超声对绝经后颈动脉斑块性质的评估及其预测脑血管意外的价值

摘要

目的 分析超声对绝经后颈动脉斑块性质的评估及脑血管意外的预测价值.方法 将2016年1月至2017年7月衡水市哈励逊国际和平医院收治的100例绝经后颈动脉硬化斑块患者根据是否发生脑血管意外分为无症状组60例和脑血管意外组40例,均进行二维超声扫查及彩色多普勒检查,观察斑块数目、大小、形状、回声强度、钙化及血流信号,根据超声检查获取的颈动脉斑块回声特点分析斑块性质,并采用Logistic回归分析其与脑血管意外症状的关系.结果 脑血管意外组患者检出斑块总数为76个,易损斑块占69.74%,均明显高于无症状组的68个和41.18%,差异均有统计学意义(P<0.05);与无症状组患者比较,脑血管意外组患者的颈动脉内膜-中膜厚(IMT)、斑块厚度、斑块面积、截面积狭窄率显著增大[(1.09±0.19)mm vs(0.82±0.14)mm、(3.04±0.58)mm vs(2.75±0.23)mm、(0.56± 0.17)mm2vs(0.46±0.11)mm2、(57.13±10.21)% vs(50.64±9.20)%],差异均有统计学意义(P<0.05);脑血管意外组患者的斑块内新生血管分级以Ⅰ级、Ⅱ级为主,占75.00%,明显高于无症状组的48.53%,差异有统计学意义(P<0.05);颈动脉斑块性质与脑血管意外症状关联度最强(OR=3.481),IMT关联度强(OR=3.114),斑块厚度、斑块面积、截面积狭窄、斑块内新生血管分级关联度中等(OR=1.584、1.645、2.365).结论 超声检查可评估绝经后颈动脉斑块性质,且斑块性质、厚度、面积等对预测脑血管意外有重要价值.%Objective To analyze the effect of ultrasound in evaluating the plaque properties of postmenopaus-al carotid artery and its predicting value in cerebrovascular accident.Methods A total of 100 patients with postmeno-pausal carotid artery atherosclerotic plaque who were treated in the Harrison International Peace Hospital of Hengshui City from January 2016 to July 2017 were divided into the asymptomatic group(n=60)and the cerebrovascular accident group(n=40)according to whether cerebrovascular accident occurs.All patients were given the two-dimensional ultra-sound scanning and color Doppler examination. The plaque number, size and shape, echo intensity, calcification and blood flow signal,and the plaque properties were analyzed according to the carotid artery plaque echo characteristics by ultrasound acquisition. Logistic regression analysis was used to analyze its relationship with cerebrovascular accidents symptoms.Results The total number of plaques detection and the proportion of vulnerable plaques in the cerebrovascu-lar accident group were significantly higher than those in the asymptomatic group(76 vs 68,69.74% vs 41.18%),P<0.05. The intima-media thickness(IMT),plaque thickness,plaque area,and cross-sectional area stenosis rate in the cerebrovas-cular accident group were significantly higher than those in asymptomatic group:(1.09±0.19)mm vs(0.82±0.14)mm, (3.04±0.58)mm vs(2.75±0.23)mm,(0.56±0.17)mm2vs(0.46±0.11)mm2,(57.13±10.21)% vs(50.64±9.20)%,P<0.05. The neovascularization grade of the cerebrovascular accident group was predominantly gradeⅠand gradeⅡ,account-ing for 75.00%, which was significantly higher than 48.53% of the asymptomatic group (P<0.05). The carotid artery plaque properties was the strongest correlated with cerebrovascular accident symptoms(OR=3.481),strongly correlated with IMT(OR=3.114), moderately correlated with the plaque thickness, plaque area, cross-sectional area stenosis, and neovascularization grade(OR=1.584,1.645,2.355).Conclusion Ultrasound examination can assess the postmenopaus-al carotid plaque properties,and the plaque nature,thickness and area have important values in predicting the cerebrovas-cular accident.