急性颈动脉血栓与动脉粥样硬化斑块合并血栓的超声评估  

Ultrasonographic evaluation of acute carotid thrombus and atherosclerotic plaque with thrombus

作　　者：张培丽[1] 孟璇[1] 王欣[1] 马东梅[1] 雷丹 杨炀[1] ZHANG Peili;MENG Xuan;WANG Xin(Department of Neurovascular Function Examination,The Second Hospital of Lanzhou Uni-versity,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院神经血管功能检查科,甘肃兰州730030

出　　处：《中风与神经疾病杂志》2023年第10期883-887,共5页Journal of Apoplexy and Nervous Diseases

基　　金：甘肃省自然科学基金项目(1506RJZA238);兰州大学第二医院“萃科技创新”计划(CY2021-BJ-A20)。

摘　　要：目的探讨血管超声在急性颈动脉血栓与颈动脉粥样硬化斑块合并血栓早期诊断中的应用价值。方法选择2018年8月―2022年9月因急性脑梗死和短暂性脑缺血发作于兰州大学第二医院血管超声检查并经影像学检查证实的急性颈动脉血栓患者42例。根据血栓的声像特征和随访,将患者分为单纯血栓组19例,混合血栓组(动脉粥样硬化斑块合并血栓)23例。对比分析2组患者一般资料、血栓声像特征、血栓随访变化及预后。结果两组患者的年龄、性别、高血压、糖尿病、心房颤动差异均无统计学意义(均P>0.05),单纯组高脂血症比例高于混合组(χ^(2)=6.019,P=0.029)。2组患者病变回声、与血管壁之间关系比较,差异有统计学意义(χ^(2)=23.693,P<0.001;χ^(2)=27.649,P<0.001);2组血栓活动性差异无统计学意义(P>0.05)。单纯组与混合组血栓发生部位与病变导致血管狭窄闭塞差异无统计学意义(P>0.05)。2组间血栓变化及预后随访差异无统计学意义(P>0.05)。结论超声可无创评估急性颈动脉血栓和动脉粥样硬化斑块合并血栓的声像特征和动态观察血栓的演变,有助于两者鉴别。Objective To evaluate the value of vascular ultrasonography for early diagnosis of acute carotid thrombi and carotid atherosclerotic plaques with thrombi.Methods We included a total of 42 patients who had acute cerebral in-farction or transient ischemic attack with acute carotid thrombosis confirmed by vascular ultrasonography and imaging ex-amination in The Second Hospital of Lanzhou University from August 2018 to September 2022.The patients were divided into pure thrombus group(19 cases)and mixed thrombus group(23 cases,arteriosclerotic plaques with thrombi)based on thrombi's sonographic characteristics and follow-up changes.The two groups were compared in general information,thrombus sonographic features,thrombus follow-up changes,and prognosis.Results There were no significant differ-ences in age,sex,hypertension,diabetes,and atrial fibrillation between the two groups(all P>0.05).The proportion of hyperlipidemia in the pure thrombus group was significantly higher than that in the mixed thrombus group(χ^(2)=6.019,P=0.029).The two groups differed significantly in the lesion's echogenicity(χ^(2)=23.693,P<0.001)and relation with the vessel wall(χ^(2)=27.649,P<0.001),with no significant difference in thrombus activity(P>0.05).No significant differences were found between the pure group and the mixed group in the location of the thrombus,the percentage of vas-cular stenosis or occlusion caused by the thrombus,and thrombus changes and prognosis at follow-up(all P>0.05).Conclusion Ultrasonography provides a noninvasive way to distinguish acute carotid thrombi from atherosclerotic plaques with thrombi by identifying sonographic features and dynamically observing the evolution process of thrombi.

关 键 词：急性颈动脉血栓 颈动脉粥样硬化斑块 超声检查 颈动脉狭窄 血管闭塞 

分 类 号：R445.1[医药卫生—影像医学与核医学]