超声造影评价颈动脉斑块新生血管的研究进展

颈动脉粥样硬化(carotid atherosclerosis,CAS)是导致脑实质缺血性病变的主要原因之一,同时,其发病率也与冠心病发病率密切相关,两者具有多种共同的危险因素[1,2].研究证实,动脉粥样硬化(ariery atheroselersis,AS)斑块的易损性是决定病情轻重的主要因素[3].因此,对颈动脉斑块的早期筛查、诊断、风险性评估及干预,具有重大意义.但目前尚缺乏敏感而特异的早期实验室检查指标[4].近年研究[5-7]发现AS斑块内常出现病理性新生血管,其在斑块发生发展进程中起关键性作用.研究已经证实[8,9],斑块新生血管是易损斑块的预测因子.应用超声造影技术检测斑块新生血管,为临床评估斑块易损性开辟了一条新的途径.如今超声造影已应用于检测及评价多种组织器官的血流灌注以及肿瘤新生血管的临床与研究中,由于它同样可显示颈动脉斑块新生血管,因此可以实时、定性、定量评估斑块易损性.     

多普勒超声与超声造影评价颈动脉粥样硬化斑块易损性的临床研究

目的应用常规彩色多普勒超声及超声造影技术评价颈动脉粥样硬化斑块(CASP)易损性及其对缺血性脑卒中事件的预测价值。方法对164例患者(包括143例缺血性脑卒中患者)行颈动脉常规彩色多普勒超声检查,共检出260个CASP,测量斑块最大厚度后,行超声造影检查,观察斑块内新生血管位置、是否达到斑块表面、对新生血管数量进行评分。结果 CASP厚度与其内新生血管数量之间呈中度正相关,且厚度≥0.4 cm时,其内新生血管数量明显增多,且约72.7%患者患有脑卒中;若新生血管到达CASP表面,则这类斑块内新生血管数量明显多于未达到斑块表面者,且约93.7%患有脑卒中的患者位于该组;CASP肩部、基底部、顶部的新生血管数量依次递减,但CASP近心端肩部与远心端肩部的新生血管数量无统计学差异。结论当CASP最大厚度≥0.4 cm、CASP肩部新生血管密度大且新生血管达到CASP表面时,发生缺血性脑卒中风险高。     

超声技术评估颈动脉易损斑块的应用进展

颈动脉易损斑块是缺血性脑梗死发病机制中的一个重要部分,识别易损斑块对脑梗死患者的诊断、治疗和预后有重要的临床意义。随着超声成像及相关技术的进步,超声不仅可以筛查颈动脉狭窄和斑块的基本特征,还可以早期提示斑块的易损性。本文拟从斑块构成、纤维帽厚度、新生血管和斑块形态四个方面来回顾超声对易损斑块评估的应用与进展。     

颈动脉斑块易损性的临床研究进展

脑卒中是人类三大死亡原因之一,以缺血性脑卒中为主,占总脑卒中的70%～75%,而动脉粥样硬化(atherosclerosis,AS)斑块破裂所致栓子是导致缺血性脑卒中主要原因,其形成不仅与斑块大小有关,而且与斑块易损性明显相关.近年来,颈动脉斑块易损性的研究越来越受到重视,如何准确评价斑块易损性是现代医学领域研究的热点之一.随着医学技术的发展,斑块易损性的研究越来越全面,现将颈动脉粥样硬化斑块易损性的临床研究进展综述如下.     

CT血管造影对缺血性脑卒中患者颈动脉斑块易损性的诊断作用

目的:研究CT血管造影对缺血性脑卒中患者颈动脉斑块易损性的诊断作用。方法:本次纳入2019年1月至2020年12月本院收治的90例颈动脉粥样硬化患者展开研究,按照是否出现缺血性脑卒中进行分组,对照组50例为未发生脑卒中患者,观察组40例为缺血性脑卒中患者。所有患者均进行CT血管造影,观察两组的检查结果。结果:两组的CT血管造影图像质量评分进行比较差异无统计学意义(P>0.05);观察组的易损性斑块检出率、颈动脉管腔狭窄率高于对照组(P<0.05);观察组中易损性斑块、稳定性斑块的颈动脉狭窄情况进行比较,差异无统计学意义(P>0.05)。结论:CT血管造影能够有效检测颈动脉斑块的易损性,适合应用在缺血性脑卒中患者中,对于临床防治缺血性脑卒中具有重要作用。     

应用超声造影技术对不同厚度颈动脉斑块内新生血管的评价

目的通过应用超声造影(CEUS)技术检测颈动脉斑块内新生血管,比较不同厚度斑块内新生血管的差异。方法选择46例经常规超声确诊存在颈动脉斑块患者,共70个斑块,应用CEUS技术检测斑块内新生血管。结果 CEUS技术检测结果显示,不同厚度低回声、等回声颈动脉斑块的增强强度与斑块厚度呈正相关(rs=0.5540.000)。结论不同厚度低回声、等回声颈动脉斑块内新生血管密度与斑块厚度呈正相关。     

颈动脉斑块内新生血管密度与血清Lp-PLA2水平的相关性研究

目的研究颈动脉斑块内新生血管密度与患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平的相关性。方法采用酶联免疫吸附试验(ELISA)测定291例在我院进行颈动脉斑块超声造影检查的患者的血清Lp-PLA2水平,并按其超声造影结果显示斑块内新生血管分布密度分级分为三组,Ⅰ~Ⅱ级为组1(28例),Ⅲ级为组2(82例),Ⅳ级为组3(181例),比较各组间血清Lp-PLA2水平。结果三组患者的血清Lp-PLA2水平存在显著差异,具有统计学意义(P0.05),三组数据两两比较,差异有统计学意义(P均0.05)。结论颈动脉斑块内新生血管分布密度越高,患者血清Lp-PLA2水平越高,两者存在明显的相关性,血清Lp-PLA2测定与颈动脉超声造影联合评估患者颈动脉斑块的易损性,可以更好地为临床筛查及干预治疗提供依据。     

颈动脉斑块超声造影增强特征与其病理特征及易损性的相关性

目的 采用超声造影（CEUS）评价颈动脉粥样硬化斑块增强特征与斑块中新生血管及弹性蛋白形态等病理特征及其易损性的相关性。方法 纳入124例颈动脉粥样硬化斑块患者,根据6个月内有无短暂性脑缺血发作（TIA）或非致死性脑卒中将其分为症状组（n=40）和非症状组（n=84）,比较组间CEUS增强等级差异;其中60例接受颈动脉内膜剥脱术（CEA）并获得病理学结果,评价CEUS增强等级与斑块内新生血管、弹性蛋白形态的相关性;以Ⅱ级增强为标准判断斑块易损性,并与病理结果对照,评价CEUS判断斑块易损性的效能。结果 症状组颈动脉斑块CEUS增强等级高于非症状组（P<0.05）。斑块CEUS表现为0级增强时,其内弹性蛋白以波浪状为主;Ⅱ级增强时,以平直或断裂状为主;不同增强等级斑块弹性蛋白形态差异具有统计学意义（P<0.05）。斑块CEUS增强等级与其微血管密度（MVD）呈正相关（r=0.62,P<0.01）。CEUS判断斑块易损性的敏感度、特异度、阳性预测值和阴性预测值分别为74.36%、61.91%、78.00%和57.00%。结论 症状性颈动脉斑块新生血管较多,其CEUS增强等级与新生血管数量及弹性蛋白形态有关;CEUS评价颈动脉粥样硬化斑块的效能较高。     

超微血管成像技术检测颈动脉斑块新生血管的临床价值

目的探讨超声超微血管成像(superb microvascular imaging, SMI)技术在评价颈动脉粥样硬化斑块内新生血管中的临床价值。方法 43例颈动脉粥样硬化斑块患者,均行SMI和超声造影(contrast-enhanced ultrasonography, CEUS)检查。以CEUS检查结果为标准,计算SMI检测斑块内新生血管的灵敏度、特异度和准确率,采用Kappa检验分析SMI和CEUS检出斑块内新生血管判断的一致性及对斑块内新生血管分级判断的一致性,采用Spearman秩相关分析SMI和CEUS检查斑块内新生血管分级与斑块厚度的相关性。结果 43例患者SMI共检出60个斑块,厚度1.5～5.6(3.4±1.0)mm,其中低回声斑块27个,低回声为主混合回声斑块33个;SMI检出斑块内新生血管的灵敏度为94.5%,特异度为80.0%,准确率为93.3%;SMI和CEUS检出斑块内新生血管的一致性及对斑块内新生血管分级判断的一致性均较好(Kappa=0.63,P0.001;Kappa=0.65,P0.001);SMI和CEUS检查斑块内新生血管分级分别与斑块厚度呈正相关(r_s=0.68,P0.001;r_s=0.69,P0.001)。结论 SMI可作为斑块内新生血管的可靠检测方法,在评价斑块内新生血管及评估斑块稳定性方面有一定价值。     

超微血管成像与超声造影评估颈动脉斑块新生血管的对比研究

目的对比分析超微血管成像(SMI)和超声造影诊断颈动脉粥样硬化斑块内新生血管的临床应用价值。方法对64例患者(99枚颈动脉粥样硬化斑块)分别行SMI和超声造影检查,比较SMI和超声造影显示颈动脉斑块内新生血管的阳性率和位置差异,以及两种方法诊断斑块内新生血管的一致性。结果超声造影对斑块内新生血管的检出率明显高于SMI(79.80%vs.53.54%),差异有统计学意义(χ~2=15.364,P=0.000)。两种方法检测斑块内新生血管分布的区域差异有统计学意义(χ~2=8.257,P<0.05)。Kappa检验显示SMI与超声造影检测斑块内新生血管具有一致性(Kappa=0.464,P=0.000)。结论 SMI与超声造影诊断斑块内新生血管各有优势,超声造影敏感性高,更易显示斑块基底部新生血管;SMI具有简便、无创、价格低廉的优点,可作为粥样硬化斑块的长期随访手段,两者联合应用可为临床提供更为准确的斑块易损信息。     

脂蛋白相关磷脂酶A2与中老年高血压患者颈动脉不稳定斑块的关系

目的 探讨血浆脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)活性水平与中老年高血压患者颈动脉不稳定斑块的关系及其临床意义.方法 选取高血压患者102例行双侧颈动脉超声检查,依据超声影像、斑块形态和回声特征综合评价分为两组:稳定斑块组50例、不稳定斑...     

进展性缺血性脑卒中与颈动脉斑块性质的关系

目的:探讨进展性缺血性脑卒中与颈动脉斑块性质之间的关系。方法:对78例进展性缺血性脑卒中患者及72例对照性缺血性脑卒中患者行颈动脉超声检查,比较两者的颈动脉粥样斑块特征、程度。根据颈动脉超声检查将颈动脉斑块分为稳定斑块和不稳定斑块(软斑、溃疡斑)进行比较。结果:进展组颈动脉斑块发生率与对照组差异无统计学意义。进展组颈动脉斑块以不稳定斑块(51.6%)为主,且进展组不稳定斑块(软斑、溃疡斑)发生率显著高于对照组(P0.01)。结论:颈动脉斑块的不稳定性与进展性缺血性脑卒中的发生密切相关。颈动脉斑块的性质可以作为预测缺血性脑卒中进展的指标。     

碱性成纤维细胞生长因子对原发性高血压患者颈动脉粥样硬化斑块的影响

目的:探讨原发性高血压患者颈动脉粥样硬化斑块与碱性成纤维细胞生长因子(bFGF)的关系及临床意义。方法:研究对象为住院高血压患者共213例,彩色多普勒超声仪检查颈动脉粥样硬化斑块,采用ELISA方法测定bFGF。结果:原发性高血压患者中无论有无斑块血清bFGF水平明显高于正常对照组(P0.01),有斑块组高于无斑块组(P0.05);斑块数量越多,bFGF含量越高;混合斑bFGF水平明显高于硬斑(P0.05)。结论:碱性成纤维细胞生长因子(bFGF)在体内参与动脉粥样硬化形成的病理过程,bFGF的测定对了解病情、判断预后及药物筛选有一定临床意义。     

椎基底动脉狭窄对患者后循环脑梗死及预后的影响研究

目的研究和分析椎基底动脉狭窄对患者后循环脑梗死(CI)及预后的影响。方法选取150例椎基底动脉狭窄患者作为研究对象,根据CT血管造影检查结果将患者分为无斑块组(n=36)、稳定斑块组(n=62)和不稳定斑块组(n=52)。对3组患者的后循环CI发病率、院时的美国国立卫生研究卒中量表(NIHSS)评分、Barthel指数评分、欧洲版神经功能缺失评分(ESS)评分、简易精神状态量表(MMSE)评分进行观察和比较。对患者进行为期2年的随访,对随访期内CI患者的再发率进行观察和比较。结果不稳定斑块组患者后循环CI的构成比显著高于无斑块组或稳定斑块组(P0.05)。不稳定斑块组患者的NHISS评分显著高于无斑块组或稳定斑块组,MMSE评分、Barthel评分、ESS评分显著低于无斑块组或稳定斑块组(P0.05)。不稳定斑块组患者的再次CI发生率显著高于无斑块组或稳定斑块组(P0.05)。结论椎基底动脉动脉粥样硬化斑块性质与患者的病情、CI发病率和预后均具有密切的相关性。     

Quantitative coronary plaque analysis predicts high-risk plaque morphology on coronary computed tomography angiography: results from the ROMICAT II trial

Semi-automated software can provide quantitative assessment of atherosclerotic plaques on coronary CT angiography (CTA). The relationship between established qualitative high-risk plaque features and quantitative plaque measurements has not been studied. We analyzed the association between quantitative plaque measurements and qualitative high-risk plaque features on coronary CTA. We included 260 patients with plaque who underwent coronary CTA in the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) II trial. Quantitative plaque assessment and qualitative plaque characterization were performed on a per coronary segment basis. Quantitative coronary plaque measurements included plaque volume, plaque burden, remodeling index, and diameter stenosis. In qualitative analysis, high-risk plaque was present if positive remodeling, low CT attenuation plaque, napkin-ring sign or spotty calcium were detected. Univariable and multivariable logistic regression analyses were performed to assess the association between quantitative and qualitative high-risk plaque assessment. Among 888 segments with coronary plaque, high-risk plaque was present in 391 (44.0%) segments by qualitative analysis. In quantitative analysis, segments with high-risk plaque had higher total plaque volume, low CT attenuation plaque volume, plaque burden and remodeling index. Quantitatively assessed low CT attenuation plaque volume (odds ratio 1.12 per 1 mm³, 95% CI 1.04–1.21), positive remodeling (odds ratio 1.25 per 0.1, 95% CI 1.10–1.41) and plaque burden (odds ratio 1.53 per 0.1, 95% CI 1.08–2.16) were associated with high-risk plaque. Quantitative coronary plaque characteristics (low CT attenuation plaque volume, positive remodeling and plaque burden) measured by semi-automated software correlated with qualitative assessment of high-risk plaque features.     

A comparison of the ability of foam swabs and toothbrushes to remove dental plaque: implications for nursing practice

This study aimed to assess the impact which the use of a toothbrush and the use of foam swabs had on the removal of dental plaque over a 6-day period Three experiments were completed and duplicated using the author's mouth and one of these experiments was completed a third time on a volunteer's mouth A plaque scoring system which quantified the amount of plaque on teeth in areas adjacent to periodontal tissue, and therefore capable of initiating inflammation, was used after plaque had been disclosed Plaque at the gum/tooth margin (gingival crevice plaque) and plaque between teeth (approximal plaque) was measured At the end of each 6-day period, which commenced with all tooth surfaces clean, the ability of the toothbrush to remove plaque was consistently better than that of swabs, and usually achieved complete visible plaque removal from all sites In contrast, plaque remained in all sites which had been cleaned using foam swabs (after using a 'swabbing'or 'scrubbing'technique) However, it was possible to remove plaque from a number of gingival crevice sites with a swab when a varied'any technique'was used on the visible disclosed plaque The plaque in all approximal sites still remained after this technique An experiment to measure the effect of using foam swabs on plaque which had been allowed to accumulate over a 6 day period produced similar results The results from this study suggest that the success of a toothbrush in removing plaque is affected by user technique (total visible plaque removal was not achievable), and that foam swabs are not able to remove plaque from some 'sheltered'areas of teeth (total visible plaque removal was not achievable) The implications of these findings to nursing practice are discussed     

Expectations and limitations of contemporary intravascular imaging: lessons learned from pathology

Acute coronary syndrome is the leading cause of death worldwide and plaque rupture is the most common underlying mechanism of coronary thrombosis. During the last 2 decades the understanding of atherosclerotic plaque progression advanced dramatically and pathology studies provided fundamental insights of underlying plaque morphology, which paved the way for invasive imaging modalities, which bring a new area of atherosclerotic plaque characterization in vivo. The development of intravascular ultrasound (IVUS) allowed the field to evaluate the principles of vascular anatomy, which is often underestimated by coronary angiography. Furthermore, IVUS image technologies were developed to obtain improved characterization of plaque composition. However, since spatial resolution of IVUS is insufficient to distinguish details of plaque morphology, a broad adoption of this technology in clinical practice was missing. Optical coherence tomography is a light-based imaging modality with higher spatial resolution compared to IVUS, which enables the assessment of vascular anatomy with great detail.     

Multimodal characterization of compositional, structural and functional features of human atherosclerotic plaques

Detection of atherosclerotic plaque vulnerability has critical clinical implications for avoiding sudden death in patients with high risk of plaque rupture. We report on multimodality imaging of ex-vivo human carotid plaque samples using a system that integrates fluorescence lifetime imaging (FLIM), ultrasonic backscatter microscopy (UBM), and photoacoustic imaging (PAI). Biochemical composition is differentiated with a high temporal resolution and sensitivity at the surface of the plaque by the FLIM subsystem. 3D microanatomy of the whole plaque is reconstructed by the UBM. Functional imaging associated with optical absorption contrast is evaluated from the PAI component. Simultaneous recordings of the optical, ultrasonic, and photoacoustic data present a wealth of complementary information concerning the plaque composition, structure, and function that are related to plaque vulnerability. This approach is expected to improve our ability to study atherosclerotic plaques. The multimodal system presented here can be translated into a catheter based intraluminal system for future clinical studies.     

速度向量成像评价冠心病患者颈动脉粥样斑块力学特性的临床研究

目的 探讨颈动脉正常和斑块部佗、硬斑块和软斑块及斑块的肩部和纤维帽顶部速度、应变及应变率变化规律.方法对86例冠心病伴颈动脉粥样斑块患者和50例正常人双侧颈动脉进行高频超声检查,检测颈动脉内膜-中层厚度(IMT);应用速度向量成像(VVI)斑点追踪技术检测颈动脉的运动速度、应变、应变率,并分组进行分析.结果冠心病组颈动脉IMT高于正常组,差异有统计学意义(P＜0.05);正常对照组颈动脉收缩期径向最大运动速度高于冠心病颈动脉无斑块部位的测值,差异有统计学意义(P＜0.05);软斑块收缩期最大运动速度、最大应变率高于硬斑块组,差异有统计学意义(P＜0.001或P＜0.05);颈动脉斑块肩部收缩期最大运动速度、应变率高于斑块纤维帽顶部.差异有统计学意义(P＜0.05或P＜0.001).结论 VVI技术可早期检测血管壁的弹性度,早期检测颈动脉荆样硬化及颈动脉粥样硬化斑块部位内膜运动的机械不一致性和不同部位的力学指标差别,有可能作为动脉粥样硬化不稳定斑块的初查和量化评价指标.     

能谱CTA分析颈动脉斑块成分及其与脑梗死的关系

目的 探讨能谱CT血管成像（CTA）区分颈动脉粥样硬化斑块成分的可行性，并分析斑块类型与脑梗死的相关性。方法 对60例经超声检出的颈动脉狭窄患者行头颈部能谱CTA和颅脑MRI。分别测量斑块、脂肪、肌肉和骨骼组织的CT值及有效原子序数，获得40~140 keV单能量图像平均CT值的特征能谱曲线，计算能谱曲线斜率。根据MRI结果评估患者是否存在脑梗死；根据能谱CTA结果将斑块分为脂质斑块、脂质核心为主的混合斑块、纤维成分为主的混合斑块、纤维斑块及钙化斑块，将脂质斑块和脂质/纤维混合斑块归为不稳定斑块，纤维斑块和钙化斑块归为稳定斑块。比较各斑块的能谱曲线斜率及有效原子序数差异；计算存在各类型斑块患者的脑梗死发生率。结果 共纳入109个斑块，包括21个脂质斑块、11个脂质核心为主混合斑块、30个纤维成分为主混合斑块、15个纤维斑块及32个钙化斑块。各斑块能谱曲线斜率及有效原子序数差异均有统计学意义（F=1 494.83、2 108.74，P均<0.01）。19例存在脂质斑块，11例见脂质核心为主混合斑块，19例存在纤维成分为主混合斑块，10例见纤维斑块，20例见钙化斑块。MRI于各类型斑块患者中分别检出13例、6例、7例、2例及1例脑梗死，相应脑梗死发生率分别为68.42%（13/19）、54.55%（6/11）、36.84%（7/19）、11.11%（1/9）及0（0/20）；60例总体脑梗死发生率为45.00%（27/60），其中存在不稳定斑块和稳定斑块患者脑梗死发生率分别为53.06%（26/49）和3.33%（1/30）。结论 能谱CTA可用于细化分析颈动脉斑块成分及类型。斑块脂质成分越多，稳定性越差，患者发生脑梗死的风险越高。