颈动脉粥样硬化与缺血性脑梗死的关系

目的探讨颈动脉粥样硬化与缺血性脑梗死的关系。方法彩色多普勒超声对80例缺血性脑梗死患者的颈动脉进行检测。结果74例脑梗死患者颈动脉有不同程度的粥样斑块形成,斑块以低回声软斑为主,所以软斑是脑梗死的主要栓子来源。结论彩色多普勒超声可检测颈动脉粥样硬化程度,提示同侧缺血性脑梗死的危险性,为缺血性脑血管疾病的预防和治疗提供可靠依据。     

缺血性中风与颈动脉粥样硬化的超声随访研究

颈动脉粥样硬化对缺血性中风的发生起着重要作用。颈动脉粥样硬化与缺血性中风发生率之间关系的估价对缺血性中风发病机理的研究和缺血性中风预防都有重要意义。该研究应用超声显示颈动脉粥样硬化严重程度来预测将来发生缺血性中风的危险率。 使用7.5MHzB型多普勒超声检查214名日本病人颈动脉狭窄和溃疡斑块程度,以此评估颈动脉     

消栓颗粒在颈动脉粥样硬化斑块治疗中的疗效观察

目的 探讨消栓颗粒对颈动脉粥样硬化斑块的干预效果。方法 收集广西贵港市中西医结合骨科医院神经内科确诊为颈动脉粥样硬化斑块的患者共175例为研究对象,采取随机分组法分成观察组和对照组,每组均给予阿司匹林肠溶片100 mg/d+阿托伐他汀钙片20 mg/晚口服,而观察组在上述基础上加用消栓颗粒口服,治疗前、后进行颈动脉超声检测,检测颈动脉粥样硬化内-中膜厚度(IMT)和斑块面积大小,并随访至6个月。结果 观察组在降低IMT、缩小主要斑块面积和改善颈动脉狭窄方面均优于对照组; 经随访半年未发现新发缺血性脑血管事件。结论 消栓颗粒有较好的抗颈动脉粥样硬化作用,与阿司匹林肠溶片、阿托伐他汀钙联合应用可以取得叠加效果,即能更好地改善颈动脉粥样硬化,促进斑块消退,降低动脉狭窄率,对减少脑血管事件的发生获益。     

斑块内新生血管分级与颈动脉粥样硬化程度相关性的新进展

颈动脉粥样硬化是导致缺血性事件发生的重要危险因素。颈动脉斑块负荷及颈动脉狭窄均与缺血性事件发生密切相关,此外,颈动脉斑块内成分也与缺血性事件发生息息相关。斑块内新生血管（intraplaque neovascularization,IPN）作为易损斑块的特征成分,通过多种机制参与颈动脉粥样斑块形成。本篇综述重点关注IPN分级与颈动脉粥样硬化程度的关系。     

颈动脉粥样硬化斑块的稳定性与缺血性脑血管疾病危险因素的相关研究

目的探讨颈动脉粥样硬化斑块稳定性与缺血性脑血管病危险因素的相关性。方法选取2010年10月-2010年12月在广州军区武汉总医院住院的缺血性脑血管病患者203例为研究对象,应用颈动脉彩色多普勒超声技术检查颈动脉粥样硬化斑块的大小、数目及性质,并评估研究对象脑梗死危险因素,行Logistic回归分析。结果脑梗死危险因素包括性别、年龄、吸烟、高血压、糖尿病、冠心病与高血压性心脏病、低密度脂蛋白、脂蛋白(a)、纤维蛋白原、超敏C反应蛋白及高同型半胱氨酸,均与颈动脉粥样硬化不稳定斑块的形成相关(P<0.05)。并且年龄、糖尿病、冠心病与高血压性心脏病、低密度脂蛋白、纤维蛋白原、同型半胱氨酸等脑梗死危险因素可纳入Logistic回归方程,为颈动脉粥样硬化不稳定斑块形成的独立危险因素。结论年龄、糖尿病、冠心病与高血压性心脏病、低密度脂蛋白、纤维蛋白原、高同型半胱氨酸等缺血性脑血管疾病危险因素是导致颈动脉粥样硬化不稳定斑块形成的独立危险因素。     

缺血性脑血管病的颈动脉超声检查与脑血管造影对比研究

目的对比颈动脉超声检查与脑血管造影在缺血性脑血管病中的诊断效果。方法选取60例疑似缺血性脑血管病患者,均接受颈动脉超声检查及脑血管造影诊断,分析诊断结果。结果颈动脉超声检查发现颈动脉粥样硬化斑块患者49例,检出率81.67%(49/60);多发斑块检出率明显高于单发斑块,混合斑块发生率明显高于硬斑和软斑,差异均有统计学意义(P0.05);斑块分布以颈动脉窦处最多,其次为颈动脉起始处,颈动脉主干最少;脑血管造影检出动脉粥样硬化56例,检出率93.3%(56/60);以脑血管病造影为金标准,颈动脉超声检查敏感性、特异性及准确度分别为91.8%、63.3%、86.7%。结论颈动脉超声在缺血性脑血管病诊断中具有较高的敏感性、特异性及准确度,能准确显示斑块分布及性质,可提高诊断准确性,但必要时需联合脑血管造影诊断。     

颈动脉粥样硬化斑块与新生血管的相关性研究进展

缺血性卒中最常见的病因是动脉粥样硬化,颈动脉粥样硬化斑块的破裂可导致卒中事件 的发生。斑块内的复杂结构特征与斑块的易损性相关。斑块内新生血管是斑块发展和不稳定性增加 的危险因素之一。因此,正确认识斑块内新生血管的病因和发病机制,以及与斑块稳定性之间的关 系,有利于早期发现颈动脉粥样硬化并正确评估其稳定程度及破裂风险,对于预防和治疗卒中具有 重要意义。     

颈动脉粥样硬化斑块易损性的影像评价研究进展

缺血性脑卒中是脑血管疾病的严重形式,具有极高的致残率和致死率.颈动脉粥样硬化斑块形成是缺血性脑卒中的重要病因,其易损性与缺血性卒中的发生明显相关.近年来,专家对颈动脉粥样硬化斑块的易损性进行了一些研究,现将相关影像学方面的研究进展综述如下.     

颈部血管彩超评价缺血性脑血管病的临床意义

目的探讨颈部血管彩色超声对缺血性脑血管疾病的临床意义。方法选取40例缺血性脑血管疾病患者为研究组,选取同期40例非缺血性脑血管疾病患者为对照组,对2组患者进行颈部血管彩超检查,观察检查结果。结果研究组颈动脉粥样硬化斑块检出率达100.0%。对照组为15.0%,研究组明显高于对照组(P0.05)。研究组颈动脉狭窄程度检出率87.5%,对照组为10.0%,研究组明显高于对照组(P0.05)。结论临床对缺血性脑血管疾病患者应用颈部血管彩色超声可以较好对颈动脉狭窄进行诊断,对预防或治疗缺血性脑血管疾病具有重要的临床意义。     

超声弹性成像技术诊断脑梗死患者颈动脉粥样硬化斑块稳定性的临床价值

目的探讨超声弹性成像技术在评估急性脑梗死患者颈动脉粥样硬化斑块稳定性中的临床价值。方法选择符合标准的患者60例,行颈动脉超声常规检查及超声弹性成像检查,将不同性质斑块的弹性评分及弹性应变率比值进行比较,分析其相关性。结果 54例患者发现颈动脉粥样硬化斑块,其中低回声斑块62个,混合回声斑块44个,强回声斑块17个。颈动脉粥样硬化低回声、混合回声及强回声斑块弹性评分比较,差异有统计学意义(P0.05)。颈动脉粥样硬化低回声斑块B/A比值1.86±0.63,混合回声斑块B/A比值7.61±2.80,强回声斑块斑块B/A比值40.41±5.90,差异有统计学意义(P0.05)。颈动脉粥样硬化斑块类型与弹性评分、斑块类型与B/A比值、弹性评分与B/A比值间的相关性分析,均存在相关性(P0.05)。结论超声弹性成像技术可反映脑梗死患者颈动脉粥样硬化斑块的硬度,不同组织声学特性斑块的弹性应变率不同,为斑块稳定性的评估提供重要信息。     

颈动脉粥样硬化斑块进展与脑缺血事件相关性的影像学研究进展

颈动脉粥样硬化斑块进展是导致缺血性脑血管事件的重要病理生理过程。斑块进展可 表现为管壁增厚、管腔狭窄或闭塞、脂质核增大、斑块内出血、纤维帽破裂等特征。随着血管影像技 术的发展,以评价斑块进展为目的的前瞻性研究越来越广泛。大量研究表明,斑块进展与未来脑血 管事件的发生显著相关。本文将对评价斑块的影像学方法的可重复性以及斑块进展与未来脑血管 事件相关性影像学研究进展进行综述,旨在更好地理解脑血管病的发病过程,并为疾病的预防提供 重要依据。     

Carotid atherosclerotic wall imaging by MRI

High spatial resolution magnetic resonance imaging (MRI) is one of the most promising modalities for visualizing the carotid atherosclerotic plaque. MR allows direct visualization of the diseased vessel wall, is capable of characterizing plaque morphology, and can potentially monitor progression of the disease. Though ultrasound and angiography have been the principal methods for determining the severity of carotid atherosclerosis and the need for endarterectomy, these methods only measure percentage of vessel stenosis. There is strong evidence that this is not the best indicator for assessing clinical risk. Improved imaging techniques are therefore needed to reliably identify the high-risk plaques that lead to cerebrovascular events. This article focuses on the current state-of-the-art in MR carotid atherosclerotic plaque imaging to evaluate plaque morphology and composition.     

颈动脉超声对冠状动脉粥样硬化性心脏病合并缺血性脑血管疾病患者颅内动脉狭窄性病变的预测价值

目的探讨颈动脉超声评价冠状动脉粥样硬化性心脏病(CAD)合并缺血性脑血管(ICVD)患者颅内动脉狭窄性病变的预测价值。方法对209例经血管造影证实冠状动脉狭窄(≥70%)同时合并缺血性脑血管疾病的患者采用彩色多谱勒超声(CDFI)和经颅多普勒超声(TCD)分别检查颈动脉和颅内动脉,并将患者分为脑动脉狭窄组与非狭窄组,分别比较两组患者颈动脉超声检查结果中差异有统计学意义的指标。结果颈动脉球部内-中膜(IMT)增厚、不均质回声斑块、多发斑块、颈动脉狭窄与CAD患者合并颅内动脉狭窄性病变之间具有良好的相关关系,(P<0.05)。结论颈动脉内膜增厚、不均质回声斑块,多发斑块、颈动脉狭窄与CAD合并ICVD患者颅内动脉狭窄性病变之间有明显的相关性。采用CDFI对冠状动脉狭窄的患者进行颈动脉检测,在心脑血管事件高危人群中进行筛选,对临床诊断与治疗具有重要的指导意义。     

颈动脉超声对冠状动脉狭窄患者缺血性脑血管疾病的评价及其与传统危险因素的关系

目的探讨颈动脉超声对预测冠状动脉狭窄患者颅内动脉狭窄的价值,以及颈动脉超声相对于其它动脉粥样硬化主要危险因素预测缺血性心脑血管疾病的优越性。方法对209例经血管造影证实冠状动脉狭窄(≥70%)的患者采用彩色多谱勒血流成像(CDFI)和经颅多普勒超声(TCD)分别检查颈动脉和颅内动脉,并将患者分为颈动脉狭窄组与非狭窄组;脑动脉狭窄组与非狭窄组,分别比较狭窄组与非狭窄组之间的危险因素及生化指标,进一步对冠状动脉狭窄合并颅内动脉狭窄的主要危险因素与颈动脉超声结果中具有显著性统计学意义的指标,分析二者之间的相关性。结果颈动脉超声对缺血性心脑血管疾病的预测价值较传统的危险因素更高。结论高血压病、颈动脉球部内膜增厚、多发斑块及不均质回声斑块对冠状动脉狭窄患者颅内动脉狭窄有明显的促进作用。采用CDFI对确诊冠状动脉狭窄患者进行检测,对心脑血管事件高危人群进行筛选、评价治疗疗效和预后具有重要意义。     

颈动脉超声造影与人血浆脂蛋白相关磷脂酶A_2在动脉粥样硬化性脑梗死预后判定中的应用

目的探讨颈动脉彩色超声造影和人血浆蛋白相关磷脂酶A2(Lp-PLA2)在动脉粥样硬化血栓性脑梗死(ATCI)诊断和预后判定中的应用价值。方法利用彩色超声造影技术对30例ATCI患者和30例TIA患者的颈动脉斑块进行评估,采用增强免疫比浊法测定Lp-PLA_2含量,并与30例健康者进行比较。结果 (1)ATCI组和TIA组患者的颈动脉稳定粥样斑块发生率和颈动脉内-中膜厚度比较均无统计学意义(P0.05),但均高于正常对照组(P0.05);3组不稳定斑块发生率和Lp-PLA_2水平比较均有统计学意义(P0.05)。(2)ATCI组中随着患者NIHSS评分的增加,颈动脉不稳定斑块的发生率和Lp-PLA_2水平均随之升高(P0.05)。结论颈动脉斑块的性质和Lp-PLA_2与ATCI有一定的相关性;Lp-PLA_2能较准确地反映颈动脉斑块的稳定性,两种检查相联合可在一定程度上预测ATCI患者的预后。     

Unstable Carotid Plaque is Associated With Coagulation Function and Platelet Activity Evaluated by Thrombelastography

Background: Rupture of unstable carotid plaque and consequently occlusive thrombus formation for the most part cause ischemic cerebral vascular event. Many researchers have been studying on the risk predictors of carotid plaque formation. But the risk factors for unstable carotid plaque have not been researched for so much. In the current study, we aimed to evaluate the association of coagulation function and carotid plaque especially unstable plaque by thrombelastography (TEG). Methods: This was a cross-sectional study. Consecutive eligible patients with acute ischemic stroke were included and their TEG data were collected. Carotid plaque was evaluated by carotid ultrasound. Echolucent plaque and heterogeneous echo plaque in ultrasound were classified as unstable carotid plaque. Patients were classified according to being with carotid plaque or unstable plaque for comparison. Results: Four hundred and seven patients were enrolled. Compared to those without carotid plaques, patients with carotid plaques had higher ages, higher incidence of hypertension and diabetes mellitus, lower k (P = .017) and higher angle (P = .021) on TEG. In the comparison between groups with unstable plaque and stable plaque, no significant difference was found in baseline characteristics; higher serum fibrinogen and higher maximum amplitude on TEG were significantly correlated to unstable carotid plaques (P = .051, P = .009). Multivariate logistic analysis revealed that age, hypertension, and smoking were independent risk factors of carotid plaques formation; higher serum fibrinogen was an independent risk factor of unstable plaques formation. Conclusions: This study demonstrates that carotid plaques formation in ischemic stroke patients has a link to abnormal coagulation function, while high platelet activity has an additional contribution to unstable plaque formation.     

急性缺血性脑血管综合征患者颈动脉粥样硬化斑块类型与巨细胞病毒激活感染的相关性分析

目的:探讨急性缺血性脑血管综合征(acute ischemic cerebro vascular syndrome,AICS)患者颈动脉粥样硬化斑块类型与巨细胞病毒激活感染的相关性。方法:急性缺血性脑血管综合征病人220例,对照人群组138人,将286例颈动脉超声的资料输入智睿电子信息技术有限公司的超声统计软件对其数据进行统计,测定外周血白细胞的人巨细胞病毒PP65抗原(Human cytomegalovirus pp65antigens)统计学方法采用SPSS13.0统计软件,各类型斑块与HCMV-PP65之间进行单因素卡方检验,结果:各类型斑块分别与正常人组各类型斑块两两之间进行的有关HCMV-PP65比较的单因素卡方检验结论提示:扁平斑组(8(53.3%)、P=0.000)、软斑组(29(39.2%)、P=0.000)、硬斑组(13(21.7%)、P=0.041)与正常人组均有统计学差异;各类型斑块间两两比较,除扁平斑组与软斑组间无统计学差异(χ2=1.027,P=0.311)外,其余各斑块组之间均有统计学差异。说明软斑组、扁平斑组、硬斑组的斑块形成均与HCMV-PP65有关,其中软斑组、扁平斑组与HCMV-PP65的相关性,较硬斑更为密切。结论:AICS患者颈动脉的易损性斑块与巨细胞病毒的激活感染密切相关,为该病的诊断和治疗提供新的线索。     

颈动脉超声对缺血性脑卒中的诊断及预后评估的价值

目的探讨颈动脉超声对缺血性脑卒中的诊断及预后评估的价值。方法选取来我院就诊的资料完整的缺血性脑卒中患者112例(卒中组),并选取同期健康体检者96例为对照组,行颈动脉超声检查,获取IMT、PSV、RI,并观察是否有颈动脉斑块及斑块性质。分析2组间各超声参数的差异,并行NIHSS、mRS评分及观察血管事件发生率,与超声参数进行比较。结果卒中组IMT、RI均较对照组明显增高(t=9.71、4.69,P=0.00),PSV较对照组减低(t=6.94,P=0.00)。卒中组斑块及易损斑块发生率较对照组明显增高(χ2=36.37、5.93,P=0.00、0.01)。随着NIHSS评分、mRS评分及血管事件发生率的增加,颈动脉的IMT、PSV、RI及斑块发生率差异均无统计学意义(P0.05)。但易损斑块发生率在不同NIHSS评分、mRS等级及血管事件发生率间差异有统计学意义(P0.05)。结论 IMT厚度、PSV、RI、是否存在颈动脉斑块及易损斑块对缺血性脑卒中有一定诊断价值,其中是否存在易损斑块与脑卒中患者病情程度及预后相关。     

B-mode ultrasound and spiral CT for the assessment of carotid atherosclerosis

More studies on the natural history of carotid artery plaques are needed to predict more reliably which plaque types or features are the most dangerous (see Table 2). Studies on carotid and coronary endarterectomy specimens indicate a dynamic process of rupture, thrombus formation, healing, and remodeling of the plaque. A plaque from a symptomatic patient may not show any signs of plaque rupture if the plaque has healed or evolved since the debut of symptoms. Selection of high-risk symptomatic patients with carotid atherosclerosis for medical or surgical treatment requires reliable, noninvasive, and cost-effective imaging methods. B-mode ultrasonography can be used for detection of early (IMT) as well as late (plaque morphology) atherosclerotic disease. Plaque morphology evaluation on spiral CT imaging is only for research and not yet for clinical use. Asymptomatic patients with carotid atherosclerosis hardly benefit from surgical treatment, as the minimal decrease in ischemic stroke risk is almost equal to the risk of perioperative stroke or death. A high degree of carotid stenosis measured using conventional angiography is an accepted risk factor for stroke but does not identify all vulnerable plaques. Echolucency on ultrasound B-mode imaging can be included as an important parameter in this risk stratification, as it appears to predict rupture-prone, lipid-rich plaques in the mild to severely stenotic carotid artery of a symptomatic patient. The subjective evaluation of plaque morphology on B-mode ultrasound should be complemented or substituted with objective evaluation such as videodensitometric analysis. This method is commercially available and is a relatively cheap and investigator-independent solution, but more studies are required to determine the exact contribution of echolucency to stroke risk. Furthermore, the evaluation of plaque morphology using ultrasound B-mode is still subject to large variations and observer-dependence, limiting its clinical use. In contrast, carotid IMT measurements are reliable to monitor progression and regression of early carotid disease as well as the impact of interventions. This method, however, suffers when used in severely diseased vessels where the boundaries of the IMT complex are hard to distinguish in all segments of the artery. Spiral CT imaging is a preliminary test for plaque characterization, as it primarily identifies calcification but not the more relevant lipid component. Moreover, it is time and resource demanding and involves use of both contrast and radiation, increasing the risk of allergic events and cancer. Standardization and continuous quality control are important, as are consensus agreements on how to quantify lesions (especially IMT), calibrate and standardize B-mode images and outline the plaque, and analyze data. The development of imaging methods for atherosclerotic research is currently fast and promising. This progress is most necessary, considering the very high demands for surrogate endpoints and risk markers in clinical intervention studies. Whether ultrasonic plaque characterization can be implemented in broad general clinical practice, for example, in screening of individuals at high risk of developing atherosclerosis and ischemic events, has to be based upon data from large prospective studies with long-term follow-up. IMT is already used in population screening, as in the ARIC study [9,101].     

基于人工智能斑块分割超声图像的影像组学在颈动脉斑块稳定性评估中的应用

目的 探讨基于人工智能斑块分割超声图像的影像组学评估颈动脉斑块的稳定性,以及其对颈动脉易损斑块与稳定性斑块的诊断效能.方法 171例缺血性脑卒中患者通过颈动脉彩超检查分为易损斑块组(83例)与稳定斑块组(88例).在人工智能斑块分割超声图像上提取369个影像组学特征,采用最小绝对收缩和选择算子方法 对影像组学特征进行降...