机构地区:[1]苏州大学附属第一医院卒中中心-颈脑血管超声科,江苏苏州215006
出 处:《中风与神经疾病杂志》2023年第5期391-396,共6页Journal of Apoplexy and Nervous Diseases
基 金:苏州市民生科技项目(No.SS202061);苏州大学技术开发合作项目(No.H211064)。
摘 要:目的 探讨单侧颈内动脉颅外段中-重度狭窄患者的粥样硬化斑块特征与临床症状的相关性。方法 苏州大学附属第一医院神经外科经颈部血管超声(CDU)及CT血管造影证实的单侧颈动脉中-重度狭窄且行颈动脉内膜切除术患者151例,根据临床表现分症状组和无症状组,CDU检查两组患者颈动脉粥样硬化斑块特征(斑块纤维帽完整性、溃疡型斑块及斑块钙化等情况),比较患者粥样硬化斑块特征及血管狭窄程度;经颅多普勒超声(TCD)记录双侧大脑中动脉(MCA)血流动力学参数(Vm、Vs、Vd及PI);CT灌注成像(CTP)记录双侧基底节、颞叶CTP各参数(CBF、CBV、MTT及TTP)。采用χ2检验分析两组患者颈动脉斑块特征及狭窄程度,采用独立样本t检验、Mann-Whitney U检验比较两组患者健患侧大脑中动脉血流动力学参数差值,以及患侧基底节及颞叶CTP参数。结果 (1)一般临床资料:症状组患者的发病年龄大于无症状组,差异有统计学意义(P<0.05)。(2)斑块特征:CDU示颈动脉中度及重度狭窄的症状组患者,其溃疡型斑块、斑块表面钙化的发生率均高于无症状组,差异有统计学意义(P<0.05)。(3)脑血流动力学改变:颈动脉中度及重度狭窄患者的双侧MCA血流动力学参数进行组间比较,症状组健患侧Vm、Vs及Vd差值均较无症状组增高,差异有统计学意义(P<0.05);颈动脉重度狭窄患者的患侧基底节及颞叶的CBF、MTT及TTP组间比较差异有统计学意义(P<0.05),但颈动脉中度狭窄患者的患侧基底节及颞叶的CTP参数组间比较差异无统计学意义(均P>0.05)。结论 颈动脉重度狭窄会引起颅内低灌注,但颈动脉中度狭窄且斑块性质不稳定同样会出现临床症状,评估颈动脉斑块特征及狭窄程度对临床个体化诊疗具有重要的临床意义。Objective To investigate the relationship between atherosclerotic plaque characteristics and clinical symptoms in patients with unilateral moderate-to-severe stenosis of the extracranial segment of the internal carotid artery.Methods We included a total of 151 patients who underwent carotid endarterectomy for unilateral moderate-to-severe carotid stenosis[confirmed by carotid Doppler ultrasonography(CDU)and computed tomography angiography]at the Department of Neurosurgery of the First Affiliated Hospital of Soochow University.They were divided into symptomatic group and asymptomatic group according to clinical manifestations.The two groups were examined by CDU for the characteristics of carotid artery plaques(fibrous cap integrity,ulcerative plaques,plaque calcification,etc.)and the degree of vascular stenosis.Transcranial Doppler ultrasonography was performed to record the hemodynamic parameters(Vm,Vs,Vd,and PI)of bilateral middle cerebral arteries(MCA).Computed tomography perfusion imaging(CTP)was performed to record the parameters(CBF,CBV,MTT,and TTP)of bilateral basal ganglia and temporal lobes.The two groups were compared for carotid plaque characteristics and the degree of stenosis using the chi-square test,and for the differences in the hemodynamic parameters of MCA between the unaffected and affected sides and the CTP parameters of the basal ganglia and temporal lobe on the affected side using the independent samples t test and the Mann-Whitney U test.Results The symptomatic group was significantly older at the age of onset than the asymptomatic group(P<0.05).The incidence rates of ulcerative plaques and plaque surface calcification were significantly higher in the symptomatic patients with moderate/severe carotid stenosis than in the asymptomatic groups(P<0.05).The differences in Vm,Vs,and Vd of MCA between the unaffected and affected sides were significantly larger in the symptomatic moderate/severe stenosis groups than in the asymptomatic moderate/severe stenosis groups(P<0.05).There were significant d
关 键 词:颈动脉狭窄 斑块特征 脑血流动力学 经颅多普勒 临床症状
分 类 号:R543.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]
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