颈动脉流场改变对斑块稳定性影响及脑梗死分型特点

发布时间：2016-04-25 10:46

摘要：目的：探讨颅外段颈动脉狭窄所致血流动力学变化对斑块稳定性影响；分析脑梗死分型与责任血管狭窄程度、斑块稳定性关系,为脑梗死发病机制、临床诊断、治疗和预防提供重要依据。方法：对168例急性脑梗死患者分别行64排CT头颈部血管成像(computerized tomography  angiograbhy  CTA)及彩色多普勒血流显像仪(Color  Doppler  Flow  Imaging  CDFI)检查，部分经CTA证实为中、重度狭窄及闭塞者于脑梗死恢复期行全脑血管造影检查(digital subtraction anginography )(DSA)，根据其责任血管狭窄程度，将168例患者分成颈动脉正常组、轻度狭窄组、中度狭窄组，重度狭窄组及闭塞组，结合CDFI及CTA评价斑块性质及流场改变，对梗死灶进行OCSP分型，再根据CTA所示脑梗死部位 ,将患者分为皮质、基底节区、放射冠和后循环梗死4种亚型。观察流场改变对斑块稳定性影响并对比不同程度颈动脉狭窄后脑梗死临床分型特点。 结果：168条责任血管，正常17.9%，轻度狭窄22.6%，中度狭窄30.9%，，重度狭窄14.8%，闭塞14.3%，中度狭窄比例最高。狭窄程度大于50%即可导致流场改变，血流速度增快，湍流形成，斑块不稳定性增加，以脂质斑及混合斑比例最高。临床以PACI多见，重度狭窄及闭塞组颈动脉斑块以混合斑多见，临床以分水岭梗死多见。轻度狭窄组，多为纤维斑块，临床以LI多见。结论：颈动脉中度狭窄因特殊的血流流场变化而导致斑块不稳定性增高，易发生动脉－动脉栓塞。

【中图分类号】中图分类号：R743.3                                文献标识码：A

To analysis on the changes of the flow field in the carotid stenosis and its effect on the stability of plaque and classification of cerebral infarction 

Wu xiao ling1, Hao jian ping2，Wang shu zhen1,Yu hong xia1 chi lu xiang 3et al.1. The 251 hospital of PLA, HE BEI zhang jia kou, 075000  2.Kiang bao county hospital, HE BEI kang bao, 076650, 3.Department of Cardiology, Shouthwest Hospital , Third Military Medical University, Chongqing 400038, China

Key  words :  Carotid arteries stenosis, the changes of flow field , the stability of plaque, cerebral infarction OCSP classification

Abstract: objective To abserve  the  changes of  hemodynamic and stability of plaque in extracranial carotid stenosis ,analyse the relationship of classification of cerebral infarction and the degree of stenosis of criminal artery and stability of plaque, for evaluating nosogenesis of cerebral infarction and clinical diagnosis,treatment, prevention search evidence.  Methods: CDFI,CTA,were performed in 168 patients with acute cerebral infarction , some moderate and severe and occlusive carotid artery which were demonstrated by CTA and CDFI were further checked by DSA during convalescence . Totally 168 acute cerebral infarction patients were divided into 5 groups based on the degree of stenosis of duty vessule .To evaluate the stability of plaque and the changes of the flow field with CDFI and CTA, OCSP clinical classification and brain image classification were finish according to CTA. Lesion distributions were classified into cortical infarction, basal ganglion infarction, centrum ovale infarction and posterior infarction.. To abserve the changes of flow field and stability of plaque ,compare the relationship between different degree of stenosis and the classification of lesion of infarction. Result : 168 duty vessel were divided into 5groups.natural 17.9%,mild 22.6%, moderate 30.9%and severe14.8%, and occlusive14.3, the proportionment of moderate stenosis is most .The degrees of stenosis >50% may lead to the changes of flow field ,speedup of the blood flow,the onflow come into being.The instability of plaque is increased ,the lipid plaque and admixture plaque is most .The PACI are  the most in all moderate group. The admixture plaque are the most in the severe and occlusive group and the PACI , TACI are t are the also the most in the severe and occlusive groups.fibrous plaque are most in mild groups,LI are most in this group,Conclusions:.Moderate carotid stenosis may lead to increase of instability of plaque as a result of the changes of flow field ,It is prone to find the artery-artery embolism.

颈动脉因其特殊的解剖结构而成为缺血性脑血管疾病的独立危险因素。在以往的研究中[1]，更多关注颈动脉狭窄严重程度，>70%的颈动脉粥样硬化性狭窄认为是血管介入治疗或CEA的指征。但近年文献更多关注斑块性质，认为易损斑是导致脑血管病发生的主要因素[2、3]，而血管狭窄程度并不能单独预测卒中风险[4]，心血管研究认为：<70%甚至<50%的非限制性的血流狭窄未来引起斑块破裂和血栓形成的病例,比更严重狭窄的斑块产生破裂的病例多。Virmani R[5]对低级别狭窄颈动脉进行研究，认为狭窄程度<70%更多存在不稳定斑块，而更多发生在狭窄程度<50%的薄纤维帽粥样瘤被认为是斑块破裂的前期病损[６]。为探讨不同程度血管狭窄所引起的流场改变是否影响斑块稳定性及与脑梗死发生相关性，我们对168例急性脑梗塞患者颅颈血管行CDFI及DSA、CTA检查，结果如下：

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