颈动脉斑块易损性与冠状动脉病变严重程度的相关性研究

发布时间：2018-04-25 02:42

  本文选题：超声 + 颈动脉硬化斑块　； 参考：《首都医科大学》2017年硕士论文

【摘要】：目的通过利用超声评估颈动脉粥样硬化斑块卒中风险等级评分与冠状动脉病变严重程度的相关性研究,探讨凭借颈动脉斑块易损性预测冠状动脉病变严重程度的临床价值,达到“心脑血管疾病同防、同治、同康复”的目的。方法选取2014年9月至2016年11月于首都医科大学附属北京安贞医院心内科、心外科经选择性冠状动脉造影检查的住院患者117名,按冠状动脉造影结果分为冠状动脉轻、中、重度狭窄组;根据患者冠状动脉病变累及支数将上述患者分为单支、双支组和三支病变组。利用常规超声检测患者颈动脉斑块回声类型、形态及大小及颈动脉管腔狭窄程度;微血流成像技术(SMI)联合超声造影技术(CEUS)检测颈动脉斑块内新生血管情况,按照颈动脉斑块性质将上述患者分为易损斑块组与稳定斑块组,按照颈动脉管腔狭窄程度将上述患者分为轻度狭窄组与中度以上狭窄组,分别比较两组患者冠状动脉狭窄严重程度的Gensini评分差异性。评价每位患者颈动脉斑块卒中风险等级,比较不同风险等级组患者冠状动脉狭窄严重程度的Gensini评分差异性。结果1、颈动脉易损斑块检出情况:117名冠心病患者经颈动脉超声检查,共检出颈动脉易损斑块45个,其中新生血管形成颈动脉斑块40个,含脂质坏死核心斑块5个,溃疡斑8个,水母斑3个,纤维帽破裂斑块1个,斑块表面细小血栓形成1个。冠状动脉轻、中、重度狭窄组颈动脉易损斑块检出率分别为21.05%%、26.92%、47.22%。冠状动脉单支、双支、三支病变组颈动脉易损斑块检出率分别为25.71%、28.57%、55.31%。2、颈动脉易损斑块组冠状动脉狭窄严重程度Gensini评分明显高于颈动脉稳定斑块组(p0.05)。3、颈动脉管腔轻度狭窄组(30%)与中度以上狭窄组(≥30%)的冠状动脉狭窄严重程度Gensini评分差异无统计学意义。4、颈动脉斑块高度、极高度风险等级组患者冠脉Gensini积分明显高于低度、中度风险组,有统计学意义(p0.05)。结论冠状动脉硬化病变程度越重,其颈动脉易损斑块发生率越高;超声评估颈动脉斑块卒中风险等级越高,冠状动脉病变越严重。颈动脉斑块性质及斑块发生缺血性脑卒中风险等级在一定程度上能够推测冠状动脉硬化狭窄严重程度,预示其急性冠脉综合征发生、发展风险相应增加。
[Abstract]:Objective to evaluate the clinical value of carotid plaque vulnerability in predicting the severity of coronary artery disease by using ultrasound to evaluate the correlation between the risk score of carotid atherosclerotic plaque stroke and the severity of coronary artery disease. To achieve the purpose of "cardio-cerebrovascular disease with prevention, treatment and rehabilitation". Methods from September 2014 to November 2016, 117 inpatients who underwent selective coronary angiography in Department of Cardiology, Beijing Anzhen Hospital, affiliated to Capital Medical University, were divided into mild and moderate coronary arteries according to the results of coronary angiography. According to the number of coronary artery involvement, the patients were divided into single vessel group, double vessel group and three vessel group. The types, shape and size of carotid plaques and the degree of carotid stenosis were detected by conventional ultrasound, and the angiogenesis in carotid plaques was detected by microflow imaging (SMI) and contrast-enhanced ultrasonography (CEUSS). According to the nature of carotid plaques, the patients were divided into vulnerable plaque group and stable plaque group. According to the degree of carotid artery stenosis, the patients were divided into mild stenosis group and moderate stenosis group. The Gensini scores of the severity of coronary artery stenosis were compared between the two groups. To evaluate the risk of carotid plaque stroke in each patient and compare the Gensini scores of coronary artery stenosis severity in different risk groups. Results 1. Carotid vulnerable plaques were detected in 117 patients with coronary heart disease by carotid ultrasound. A total of 45 carotid vulnerable plaques were detected, including 40 carotid plaques formed by neovascularization, 5 core plaques with lipid necrosis and 8 ulcer plaques. There were 3 spots of jellyfish, 1 plaque of rupture of fibrous cap and 1 small thrombus on plaque surface. The detection rate of vulnerable plaque of carotid artery in patients with mild, moderate and severe coronary artery stenosis was 21.05 and 26.92, respectively. Single coronary artery, double coronary artery, The detection rate of carotid artery vulnerable plaque in the three vessel lesion group was 25.71 and 28.577.The Gensini score of coronary artery stenosis in the carotid artery vulnerable plaque group was significantly higher than that in the carotid artery stable plaque group (P 0.05. 3 and 30% in the mild carotid artery stenosis group) and more than moderate in the carotid artery vulnerable plaque group (P < 0.05) and the severity of coronary artery stenosis in the carotid artery vulnerable plaque group was significantly higher than that in the carotid artery stable plaque group. There was no significant difference in Gensini score of severity of coronary artery stenosis in narrow group (鈮，

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