑梗死患者（对照组）的颈动脉用多普勒超声进行检测，比较两组患者颈动脉粥样斑块的情况。结果脑梗死组出现颈动脉粥样斑块44例（78．6％），明显多于对照组9例（18．0％），差异有统计学意义（P〈0．01）。结论脑梗死的发生与颈动脉粥样斑块密切相关，颈动脉粥样斑块可作为预测及评价脑梗死的重要指标。     

颈动脉粥样硬化斑块与急性脑梗死患者血脂、血压的相关性研究

目的 探讨颈动脉粥样硬化斑块与急性脑梗死患者血脂、血压的关系.方法 将123例急性脑梗死患者分为脑梗死合并高血压组与脑梗死组,并将51例年龄、性别匹配的健康体检者设为对照组.测量所有患者的血压、血脂,采用彩色多普勒超声检查急性脑梗死患者的颈动脉内膜-中层厚度(IMT)、斑块数量、部位.结果 高血压组颈动脉粥样硬化斑块的发生率达94.9%,发生率和IMT均明显高于脑梗死组和对照组(P＜0.05);斑块最好发的部位为颈总动脉分叉处(BIF),有颈动脉粥样硬化斑块者的血压、胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)均明显高于无粥样硬化斑块者(P＜0.05).结论 颈动脉粥样硬化斑块是脑梗死的重要危险因素之一,而高血压与高血脂是粥样硬化斑块形成的高危因素.     

彩色多普勒超声在脑梗死患者颈动脉病变中的应用价值

目的 应用彩色多普勒超声检查探讨颈动脉粥样硬化病变与脑梗死的关系及其超声表现特点.方法 对96例首次发病的脑梗死患者进行了颈动脉彩色多普勒超声检查.结果 96例脑梗死患者有颈动脉粥样硬化斑块形成者73例,检出率76.0%.颈动脉粥样硬化斑块好发于颈动脉分叉处.脑梗死患者常伴有颈动脉软斑、溃疡斑的存在.结论 颈动脉粥样硬化斑块与脑梗死有密切相关性.彩色多普勒超声可检测颈动脉粥样硬化斑块并判断斑块类型,同时判断斑块部位及颈动脉狭窄程度,对脑梗死发生的预测及临床早期干预有者重要临床价值.     

老年脑梗死患者颈动脉粥样硬化斑块及相关因素分析

目的探讨老年脑梗死患者颈动脉粥样硬化斑块的发生与相关因素的关系。方法应用HDI-5000彩色多普勒超声仪,分别对160例老年脑梗死患者(脑梗死组)和60例非脑梗死患者(对照组)的颈动脉进行检测,观察颈动脉粥样硬化斑块的发生及与血糖、血脂、血浆纤维蛋白原的关系。结果脑梗死组患者颈动脉粥样硬化斑块发生率为77.5%,对照组为20.0%,两组差异有统计学意义(P<0.01)。脑梗死组颈动脉粥样硬化斑块好发于颈总动脉分叉处。高血压、血脂异常、糖尿病、LDL升高、高纤维蛋白原是老年脑梗死颈动脉粥样硬化斑块形成的危险因素。结论对老年脑梗死患者进行颈动脉超声检查,及早发现颈动脉粥样硬化斑块并积极控制危险因素,对预防和治疗老年脑梗死具有重要意义。     

颈动脉粥样硬化斑块发病特征及与脑梗死的关系

目的　分析国人颈动脉粥样硬化 (CAS)斑块发病特征及与脑梗死的相关性。方法　应用磁共振血管成像技术对 10 5 8例怀疑脑部缺血或颈动脉病变患者进行颈动脉检测 ,评价粥样硬化斑块的发病部位、形态、大小与数目。结果　 10 5 8例患者中 198例经CT或磁共振成像证实为脑梗死 ,同时磁共振血管造影术检测到同侧CAS斑块 ;36例检测到CAS斑块 ,但未发现脑梗死灶 ;70例证实为脑梗死 ,但未检测到CAS斑块 ;790例梗死灶及粥样硬化斑块均未检测到。所有CAS患者 ,只累及 1段血管者 12 9例 ,累及多段血管者 10 5例 ,其中两侧颈动脉多发粥样硬化斑块并动脉狭窄 16例。 198例脑梗死患者 ,粥样硬化斑块多发生于颈总动脉分叉处 ,斑块累及多段血管。 36例无脑梗死患者 ,斑块多表现为浅小斑块 ,主要位于颈总动脉主干。结论　颈动脉粥样硬化斑块是脑梗死重要危险因素。     

红细胞膜总胆固醇含量——急性冠状动脉综合征的一个新型标志物

急性冠状动脉综合征是由于纤维斑块破裂引发冠状动脉内血栓而导致的。斑块破裂部分上取决于坏死的脂质中心的大小,而红细胞转运胆固醇进入坏死中心则有助于脂质中心的增长。现对急性冠状动脉综合征和红细胞膜胆固醇的含量之间的关系进行了综述,探讨了红细胞膜胆固醇影响斑块稳定性的机制。红细胞膜胆固醇水平不仅仅反映了冠状动脉疾病活动性,而且也是急性冠状动脉综合征强的预测因子。     

冠状动脉CT血管成像定量参数与老年冠心病患者病情严重程度的相关性

目的探讨冠状动脉CT血管成像定量参数与老年冠心病患者病情严重程度的相关性。方法回顾性分析在我院治疗的老年冠心病患者150例为观察组,同时收集健康志愿者150例为对照组,行冠状动脉CT血管成像检查,获取斑块及血管体积、斑块负荷、血管狭窄、血管重建等定量参数,分析定量参数与冠心病患者病情严重程度的相关性。结果与对照组比较,观察组斑块数[(2.43±0.53)个vs(0.82±0.32)个,P=0.000]、非钙化斑块体积[(321.84±124.92)mm^3 vs(125.83±43.28)mm^3,P=0.000]、钙化斑块体积[(43.28±12.84)mm^3 vs(12.74±4.39)mm^3,P=0.000]、总斑块体积[(365.12±109.85)mm^3 vs(138.57±40.92)mm^3,P=0.000]和重建指数(1.89±0.43 vs 1.12±0.24,P=0.000)等均显著增高。Pearson线性相关分析显示,斑块数、非钙化斑块体积、钙化斑块体积、总斑块体积、非钙化斑块负荷、钙化斑块负荷、总斑块负荷、血管狭窄程度与LVEF呈负相关(P<0.01),与平均室壁应力、左心室质量指数、左心室收缩末期容积、左心室舒张末期容积呈正相关(P<0.05,P<0.01)。结论冠状动脉CT血管成像定量参数与老年冠心病患者病情严重程度相关,可用于评估患者预后。     

冠状动脉CT血管造影综合评估易损斑块的进展

急性冠状动脉综合征（ACS）是以冠状动脉粥样硬化斑块破裂或侵袭,继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征。与稳定斑块相比,容易破裂的斑块具有明显的影像学特征：大斑块体积,低衰减斑块,餐巾指环标志,正性重构和点状钙化,这为在导致临床事件之前运用非侵入性成像识别易损斑块提供了独特的机会。随着影像技术的发展,冠状动脉CT 血管造影（CCTA）无创性评价冠状动脉易损斑块的作用已成为国内外研究热点。笔者就CCTA在评估冠状动脉斑块易损性方面的临床应用现状与进展等方面作一综述。     

Risk of thrombosis in human atherosclerotic plaques: role of extracellular lipid, macrophage, and smooth muscle cell content.

OBJECTIVE--To assess the size of the lipid pool and the number of smooth muscle cells and monocyte/macrophages in human aortic plaques that were intact and to compare the results with those in aortic plaques undergoing ulceration and thrombosis. DESIGN--The lipid pool was measured as a percentage of the total cross sectional area of the plaque. Immunohistochemistry was used to identify cell types (monocytes/macrophages (M phi) by EBM11 and HAM56, smooth muscle cells by alpha actin). The area of the tissue occupied by each cell type was measured by quantitative microscopy in the peripheral (shoulder) area of the plaque and the plaque cap. Absolute counts of each cell type were expressed as the ratio of SMC:M phi. MATERIAL--Aortas were obtained at necropsy from men aged less than 69 years who died suddenly (within 6 hours of the onset of symptoms) of ischaemic heart disease. 155 plaques from 13 aortas were studied. Four aortas showed intact plaques only (group A, n = 31). Nine aortas showed both intact plaques (group B, n = 79) and plaques that were undergoing thrombosis (group C, n = 45). RESULTS--In 41 (91.1%) of the 45 plaques undergoing thrombosis (group C) lipid pools occupied more than 40% of the cross sectional area of the plaque. Only 12 (10.9%) of the 110 intact plaques (groups A + B) had lipid pools of this size. The mean size of the lipid pool in plaques of groups A, B, and C was 12.7%, 27.3% and 56.7% respectively. Compared with intact plaques those undergoing thrombosis contained a smaller volume of smooth muscle cells (2.8% v 11.8%) and a larger volume of monocyte/macrophages (13.7% v 2.9%) in the plaque cap. The ratio of the number of smooth muscle cells to monocytes/macrophages was 7.8 in group A plaques, 4.1 in group B plaques, and 1.0 in group C plaques. This gradient was the result of an absolute increase in monocyte/macrophages and an absolute decrease in smooth muscle cells. CONCLUSIONS--In the aorta ulceration and thrombosis were characteristic of plaques with a high proportion of their volume occupied by extracellular lipid, and in which there was a shift toward a preponderance of monocyte/macrophages compared with smooth muscle cells in the cap.     

Changes in the proliferative activities of cells in experimental atherosclerotic plaques during remodeling

To investigate the relationship between cytologic alterations and cellular proliferation during atherosclerotic remodeling, we examined experimental atheromatous plaques by immunohistochemistry. Plaques were formed on rabbit aortas by cholesterol-enriched diets and mechanical stimulation over a period of 2 months. Plaques were examined 1 month and 6 months after induction. We used antibodies RAM-11, HHF-35, and monoclonal anti-proliferating cell nuclear antigen (PCNA) antibody for detection of macrophages (Mphi), smooth muscle cells (SMC), and PCNA, respectively. One month after induction, the plaques revealed a thickened intima with a fibrofatty histologic pattern or accumulation of foam cells. With either histologic pattern, foam cells were found to be Mphi and proliferative activity was mainly observed in Mphi. Six months after induction, calcification and organization were seen on the induced plaques, suggesting progression of remodeling. There were fewer Mphi and more SMC compared with plaques examined 1 month after induction. Proliferative activity was observed mainly in SMC. We have demonstrated that the proliferative activity of cell types changes during remodeling of atheromatous plaques. Our results suggest an important relationship between the proliferative activity of SMC and remodeling.     

冠状动脉CT成像与易损斑块

冠状动脉内斑块破裂或侵蚀所致的急性腔内血栓是急性冠状动脉综合征的主要原因。防止急性血栓形成成为了降低冠状动脉粥样硬化性心脏病病死率的唯一有效策略。斑块易破裂的冠状动脉病变与稳定斑块相比,存在不同的形态学改变。因此可以利用特殊的成像方法来识别这些易损斑块。亚毫米空间分辨率和图像质量优良的现代计算机断层扫描方法可以对冠状动脉斑块进行检测、分析和量化。斑块体积较大、低CT衰减、餐巾环征、正性重构以及点状钙化等与斑块容易破裂有密切关系。将冠状动脉斑块的形态学与功能特征等相结合,在未来有可能成为检测易损斑块的新方法。现将就多层螺旋CT与冠状动脉易损斑块的检测做一综述。     

Where is the trace? Molecular imaging of vulnerable atherosclerotic plaques

Serious cardiovascular events frequently arise from rupture of vulnerable atherosclerotic plaques. Not infrequently, these plaques are clinically silent and suddenly cause acute complications such as myocardial infarction, which in a high percentage are fatal. Thus, identifying individual patients with vulnerable plaques at high risk for plaque rupture is a central challenge in clinical medicine. This review highlights noninvasive scintigraphic techniques, which use radiolabeled molecules to detect functional aspects in atherosclerotic plaques by visualizing their biological activity. One major principle is the molecular imaging of inflammation with radionuclide tracers, including detection of metabolic activity, chemotaxis, cell recruitment, and lipoprotein enrichment. Additional studies focus on visualization of apoptosis, angiogenesis, or proteolysis. A central feature of plaque vulnerability is its thrombogenicity. Therefore, detection of thrombogenic plaques is another promising principle of molecular imaging. If a reliable protocol to image vulnerable plaques, which are prone to rupture, can be established and introduced into clinical practice, the required measures such as atheroprotective medication or revascularization could be undertaken to prevent serious cardiovascular events.     

氯吡格雷对兔主动脉球囊损伤后内膜增生的影响

目的观察氯吡格雷对家兔动脉球囊损伤后内膜增生的影响并探讨相关机制。方法将12只已通过球囊损伤主动脉内膜方法建立动脉粥样硬化斑块破裂的模型的成年雄性新西兰大白兔平均分成高胆固醇组和氯吡格雷组,另有6只健康成年雄性新西兰大白兔为对照组。测定各组家兔在主动脉内膜剥脱术前后的血清总胆固醇与甘油三酯水平,测定斑块内巨噬细胞及胶原含量变化,血浆中P-选择素的含量的变化,组织型纤溶酶原激活剂(t-PA)及纤溶酶原激活剂抑制物-1(PAI-1)活性的改变。测定血管内膜厚度及管腔狭窄度改变。结果斑块内巨噬细胞及胶原总平均值在高胆固醇组和氯吡格雷组明显高于对照组。在氯吡格雷组斑块内巨噬细胞的总平均值明显低于高胆固醇组,而斑块内胶原总平均值在氯吡格雷组高于高胆固醇组。氯吡格雷组在斑块破裂后P-选择素的含量较用药前明显降低,而高胆固醇组则明显升高。氯吡格雷组在斑块破裂后t-PA活性与用药前相比无明显变化,高胆固醇组明显下降。高胆固醇组在斑块破裂后PAI-1活性较用药前明显升高,氯吡格雷组在斑块破裂后PAI-1活性比用药前轻度下降。高胆固醇组和氯吡格雷组内膜均有不同程度增厚,但氯吡格雷组内膜及管腔狭窄度均明显低于高胆固醇组。结论氯吡格雷通过抑制血栓的形成和减少斑块内巨噬细胞的迁移和增殖来减轻动脉炎症反应,达到缩小动脉粥样硬化斑块面积、减轻内膜增生作用。     

Clinical imaging of the high-risk or vulnerable atherosclerotic plaque

The study of atherosclerotic disease during its natural history and after therapeutic intervention will enhance our understanding of disease progression and regression and aid in selecting appropriate treatments. Several invasive and noninvasive imaging techniques are available to assess atherosclerotic vessels. Most of the standard techniques identify luminal diameter, stenosis, wall thickness, and plaque volume; however, none can characterize plaque composition and therefore identify the high-risk plaques. We will present the different imaging modalities that have been used for the direct assessment of the carotid, aortic, and coronary atherosclerotic plaques. We will review in detail the use of high-resolution, multicontrast magnetic resonance for the noninvasive imaging of vulnerable plaques and the characterization of plaques in terms of their various components (ie, lipid, fibrous, calcium, or thrombus).     

320排动态容积CT冠状动脉成像对胸痛患者的诊断价值

目的探讨320排动态容积CT冠状动脉成像对胸痛患者冠状动脉狭窄病变及斑块性质的诊断价值。方法对38例因胸痛住院患者先行冠状动脉CT血管造影（CCTA）检查,其中符合冠心病诊断的30例患者于2周内再行冠脉造影（CAG）检查,分析CCTA对冠脉狭窄病变的诊断价值;将冠心病患者分为稳定性心绞痛（SAP）组和急性冠脉综合征（ACS）组,根据不同CT值,将冠状动脉斑块分为软斑块、混合斑块、钙化斑块3类,观察3类斑块在两组患者中的不同构成。结果以CAG为金标准,CCTA对冠脉狭窄诊断的敏感性为91.84%,特异性97.83%,阳性预测值93.75%,阴性预测值97.12%,正确率96.26%,两种检查方法在诊断冠状动脉狭窄病变上差异无统计学意义;两种检查方法对冠脉狭窄程度的判断具有较好一致性（Kappa值=0.829）;ACS患者以软斑块为主（55.9%）,而SAP患者以钙化斑块为主（65%）,差异有统计学意义。结论 CCTA能准确诊断有意义的冠状动脉狭窄病变,且对冠状动脉斑块性质的判断有一定意义,CT值较低的软斑块与ACS有联系。