颈动脉窦部斑块壁面剪应力的定量分析及其影响因素  

Quantitative analysis and influence factors of wall shear stress at carotid sinus plaque

作　　者：刘秋云[1] 陈明[2] 傅晓红[1] 江梅[3] 夏红卫 LIU Qiu-yun;CHEN Ming;FU Xiao-hong(Department of Ultrasound,Second Military Medical University Affiliated Shanghai Pudong New Area Gongli Hospital,Shanghai 200135,China)

机构地区：[1]上海市浦东新区公利医院超声科,200135 [2]同济大学附属东方医院心脏医学部,上海200120 [3]上海市浦东新区公利医院神经内科,200135

出　　处：《放射学实践》2018年第9期961-965,共5页Radiologic Practice

基　　金：上海市卫计委面上项目(201440051);上海市浦东新区卫计委课题面上项目(PW2016A-19)

摘　　要：目的:利用剪应力分布图绘制软件定量分析颈动脉窦部斑块附近壁面剪应力(WSS)的分布情况及其影响因素。方法:选取本院急性缺血性脑卒中(AIS)患者30例为研究对象,AIS患者行颈动脉超声检查,测量并记录斑块凸入管腔厚度。采集颈动脉窦部斑块彩色多普勒血流成像(CDFI)动态图并利用剪应力分布图绘制软件绘制颈动脉窦部斑块附近的二维、三维剪应力空间分布图。比较斑块肩部近心端与肩部远心端WSS的平均值,分析WSS与斑块厚度的相关性,并利用多元线性回归分析影响WSS变化的因素。结果:剪应力二维空间分布图可见斑块肩部近心端颜色明亮,远心端颜色暗淡。三维空间分布图可见斑块肩部近心端代表WSS值的Z轴波幅较远心端明显增高。斑块肩部近心端的舒张末期WSS为(8.15±2.27)dyne/cm2,远心端为(4.82±0.95)dyne/cm2,近心端WSS显著高于远心端,差异有统计学意义(t=7.440,P=0.000)。斑块肩部近心端WSS与斑块厚度呈正相关(r=0.496,P=0.005)。多元线性回归分析结果显示,斑块厚度是斑块肩部近心端WSS的影响因素,差异有统计学意义(P=0.005);拟合方程为WSS=-1.746+3.574×斑块厚度,拟合优度R2=0.246。结论:剪应力分布图绘制软件的定量分析结果显示斑块肩部近心端WSS高于远心端,斑块厚度是斑块WSS的主要影响因素。Objective:To quantitatively analyze the distribution of wall shear stress(WSS)near carotid sinus plaque and the influencing factors by using shear stress mapping software.Methods:Thirty patients with acute ischemic stroke(AIS)in our hospital were enrolled as the study subjects.Ultrasound examination of carotid artery was performed to measure and record the thickness of plaque protruding into the lumen.A dynamic color Doppler flow imaging(CDFI)map of carotid sinus plaque was collected and a 2D&3D shear stress spatial distribution map was drawn near the carotid sinus plaque using shear stress mapping software.The mean value of WSS at the proximal and the distal end of the plaque shoulder was compared.The correlation between WSS and plaque thickness was analyzed.Multiple linear regression was used to explore the factors affecting the changes of WSS.Results:The 2D shear stress spatial distribution map showed that the proximal end of the plaque was bright and the distal end was dark.The 3D shear stress spatial distribution map showed that the amplitude of the Z axis representing the WSS value at the proximal end of the plaque shoulder was significantly higher than that at the distal end.The WSS at the proximal end of the plaque shoulder was(8.15±2.27)dyne/cm 2,and the distal end was(4.82±0.95)dyne/cm 2.The proximal WSS was significantly greater than that at the distal end,and the difference was statistically significant(t=7.440,P=0.000).There was a positive correlation between the WSS at the proximal end of the plaque shoulder and plaque thickness(r=0.496,P=0.005).Multiple linear regression revealed that plaque thickness was an influencing factor for WSS at the proximal end of the plaque,and the difference was statistically significant(P=0.005).The fitting equation was:WSS=-1.746+3.574*plaque thickness.The goodness of fit R2=0.246.Conclusion:The shear stress mapping software proves that WSS at the proximal end of the plaque shoulder is larger than that at the distal end,and the plaque thickness is the main influenci

关 键 词：急性缺血性脑卒中 颈动脉窦部斑块 斑块肩部 近心端 壁面剪应力 超声检查 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]