超声观察颈动脉粥样硬化斑块纤维帽完整性的临床价值简

目的回顾分析单侧前循环急性脑卒中患者颈动脉超声检查结果，探讨粥样硬化斑块纤维帽完整性对斑块稳定性的影响。方法通过彩色多普勒超声长轴和短轴观察并记录颈动脉管壁、粥样硬化斑块及纤维帽完整性，以及单侧颈动脉低、中等和强回声斑块数目，判断狭窄动脉血流动力学变化。结果86例患者共检出粥样硬化斑块215个，共77例患者发现纤维帽不完整，72例存在低回声斑块，仅5例检出中等回声斑块（x^2=37．703，P=0．000）。其中患侧纤维帽不完整者46例、健侧31例（x^2=5．291，P=0．021）；患侧检出低回声斑块者56例、健侧44例（x^2=0．168，P=0．682）。共计发现颈动脉狭窄15例，均为低回声斑块所致，分别发生于颈内动脉起始部（10例）、颈动脉分叉部（4例）、颈外动脉（1例），以颈动脉分叉部（8．16％，4／49）与颈内动脉起始部（27．03％，10／37）之间差异具有统计学意义（x^2=3．900，P=0．048）。结论动脉粥样硬化斑块纤维帽完整性与脑卒中关系密切。纤维帽不完整的粥样硬化斑块以低回声斑块为主，通过超声波评价斑块回声及其表面纤维帽完整性，可以判断斑块稳定性，而观察斑块纤维帽完整性较单纯评价斑块回声特点更具临床价值。

Clinical value of atherosclerotic plaque fibrous cap integrity observed by ultrasound

Objective To retrospectively patients with unilateral anterior circulation acute analyze carotid ultrasonography detection results in ischemic stroke, and to observe the influence of atherosclerotic plaque fibrous cap integrity on plaque stability. Methods In the long axis and the short axis of color Doppler ultrasonograpy, carotid artery wall, atheroselerotie plaques and the integrity of fibrous cap, as well as the number of plaques with low, medium and strong echo in unilateral carotid artery were observed and recorded, so as to judge the hemodynamic situation of stenosis artery. Results A total of 215 plaques were found in 86 patients, among whom 77 patients with incomplete fibrous cap, 72 cases with low echo plaques and 5 cases with medium echo plaques （X2= 37.703, P = 0.000）. There were 46 cases with incomplete fibrous cap in the affected side and 31 cases with incomplete fibrous cap in the uninjured side （X2 = 5.291, P = 0.021）; 56 cases with low echo plaques in affected side and 44 cases with low echo plaques in uninjured side （X2= 0.168, P = 0.682）. Fifteen cases presented carotid artery stenosis caused by low echo plaques located in initial part of internal carotid artery （10 cases）, carotid bifurcation （4 cases） and external carotid artery （1 case）. There was significant difference （X2= 3.900, P = 0.048） between carotid bifurcation （8.16%, 4/49） and initial part of internal carotid artery （27.03%, 10/37）. Conclusions The relationship between atherosclerotie plaque fibrous cap integrity and stroke is close. Plaques with incomplete fibrous cap are mainly low echo plaques. Therefore, ultrasonic evaluation of plaque echo and fibrous cap integrity can judge the stability of plaque. Besides, it is more significant to examine fibrous cap integrity than simply assess plaque echo features clinically.