三维超声定量评价颈动脉斑块药物治疗效果的研究

发布时间：2018-03-11 01:19

  本文选题：颈动脉斑块　切入点：三维超声(3D-US)　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:应用三维颈动脉超声(Three dimensional ultrasound,3D-US)获取颈动脉斑块患者三维图像数据,应用三维超声斑块定量分析软件(vessel plaque quantification,VPQ)得出:斑块灰阶中位数值(Gray scale median,GSM)、标准化管壁指数(Normalized wall index,NWI)以及斑块体积(Plaque volume,PV)等定量参数,对比分析药物治疗前后斑块各参数的变化情况,旨在探讨基于3D-US的GSM、NWI以及PV参数在定量评价颈动脉斑块药物治疗效果中的应用价值,并分析GSM、NWI及PV与血脂(TC、TG、LDL-C、HDL-C)、吸烟等危险因素的关系。方法:1.研究对象:收集2015年5-10月陆军总医院神经内科就诊的颈动脉斑块患者81例共计93枚斑块,治疗前接受颈动脉3D-US、3.0T MRI和血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)水平检测。接受阿托伐他汀治疗(20mg/d)6~12个月进行3D-US和血脂的随访。共有55例患者共计62枚斑块纳入随访,平均随访时间10.8个月。2.患者分组:(1)根据治疗前MRI及3D-US的GSM值将斑块分为低风险组(28例)、中等风险组(13例)和高风险组(21例);(2)根据患者药物治疗期间是否戒烟分为:戒烟组(52例)和未戒烟组(10例)。3.应用三维超声VPQ分析软件获取各组斑块的灰阶中位数值(GSM)、标准化管壁指数(NWI)以及斑块体积(PV)参数,对比分析药物治疗前后各组内、组间血脂和各参数的变化并分析他们之间的关系。结果:1.治疗前血清TC、TG、LDL-C、HDL-C水平各组间无显著差异,治疗后TC和LDL-C水平明显减低(P0.05),TG、HDL-C水平无显著变化;治疗后高风险组LDL-C水平明显低于低风险、中等风险组,差异有统计学意义(P0.05)。2.高风险组和中等风险组GSM值治疗后较治疗前显著升高(33.87±6.53 vs27.50±7.82、47.35±5.42 vs 44.56±4.36,P0.05)而低风险组斑块GSM值升高不显著(63.13±10.41 vs 62.01±10.68,P0.05);高风险组NWI治疗后较治疗前显著降低(0.40±0.08 vs 0.44±0.07,P0.05),而中等风险组及低风险组NWI值药物治疗前后变化不明显(0.43±0.09 vs 0.43±0.09、0.46±0.10 vs 0.45±0.07,P0.05);高风险组PV治疗后较治疗前显著降低(0.25±0.09 vs 0.29±0.08,P0.05),而中等风险组及低风险组NWI值药物治疗前后变化不明显(0.28±0.18 vs 0.28±0.18、0.27±0.17 vs 0.26±0.16,P0.05)。3.治疗前后三组GSM的差值与治疗前后LDL-C差值呈负相关(r=-0.28,p=0.03),而与TC、TG、HDL-C不相关。治疗前后三组NWI、PV的差值与血脂(TC、TG、LDL-C、HDL-C)差值均不相关(P0.05)。4.戒烟组GSM值治疗后较治疗前显著升高(51.14±15.64 vs 46.85±18.47,P0.05),而未戒烟组GSM值治疗后较治疗前显著降低(43.34±12.96 vs 45.58±12.76,P0.05)。戒烟组NWI值治疗后较治疗前显著降低(0.42±0.08 vs 0.44±0.07,P0.05),而未戒烟组NWI值治疗后较治疗前显著升高(0.54±0.09 vs0.46±0.09,P0.05)。戒烟组PV值治疗后较治疗前显著降低(0.28±0.17 vs0.30±0.15,P0.05),而未戒烟组NWI值治疗后较治疗前显著升高(0.31±0.09vs 0.23±0.10,P0.05)。结论:3D-US所获GSM、NWI以及PV值可以作为临床评价颈动脉斑块药物治疗效果的可靠指标,尤其对于中等风险及高风险的颈动脉斑块应用价值更大。三项指标中,GSM的敏感性更好,具有更好的临床运用价值。戒烟组和未戒烟组三项参数均出现了反方向的变化,表明吸烟在斑块药物治疗过程中具有负面影响。
[Abstract]:Objective: the application of three-dimensional ultrasound of carotid artery (Three dimensional ultrasound, 3D-US) for carotid plaque in three-dimensional image data analysis software, using 3D ultrasound plaque (vessel plaque quantification, quantitative VPQ) that a plaque in the gray scale numerical (Gray scale median, GSM), the standard wall index (Normalized wall index, NWI) and the plaque volume (Plaque volume, PV) and other quantitative parameters change comparative analysis before and after drug treatment of different patch parameters, to investigate 3D-US based on GSM, the application value of NWI and PV parameter in quantitative assessment of carotid plaque in drug therapy, and analysis of GSM, NWI and PV (TC, TG, and blood lipid LDL-C, HDL-C), the relationship between smoking and other risk factors. Methods: 1. subjects: from 2015 5-10 months the Army General Hospital neurology clinic of the carotid plaque in 81 patients a total of 93 gold plaque underwent carotid artery before treatment 3D-US, 3.0T, MRI and serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) levels were detected. Treated with atorvastatin (20mg/d) of 3D-US and serum lipids in 6~12 months of follow-up. There were 55 cases of patients with a total of 62 gold plaque in the follow-up, the mean follow-up time was 10.8 months.2. patients were divided into two groups: (1) according to MRI before treatment and 3D-US GSM values were divided into low risk group (28 cases), moderate risk group (13 cases) and high risk group (21 cases); (2) according to the patients during the medication would stop smoking points as smoking cessation group (52 cases) and non smoking group (10 cases) a numerical application of three dimensional ultrasound gray scale.3. VPQ analysis software to obtain each plaque in (GSM), standard wall index (NWI) and plaque volume (PV) parameters, comparative analysis of before and after treatment in each group, and analyze the changes between the groups blood lipids and parameters between them Results: 1.. Serum TC, TG, LDL-C, HDL-C had no significant difference between groups TC and LDL-C level, was significantly reduced after treatment (P0.05, TG), no significant changes in HDL-C levels after treatment; the high risk group of LDL-C were significantly lower than those of low risk, medium risk group, the difference was statistically significant (P0.05.2.) high risk group and moderate risk group GSM value after treatment was significantly higher than that before treatment (33.87 + 6.53 vs27.50 + 44.56 7.82,47.35 + 5.42 vs + 4.36, P0.05) and low risk group GSM plaque is not significantly increased (63.13 + 10.41 vs 62.01 + 10.68, P0.05); high risk group NWI after treatment reduced (0.40 + 0.08 vs 0.44 + 0.07, P0.05), and moderate risk group and low risk group NWI value before and after drug treatment did not change significantly (0.43 + 0.09 vs 0.43 + 0.09,0.46 + 0.10 vs 0.45 + 0.07, P0.05); high risk group PV after treatment were significantly lower than those before treatment (0.25 + 0.09 vs 0.29 + 0.08 ,P0.05),鑰屼腑绛夐�庨櫓缁勫強浣庨�庨櫓缁凬WI鍊艰嵂鐗╂不鐤楀墠鍚庡彉鍖栦笉鏄庢樉(0.28卤0.18 vs 0.28卤0.18,0.27卤0.17 vs 0.26卤0.16,P0.05).3.娌荤枟鍓嶅悗涓夌粍GSM鐨勫樊鍊间笌娌荤枟鍓嶅悗LDL-C宸�澹�

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