颈动脉血管重构及斑块声学特征与脑梗死的相关性研究

目的彩色多普勒血流显像（CDFI）和经颅多普勒超声（（TCD）技术结合评价颈动脉颅外、颅内段血管重构，以及斑块声学特征与脑梗死的相关性。方法163例中老年患者，检测颈动脉颅外段，根据重构指数分为正性重构（A组）51例、负性重构（B组）62例、无重构（C组）50例。观察各组颈动脉内-中膜厚度、有无斑块、斑块类型及声学特征，计算斑块面积（PA）、血管总面积（TVA）、管腔有效面积（LA）；并同时行TCD颅内段动脉检测。结果脑梗死发生率的大小依次为A组、B组和c组，各组间比较均P〈0．05；A组不稳定斑块、大脑中动脉血流异常发生比高于B组和C组，均P〈0．05，斑块部位TVA与PA呈正相关（r=0．66，P〈0．05）；B组斑块部位LA与PA呈负相关（r=-0．48，P〈0．05）；斑块回声类型不同，其脑梗死发生率有一定差异，依次表现为低回声脂质斑块大于中等水平回声纤维斑块、混合回声斑块和强回声斑块，均P〈0．05。结论颈动脉血管重构类型与脑梗死的发生密切相关，对血管斑块特征的检测分析，对预测脑梗死的发生有重要的临床意义。

Study on the correlation of vascular remodeling in carotid artery and acoustic features of plaques and cerebral infarction

Objective To explore the correlation of vascular remodeling in carotid artery （ extracranial and intracranial segment）, the acoustic characteristics of plaques and cerebral infarction by color Doppler ultrasound （CDFI） and transcranial Doppler ultrasound （（TCD） technology. Methods The segments of extracranial carotid artery in 163 elderly patients were detected, and they were divided into positive remodeling group （Group A,51 patients） , negative remodeling group（Group B,62 patients） and no-remodeling group（Group C,50 patients） according to the index of remodeling. The intima-media thickness of carotid artery, plaques, the types of plaque and acoustic characteristics in carotid artery were observed. Then plaque area （PA）, total vessel area （TVA） and lumen area （LA） were calculated, At the same time, the segments of intracranial carotid artery were detected by TCD. Results The incidence of cerebral infarction followed by A, B and C group （ P 〈 0.05 ）. The incidence of unstable atherosclerotic plaques and abnormal blood flow in middle cerebral artery in A group was significant higher than those in B and C group （ P 〈 0.05 ）. There was positive correlation between TVA and PA in A group （ r = 0. 66, P 〈 0.05 ）, while there was negative correlation between LA and PA in B group （ r = - 0. 48, P 〈 0.05 ）. With the different plaque echo types, the incidence of cerebral infarction had some differences, in turn reflected that in low echo plaques was significant higher than in medium echo plaques, mixed echo plaques and high echo plaques （ P 〈 0.05 ）. Conclusion Vascular remodeling in carotid artery is closely related to cerebral infarction. Acoustic features of plaques have important clinical value to predict cerebral infarction.