实时剪切波弹性成像评价急性缺血性脑梗死患者颈动脉僵硬度参数的临床研究

摘要

目的 应用实时剪切波弹性成像(SWE)技术获取急性缺血性脑梗死(AIS)患者颈动脉纵向弹性模量,探讨其评估颈动脉僵硬度的可行性.方法 选取AIS患者179例(AIS组)和同期健康体检者168例(对照组),应用超声射频信号血管内中膜分析技术和血管硬度定量分析技术测量两组双侧颈动脉内-中膜厚度(CIMT)、颈动脉管径(CCAD)及环向弹性模量参数脉搏波传导速度(PWV);SWE技术检测双侧颈动脉浅壁纵向弹性模量参数平均弹性模量的平均值(MEmean)和最大弹性模量的平均值(MEmax);并行ROC和相关性分析.结果 AIS组CIMT、CCAD、PWV、MEmean和MEmax均大于对照组,差异均有统计学意义(均P<0.05).MEmean与年龄、收缩压和PWV呈正相关(r=0.221、0.174、0.776,均P<0.05).CCAD、CIMT、PWV、MEmax和MEmean预测AIS患者的ROC曲线下面积及其相应的95%可信区间分别为0.614(0.561~0.665)、0.605(0.552~0.656)、0.586(0.533~0.638)、0.570(0.517~0.622)及0.550(0.496~0.602);且MEmax预测AIS的曲线下面积大于MEmean预测AIS的曲线下面积,差异有统计学意义(Z=2.556,P=0.011).结论 AIS患者颈动脉僵硬度增加,环向和纵向弹性模量参数评价动脉硬化具有等效性;SWE技术可通过检测颈动脉纵向弹性模量评估颈动脉的僵硬度.%Objective To assess the feasibility of the arterial stiffness using the longitudinal elastic modulus of carotid artery in patients with acute ischemic stroke(AIS) by shear wave elastography(SWE).Methods One hundred and seventy-nine patients with AIS(AIS group ) and 168 healthy control subjects(control group ) were included . Pulse wave velocity (PWV), carotid intima-media thickness(CIMT) and common carotid arterial diameter(CCAD) of bilateral carotid arterials were measured by quality arterial stiffness and quality intima media thickness.The average values of longitudinal average elastic modulus(MEmean) and the maximum elastic modulus(MEmax) in the areas of superficial walls of bilateral carotids were analyzed by SWE.ROC curve and correlation analysis were performed .Results Compared with the control group,the CIMT,CCAD, PWV,MEmean and MEmax in AIS group were increased (all P<0.05).MEmean and MEmax were positively related to age, systolic blood pressure and PWV (r=0.221,0.174,0.776,respectively,all P<0.05). The area under the ROC curves for CCAD,CIMT,PWV,MEmax,MEmean and 95%CI for them were 0.614(0.561~0.665),0.605(0.552~0.656),0.586(0.533~0.638),0.570 (0.517~0.622) and 0.550 (0.496~0.602), respectively. The difference of the area under the ROC curves between the MEmax and MEmean was statistically significant(Z=2.556 , P=0.011). Conclusion Arterial stiffness can be evaluated with longitudinal elastic modulus by SWE.