三维超声血管斑块定量分析技术评估颈动脉粥样硬化斑块  

Evaluation of carotid atherosclerotic plaques by vascular plaque quantification(VPQ)technology of three-dimensional ultrasonography

作　　者：邢海英[1,2] 陈玉辉 许珂[1,2] 黄点点[1,2] 彭清 刘冉 孙葳[1,2] 黄一宁 XING Hai-ying;CHEN Yu-hui;XU Ke;HUANG Dian-dian;PENG Qing;LIU Ran;SUN Wei;HUANG Yi-ning(Department of Neurology,Peking University First Hospital,Beijing 100034,China;Department of Neurology,Beijing Key Laboratory of Neurovascular Disease Discovery,Beijing,China;Department of Neurology,Beijing Hospital,Beijing 100730,China)

机构地区：[1]北京大学第一医院神经内科,北京100034 [2]神经系统小血管病探索北京市重点实验室,北京100034 [3]北京医院神经内科,北京100730

出　　处：《北京大学学报（医学版）》2022年第5期991-999,共9页Journal of Peking University:Health Sciences

摘　　要：目的:分析应用三维超声血管斑块定量分析技术(vascular plaque quantification,VPQ)评估颈动脉粥样硬化斑块的可行性并观察他汀类药物对颈动脉粥样硬化斑块的影响。方法:选择2016年1月至2018年9月于北京大学第一医院神经内科治疗的颈动脉粥样硬化患者,采用三维超声检查患者的双侧颈动脉,对存在颈动脉粥样硬化斑块的患者采用VPQ测量颈动脉斑块的灰阶中位数(gray scale median,GSM)及其他血管参数。根据斑块的GSM,分为低GSM组(GSM<40)和高GSM组(GSM≥40),比较两组患者的临床特征和斑块特征,分析斑块的稳定性。根据患者是否服用他汀类药物,将患者分为他汀组和非他汀组,比较两组患者在3个月和2年时颈动脉斑块GSM及其他血管参数的变化。结果:共入组120例患者,其中男性79例,女性41例,平均年龄(65.39±9.11)岁。低GSM组31例,高GSM组89例。低GSM组管腔的狭窄程度更重(面积狭窄率41.32%±21.37%vs.29.79%±17.16%,P<0.05)。低GSM组的标准化管壁指数(normalized wall index,NWI)显著大于高GSM组(0.61±0.14 vs.0.52±0.12,P<0.01),观察了77例患者颈动脉粥样硬化斑块的变化,其中男51例,女26例,年龄(64.96±9.58)岁,根据是否服用他汀类药物分为他汀组(n=56)和非他汀组(n=21)。与基线相比,3个月随访时两组患者的颈动脉斑块体积、面积、管腔狭窄度、GSM变化差异均无统计学意义(P>0.05);2年随访时,他汀组的GSM增加[中位数10.00(2.00,28.00)],而非他汀组的GSM减低[中位数-7.00(-11.00,5.50)],组间差异有统计学意义(P<0.01)。他汀组的颈动脉斑块体积无明显增加,而非他汀组的斑块体积略增加,但两组的变化值差异无统计学意义[他汀组斑块体积增加[中位数0.00(-30.00,40.00)mm^(3),非他汀组为30.00(10.00,70.00)mm^(3),P>0.05]。结论:三维超声(three dimensional ultrasound,3DUS)的VPQ可测量颈动脉斑块的GSM,低GSM(GSM<40)组患者的血管狭窄程度更重,标准化管壁指�Objective:To analyze the feasibility of using vascular plaque quantification(VPQ)to evaluate carotid atherosclerotic plaques and to observe the effect of statins on carotid atherosclerotic plaques.Methods:Patients with carotid plaques from January 2016 to September 2018 in Peking University First Hospital Neurology Department were recruited and underwent three-dimonsional ultrasound(3DUS).Their gray scale median(GSM)and other parameters of carotid plaques were measured with VPQ.The patients were divided into low GSM group(GSM<40)and high GSM group(GSM≥40).The clinical characteristics and plaque characteristics of the patients in the two groups were compared to analyze the stability of plaques.According to whether taking statins or not,the patients were further divided into statin group and non-statin group,plaque GSM and other parameters of their carotid plaques were measured and the changes of carotid plaques at the end of 3 months and 2 years were observed.Results:A total of 120 patients were enrolled,including 79 males and 41 females,with an average age of(65.39±9.11)years.The patients were divided into low GSM group(31 cases)(GSM<40)and high GSM group(89 cases)(GSM≥40).The stenosis of the lumen in the low GSM group was more severe(the area stenosis rate was 41.32%±21.37%vs.29.79%±17.16%,P<0.05).The nor-malized wall index(NWI)of plaque in low GSM group was significantly higher than that in high GSM group(0.61±0.14 vs.0.52±0.12,P<0.01).A total of 77 patients,including 51 males and 26 females,aged(64.96±9.58)years,were enrolled to observe the statin effects on carotid plaque.They were divided into statin group(n=56)and non-statin group(n=21)according to whether taking statins or not.At the baseline and 3-month follow-up,there were no significant differences in carotid plaque volume,area,degree of luminal stenosis and GSM between the two groups(P>0.05).At the end of the 2-year follow-up,GSM increased in the statin group[median 10.00(2.00,28.00)]but decreased in the non-statin group[median-7.00(-11.00,5.

关 键 词：三维超声 血管斑块定量分析 颈动脉斑块 灰阶中位数 他汀 

分 类 号：R543.4[医药卫生—心血管疾病]