目的 探讨超微血管成像(SMI)技术在评价颈动脉粥样硬化斑块内新生血管情况与其临床症状关系中的价值.方法 选择2015年3月至2017年2月于上海市嘉定区中心医院经超声检查发现颈动脉粥样硬化斑块形成的患者146例,根据是否出现脑血管事件分为有临床症状组96例和无临床症状组50例.应用SMI技术及超声造影(CEUS)技术观察斑块内有无新生血管并进行分级,通过单因素、多因素分析评价斑块内新生血管程度与临床症状的关系;通过一致性分析将SMI技术和GEUS技术进行比较,并分析2种方法的敏感性和特异性.结果 有临床症状组和无临床症状组患者的颈动脉粥样硬化斑块平均厚度分别为(3.09 ±0.79)、(2.89 ±0.49) mm,2组比较差异无统计学意义(P＞0.05);有临床症状组患者中,颈动脉斑块内新生血管形成者80例(83.33％);无临床症状组中,颈动脉斑块内新生血管形成者20例(40.00％);有临床症状组患者颈动脉斑块内新生血管形成者比例显著高于无临床症状组(Z=-6.488,P＜0.05).有临床症状组和无临床症状组患者的颈动脉斑块内新生血管SMI分级与CEUS分级均有较好的一致性(P＜0.05).SMI检查结果中,颈动脉斑块内有血流信号者100例,其中有临床症状组80例,无临床症状组20例;颈动脉斑块内无血流信号者46例,其中有临床症状组16例,无临床症状组30例.GEUS检查结果中,颈动脉斑块内有血流信号者109例,其中有临床症状组81例,无临床症状组28例;颈动脉斑块内无血流信号者37例,其中有临床症状组15例,无临床症状组22例.SMI技术预测发生临床症状的敏感性为83.3％,特异性为40.0％.GEUS预测发生临床症状的敏感性为84.4％,特异性为56.0％.结论 SMI技术可简便易行地检测颈动脉粥样硬化斑块内的新生血管,同时,新生血管的程度与临床症状的发生具有一定的相关性,SMI技术对评价颈动脉斑块内新生血管形成具有重要意义.%Objective To investigate the value of superb micro-vascular imaging (SMI) in evaluating the relationship between neovascularization in carotid atherosclerotic plaque and clinical symptoms.Methods A total of 146 patients with carotid atherosclerotic plaque which were found by ultrasonography were selected from March 2015 to February 2017 in the Central Hospital of Jiading District of Shanghai.The patients were divided into clinical symptom group(n =96) and symptomless group (n =50) according to cerebrovascular events.The neovessels of carotid atherosclerotic plaque was observed and classified by SMI and contrast-enhanced ultrasound (CEUS).The relationship between the degree of neovascularization and clinical symptoms was analyzed by univariate analysis and multivariate analysis.SMI and GEUS were compared by consistency analysis,and the sensitivity and specificity of the two methods were analyzed.Results The average thickness of carotid atherosclerotic plaques in clinical symptoms group and symptomless group was (3.09 ± 0.79) and (2.89 ± 0.49) mm respectively,there was no significant difference between the two groups (P ＞ 0.05).There were 80 (83.33％) patients with neovascularization in carotid atherosclerotic plaque in the clinical symptoms group,and there were 20 (40.00％) patients with neovascularization in carotid atherosclerotic plaque in the symptomless group,the proportion of patients with neovascularization in carotid atherosclerotic plaque in the clinical symptoms group was significantly higher than that in the symptomless group (Z =-6.488,P ＜0.05).The SMI classification was in good agreement with the CEUS classification in the two groups (P ＜ 0.05).SMI showed the blood flow signal within carotid plaque in 100 cases,including 80 cases in the clinical symptoms group and 20 cases in the symptomless group.SMI showed no blood flow signal within the carotid plaques in 46 cases,including 16 cases in the clinical symptoms group and 30 cases in the symptomless group.GEUS showed the blood flow signal within carotid plaque in 109 cases,including 81 cases in the clinical symptoms group and 28 cases in the symptomless group.GEUS showed no blood flow signal within the carotid plaques in 37 cases,including 15 cases in the clinical symptoms group and 22 cases in the symptomless group.The sensitivity and specificity of SMI predicting the occurrence of clinical symptoms was 83.3％ and 40.00％ respectively.The sensitivity and specificity of GEUS predicting the occurrence of clinical symptoms was 84.4％ and 56.00％ respectively.Conclusions SMI can easily detect neovessels in carotid atherosclerotic plaques,and the degree of neovascularization is related to the occurrence of clinical symptoms.SMI technique plays an important role in evaluating the neovascularization in carotid plaques.
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