急性脑梗死患者颈动脉超声造影对斑块稳定性的诊断价值及其与发病机制的相关性研究

发布时间：2018-04-06 23:12

本文选题：脑梗死　切入点：颈动脉超声造影　出处：《首都医科大学》2017年硕士论文

【摘要】：目的:探讨急性前循环脑梗死患者颈动脉超声造影对不稳定斑块的诊断价值及其与脑梗死发病机制和复发的相关性,为二级预防策略的制定提供参考。方法:本研究纳入2015年10月至2016年12月期间,于首都医科大学附属北京天坛医院住院治疗的急性前循环脑梗死患者,病因均为颅内/外大动脉粥样硬化。入组患者发病14天内行头颅MR、梗死灶同侧颈动脉普通超声及超声造影检查,并于90±7天随访缺血性脑卒中复发情况。采用Logistic回归分析超声检查下斑块稳定性与头MR DWI序列所示责任梗死灶形态的相关性,利用受试者工作特征(ROC)曲线计算不稳定斑块对颅内栓塞形态梗死灶的诊断价值,并使用生存分析探讨其对缺血性卒中复发的预测作用。结果:93例脑梗死患者行梗死灶同侧颈动脉超声造影检查,35例(37.6%)合并不稳定斑块。颈动脉超声造影下不稳定斑块是栓塞形态梗死灶的独立危险因素(OR=3.63,95%CI 1.19-11.12,P=0.02),且在不合并颅内大血管病变的患者中相关性更强(OR=5.67,95%CI 1.36-23.67,P=0.02)。相较于普通超声,超声造影下不稳定斑块对颅内栓塞形态梗死灶有中等诊断价值(ROC曲线下面积0.73,P=0.01),可以为脑梗死患者动脉到动脉栓塞机制的诊断提供更多依据。单因素分析时,超声造影下不稳定斑块是脑梗死患者3月内复发的预测因素(P=0.04)。结论:在急性动脉粥样硬化性脑梗死患者中,和普通颈动脉超声相比,超声造影对不稳定斑块的判断更准确,超声造影下斑块稳定性与发病机制和预后相关,对二级预防方案的制定具有参考意义。
[Abstract]:Objective: to investigate the diagnostic value of carotid ultrasonography in patients with acute anterior circulation cerebral infarction (ACI) and its correlation with the pathogenesis and recurrence of cerebral infarction in order to provide reference for the formulation of secondary prevention strategy.Methods: from October 2015 to December 2016, patients with acute anterior circulatory cerebral infarction (ACI) hospitalized in Temple of Heaven Hospital, Beijing affiliated to Capital Medical University, were treated with intracranial / external arteriosclerosis.The patients in the group were examined with head MRR, ipsilateral carotid ultrasound and contrast-enhanced ultrasonography within 14 days of onset, and the recurrence of ischemic stroke was followed up for 90 卤7 days.Using Logistic regression analysis, the correlation between plaque stability and the responsible infarct shape in head Mr DWI sequence was studied. The diagnostic value of unstable plaque in intracranial embolism was calculated by using the operating characteristics of the subjects.Survival analysis was used to investigate its predictive effect on ischemic stroke recurrence.Results 35 cases (37.6%) with unstable plaque were examined by ipsilateral carotid ultrasonography in 93 patients with cerebral infarction.Compared with conventional ultrasound, unstable plaques under contrast-enhanced ultrasound have moderate diagnostic value for cerebral embolism. The area under the ROC curve is 0.73 ~ 0.01, which can provide more evidences for the diagnosis of arterial to artery embolization mechanism in cerebral infarction patients.In univariate analysis, unstable plaques under contrast-enhanced ultrasonography were the predictors of recurrence in patients with cerebral infarction within 3 months.Conclusion: in patients with acute atherosclerotic cerebral infarction, contrast-enhanced ultrasonography is more accurate in judging unstable plaque than common carotid ultrasound, and plaque stability is related to pathogenesis and prognosis.It has reference significance for the formulation of two-level prevention plan.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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