超声造影技术在多发大动脉炎活动性和治疗效果评估中的应用价值  

The Application Value of Contrast-Enhanced Ultrasound in Evaluating the Activity and Treatment Effect of Takayasu Arteritis Involving the Carotid Artery

作　　者：侯颖 张岩 苏小佩 胡伟 李爽 袁丽君 Hou Ying;Zhang Yan;Su Xiaopei;Hu Wei;Li Shuang;Yuan Lijun(Department of Ultrasound,The Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,China;Department of Rheumatology and Immunology,The Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院超声诊断科,西安市710038 [2]空军军医大学第二附属医院风湿免疫科,西安市710038

出　　处：《中国超声医学杂志》2023年第10期1171-1175,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的通过血管超声造影(CEUS)技术评价累及颈动脉的多发大动脉炎(TA)患者增厚管壁内的新生血管情况,为评估病变活动性和治疗效果提供客观依据。方法纳入来我院就诊、进行了2次以上常规颈部血管超声并同时进行了CEUS的TA患者65例。临床疾病活动性评估采用印度2010-A(ITAS-A)评分系统。比较免疫抑制剂和激素治疗前后(治疗时间3~67个月,中位时间16.5个月)各参数变化,并评价其相关性。结果患者治疗后ITAS-A分数显著下降[(6.3±3.6)vs.(3.2±2.7),P<0.0001],颈动脉CEUS分级[(2.22±0.76)vs.(1.55±0.60),P<0.0001]显著降低,管壁平均厚度明显减小[(2.49±1.04)mm vs.(1.92±0.75)mm,P=0.001],红细胞沉降率(ESR)[(39.50±35.14)mm/h vs.(15.68±19.78)mm/h,P<0.0001]和hs-CRP[(25.04±36.97)mg/L vs.(7.10±18.45)mg/L,P=0.001]明显下降。颈动脉CEUS分级与ITAS-A分数、管壁平均厚度、血沉、超敏C反应蛋白(hs-CRP)显著相关(r=0.55、0.62、0.51、0.46,P<0.0001)。患者症状明显减轻,没有出现明显不良反应及并发症。结论CEUS技术可以及时、直观、准确评估大动脉炎管壁新生血管情况及治疗前后变化,提示该技术可作为评估疾病活动性及治疗效果的客观方法,可为临床诊疗方案制定和调整提供可靠的可视化客观依据。Objective To evaluate the neovascularization in the thickened wall of takayasu arteritis(TA)patients with carotid artery involvement using contrast-enhanced ultrasonography,(CEUS),and to provide objective basis for evaluating lesion activity and treatment effectiveness.Methods A total of 65 TA patients were enrolled,all of whom underwent more than two routine carotid artery ultrasounds and CEUS simultaneously.The clinical evaluation of disease activity was evaluated with Indian takayasu score 2010-A(ITAS-A).The changes of parameters before and after immunosuppressive drug and hormone medicine treatment(treatment time 3-67 months,median time 16.5 months)were compared,and their correlations were evaluated.Results Post-treatment,the ITAS-A score of the patients significantly decreased[(6.3±3.6)vs.(3.2±2.7),P<0.0001],the carotid CEUS grading[(2.22±0.76)mm vs.(1.55±0.60)mm,P<0.0001] significantly decreased,and the average thickness of the carotid artery wall significantly decreased[(2.49±1.04)mm vs.(1.92±0.75)mm,P=0.001].The erythrocyte sedimentation rate(ESR)[(39.50±35.14)mm/hvs.(15.68±19.78)mm/h,P<0.0001]and hs-CRP[(25.04±36.97)mg/Lvs.(7.10±18.45)mg/L,P=0.001] decreased significantly.After treatment,carotid artery CEUS grading was significantly decrease,which was significantly correlated with ITAS-A score,average wall thickness,ESR and hs-CRP(r=0.55,0.62,0.51,0.46,P<0.0001).The symptoms of the patients were significantly relieved,and there were no adverse reactions and complications.Conclusions TA patients require long-term follow-up to observe therapeutic effects.CEUS technology can timely and intuitively evaluate the neovascularization of the carotid wall and the changes pre-and post-treatment in TA patients.This indicates that CEUS can be used as an objective method to evaluate disease activity and treatment effectiveness,and can provide reliable visual and objective basis for the formulation and adjustment of clinical diagnosis and treatment plans.

关 键 词：多发大动脉炎 疗效评估 超声造影技术 活动性 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543[医药卫生—诊断学]