超声造影评价颈动脉狭窄中斑块内新生血管的情况  

Evaluation of carotid plaque neovascularization in carotid stenosis by contrast-enhanced ultrasound

作　　者：田艳[1] 王秀红[2] 武敬平[1] 刘健[1] 马姣姣[1] 郑敏[1] Tian Yan;Wang Xiuhong;Wu Jingping;Liu Jian;Ma Jiaojiao;Zheng Min(Department of Ultrasound,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pathology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院超声科,北京100029 [2]中日友好医院病理科,北京100029

出　　处：《中华医学杂志》2019年第21期1656-1659,共4页National Medical Journal of China

摘　　要：目的通过超声造影检查(CEUS)对颈动脉狭窄中颈动脉斑块内新生血管的识别,提供预测脑卒中除颈动脉狭窄之外的风险标志物——斑块内新生血管。方法自2017年1至9月在中日友好医院住院的40例颈动脉硬化斑块患者,进行CEUS。应用CEUS测得的颈动脉斑块内造影增强强度(EI)与颈动脉内膜剥脱术(CEA)后组织病理学测得的斑块内微血管密度(MVD)相比较。超声造影观察斑块内有无增强并将斑块增强分为0~2级。用时间强度曲线(TIC)定量分析软件分别计算斑块内EI、斑块内EI与颈动脉管腔内EI比值。CEA术后颈动脉斑块进行病理切片CD34染色,测定斑块内新生血管密度。结果斑块增强0级17例(42.5%),1级9例(22.5%),2级14例(35.0%)。不同分级患者的年龄、EI1、EI1/EI2及CD34差异有统计学意义(P<0.05),但性别及EI2差异无统计学意义(P>0.05)。CD34染色得到的新生血管密度与EI1(r=0.836,P<0.001)、EI1/EI2(r=0.955,P<0.001)呈高度正相关,与年龄(r=0.066,P=0.684)、EI2(r=0.159,P=0.328)无显著性相关。结论CEUS可以观察颈动脉斑块内新生血管情况,作为评价斑块稳定性的简便、无创方法。CEUS还可能有助于提取易损斑块的特征,如急性斑块内出血。Objective The identification of neovascularization in carotid plaque in carotid artery stenosis by contrast-enhanced ultrasound(CEUS)provides other risk markers for stroke besides carotid artery stenosis-intraplaque neovascularization.Methods From January 2017 to September 2017,40 patients with carotid atherosclerosis plaque were examined by contrast-enhanced ultrasound in China-Japanese Friendship Hospital.The enhancement intensity(EI)measured by contrast-enhanced ultrasound was compared with the micro-vessel density(MVD)measured by histopathology after carotid endarterectomy(CEA).Contrast-enhanced ultrasound was used to observe whether there was enhancement in the plaque and the enhancement was divided into 0-2 grades.The EI in plaque,the ratio of EI in plaque to EI in carotid artery lumen were calculated by time intensity curve quantitative analysis software.Pathological sections of carotid plaques after CEA were stained with CD34 and neovascularization density was measured.Results There were significant differences in age,EI1,EI1/EI2 and CD34 among patients with different grades of plaque enhancement(P<0.05),but no significant differences in gender and EI2(P>0.05).The density of neovascularization obtained by CD34 staining was highly positively correlated with EI1(r=0.836,P<0.001),EI1/EI2(r=0.955,P<0.001),but not with age(r=0.066,P=0.684),EI2(r=0.159,P=0.328).Conclusions Contrast-enhanced ultrasound can observe the neovascularization in carotid plaque,which is a simple and non-invasive method to evaluate the stability of carotid plaque.CEUS may also help to extract features of vulnerable plaques,such as acute intraplaque hemorrhage.

关 键 词：新生血管 颈动脉狭窄 颈动脉内膜剥脱术 

分 类 号：R651.12[医药卫生—外科学] R445.1[医药卫生—临床医学]