不同类型冠心病患者股动脉斑块超声特征

目的 探讨股动脉斑块声像特征诊断非ST段抬高型急性冠状动脉综合征（NSTE-ACS）的价值。方法 选取冠心病伴颈动脉及股动脉斑块患者72例，分为NSTE-ACS组（n=42）和慢性心肌缺血综合征（CIS）组（n=30），行CEUS、三维超声及灰阶强度定量分析，检测斑块造影增强强度（EI）、斑块体积、形态特征及回声灰阶强度（EL）等参数并进行对比分析。结果 NSTE-ACS组斑块EI、形态不规则斑块比例高于CIS组，EL低于CIS组（P均<0.05）。颈动脉和股动脉斑块EI、EL和形态分类均与NSTE-ACS具有相关性（P均< 0.05）。股动脉斑块EI、EL为NSTE-ACS的危险因素（OR=1.222、1.177，P<0.05）。颈动脉斑块EI、EL诊断NSTE-ACS的曲线下面积（AUC）分别为0.801、0.757（P均< 0.001），股动脉斑块EI、EL的AUC分别为0.814、0.774（P均< 0.001）。结论 股动脉斑块内新生血管、形态特征和内部回声均与NSTE-ACS存在相关性，且较颈动脉更强；多种超声技术联合评价股动脉斑块声像图特征有望成为预测冠状动脉斑块稳定性、筛查冠心病高危患者的参考指标。

Ultrasonic characteristics of femoral artery atherosclerotic plaques in patients with different types of coronary heart disease

Objective To explore correlation between ultrasonic characteristics of femoral artery atherosclerotic plaques and non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods Seventy-two patients with coronary heart disease (CHD) coexisting carotid artery and femoral artery plaques were divided into NSTE-ACS group (n=42) and chronic ischemic syndrome (CIS) group (n=30). The enhanced intensity (EI), volume, shape and internal echo level (EL) of plaques were detected with contrast-enhanced ultrasonic imaging and three-dimensional ultrasound combined with ultrasonic grey-scale intensity quantitative analysis, and all parameters were analyzed between the two groups. Results EI and the proportion of irregular artery plaques were higher, and EL was lower in NSTE-ACS group than those in CIS group (all P<0.05). EI, EL and shape of carotid artery and femoral artery plaques were correlated with NSTE-ACS (all P < 0.05). EI and EL of femoral artery plaques were risk factors for NSTE-ACS (OR=1.222, 1.177, P < 0.05). Areas under ROC curve of EI and EL of carotid artery plaques were 0.801 and 0.757 (both P<0.001), and those of femoral artery plaques were 0.814 and 0.774, respectively (both P<0.001). Conclusion Neovascularization, shape and internal echo are correlated with NSTE-ACS, and the correlation of femoral artery plaques with NSTE-ACS is more significant than that of carotid artery plaques. Detecting ultrasonic characteristics of femoral artery atherosclerotic plaque can provide references to early identify unstable plaque and screening high-risk patients with CHD.