超声造影检查颈动脉粥样硬化斑块新生血管对缺血性卒中复发的预测价值  

Predictive value of carotid atherosclerotic plaque neovascularization by contrast-enhanced ultrasound multimodal imaging for recurrent ischemic stroke

作　　者：齐健 李权[1] 张学新[1] 杨环玮 周进 Qi Jian;Li Quan;Zhang Xuexin;Yang Huanwei;Zhou Jin(Department of Cardiology,Qinhuangdao Hospital of Traditional Chinese Medicine,Qinhuangdao 066000,Hebei,China;Department of Medical,Qinhuangdao Hospital of Traditional Chinese Medicine,Qinhuangdao 066000,Hebei,China;Department of Pulmonary Diseases,Qinhuangdao Hospital of Traditional Chinese Medicine,Qinhuangdao 066000,Hebei,China)

机构地区：[1]秦皇岛市中医医院心血管病科,河北秦皇岛066000 [2]秦皇岛市中医医院医务科,河北秦皇岛066000 [3]秦皇岛市中医医院肺病科,河北秦皇岛066000

出　　处：《血管与腔内血管外科杂志》2023年第2期220-225,共6页Journal of Vascular and Endovascular Surgery

基　　金：河北省中医药管理局科研计划项目(2022538);秦皇岛市科学技术研究与发展计划(202005A034)。

摘　　要：目的研究超声造影(GEUS)检查颈动脉粥样硬化斑块新生血管对缺血性卒中复发的预测价值。方法收集2017年6月至2020年3月于秦皇岛市中医医院就诊的78例缺血性卒中且颈内动脉(ICA)至少有一处动脉粥样硬化斑块患者的临床资料。所有患者均进行颈动脉超声CEUS和检查,分析GEUS检查颈动脉粥样硬化斑块新生血管的影响因素及缺血性卒中复发的预测因素。结果78例患者均进行CEUS检查,仅50例符合新生血管成像标准,根据有无新生血管形成将其分为新生血管形成组(n=40,斑块为1、2级)和新生血管未形成组(n=10,斑块为0级)。不同颈动脉狭窄程度中弥漫性新生血管发生率比较,差异无统计学意义(P﹥0.05)。低回声斑块中2级占77.8%(14/18),明显高于高回声斑块的15.0%(9/60),差异有统计学意义(P﹤0.01)。斑块的平均时间-强度曲线增强值为(19.40±2.35)分贝,评估者间、观察者内部一致性均较好。单因素分析结果显示,斑块以低回声为主、既往使用他汀类药物均可能是GEUS检查颈动脉粥样硬化斑块形成新生血管的影响因素(P﹤0.05)。多变量分析结果显示,既往使用他汀类药物是GEUS检查颈动脉粥样硬化斑块形成新生血管的保护因素[优势比(OR)=0.30,95%CI:0.10~0.90,P=0.032]。78例患者均完成了随访,14例患者缺血性卒中复发(原始颈动脉区域),且均有新生血管形成。Cox比例风险多变量模型显示,CEUS检查的时间-强度曲线、新生血管分级均与缺血性卒中复发独立相关(P﹤0.05)。结论CEUS检查的斑块内新生血管是颈动脉粥样硬化患者中缺血性卒中复发的独立预测因素,但不适用于合并钙化斑块患者。Objective To study the predictive value of carotid atherosclerotic plaque neovascularization by contrast-enhanced ultrasound(CEUS)for recurrent ischemic stroke.Method Clinical data of 78 patients with ischemic stroke and at least one atherosclerotic plaque in the internal carotid artery(ICA)admitted to Qinhuangdao Hospital of Traditional Chinese Medicine from June 2017 to March 2020 were selected.All patients underwent carotid ultrasound and CEUS.The influencing factors of CEUS in detecting carotid atherosclerotic plaque neovascularization and predicative factors for recurrent ischemic stroke were analyzed.Result A total of 78 patients underwent CEUS examination,50 cases met the neovascularization criteria,they were divided into the neovascularization group(n=40,grade 1-2 plaques)and non-neovascularization group(n=10,grade 0 plaques).There was no significant difference in the incidence of diffuse neovascularization among different degrees of carotid stenosis(P>0.05).In low echo plaques grade 2 accounted for 77.8%(14/18),significantly higher than high echo plaques of 15.0%(9/60),the difference was statistically significant(P<0.05).The mean time-intensity curve enhancement value of plaques was(19.40±2.35)dB,good consistency between raters and within observers.Univariate analysis showed low echo plaques and previous use of statin may be the potential influencing factors for CEUS in detecting carotid atherosclerotic plaque neovascularization(P<0.05).Multivariate analysis showed the previous use of statin was the protective factor[odds ratio(OR)=0.30,95%CI:0.10-0.90,P=0.032].All 78 patients completed the follow-up,14 cases had recurrent ischemic stroke in original carotid arteries,all with new blood vessels.Cox proportional risk multivariable model showed time-intensity curve and grade of neovascularization detected by CEUS were independently associated with recurrence of ischemic stroke(P<0.05).Conclusion Intra-plaque neovascularization detected by CEUS is an independent predictor of ischemic stroke recurrence in pa

关 键 词：超声造影 动脉粥样硬化 新生血管 复发 预测 

分 类 号：R543[医药卫生—心血管疾病]