经皮超声治疗颈动脉粥样硬化斑块的临床疗效观察

发布时间：2018-05-13 16:43

本文选题：颈动脉 + 粥样硬化斑块　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的研究颈动脉粥样硬化斑块(Carotid atherosclerotic plaque)经过经皮超声治疗前后斑块大小的变化,以及颈动脉粥样硬化斑块形成的相关危险因素与经皮超声治疗前后颈动脉粥样硬化斑块大小变化的关系。方法根据纳入及排除标准,收集2015年5月~2016年5月来自大连市中心医院神经内科的住院的并且经颈动脉超声检查有颈动脉粥样硬化斑块或颈动脉轻中度狭窄的患者,共60例,男性29例,女性31例,年龄40-85岁,平均年龄65.07±8.74岁。共分为两组,A组(n=30),即单侧斑块组,主要为单侧颈动脉粥样硬化斑块者,给予超声治疗;B组(n=30),即双侧斑块组,主要为双侧颈动脉粥样硬化斑块者或轻中度狭窄的患者,该组分为两个亚组:B1组:一侧给予单纯药物治疗(阿托伐他汀钙片20mg+阿司匹林肠溶片100mg);B2组:另一侧在药物治疗基础上联合经皮超声治疗(阿托伐他汀钙片20mg+阿司匹林肠溶片100mg+超声治疗)。所有患者均记录年龄、性别、体重、身高、吸烟史、高血压病史、糖尿病史、脑梗死病史等一般资料,并且记录治疗前后总胆固醇(total cholesterol,TC)、纤维蛋白原(Fibrinogen,FIB)、甘油三酯(triacylgly-cerol,TG)、D-二聚体、高密度脂蛋白胆固醇(high-density lipoprotein-cholesterol,HDL-C)、同型半胱氨酸(homocysteine,Hcy)、低密度脂蛋白胆固醇(Low-density lipoprotein-cholesterol,LDL-C)、超敏C反应蛋白(High Sensitivity C-reaction Protein,Hs-CRP)水平等血液指标的检测结果以及记录治疗前颈动脉粥样硬化斑块的长度(Length before treatment,Lb)及厚度(Thickness before treatment,Tb)、治疗后斑块的长度(Length after treatment,La)及厚度(Thickness after treatment,Ta)、斑块的长度变化(Lb-La,,△L)及厚度变化(Tb-Ta,△T)。运用SPSS 20.0统计分析软件对数据进行处理,P0.05为差异有统计学意义。结果1、A组与B组的一般资料,即性别、年龄、糖尿病史、脑梗死病史、体重指数(BMI)、吸烟史、高血压病史,以及治疗前FIB、D-二聚体、Hs-CRP、Hcy、TC、TG、HDL-C、LDL-C相比无统计学差异。2、La与Lb相比及Ta与Tb相比,A组、B2组均减小,且有显著统计学差异(P0.01)。B1组治疗后斑块大小较治疗前无明显减小,无统计学差异。3、A组治疗后TG、LDL-C、Hcy、FIB、Hs-CRP与治疗前相比有所减小,但无统计学差异。治疗后TC较治疗前有所减小,治疗后HDL-C、D-二聚体较治疗前有所增大,均具有显著统计学差异(P0.05)。B1、B2两组治疗后TC、Hcy、TG、FIB、LDL-C、D-二聚体、Hs-CRP与治疗前相比无统计学差异。治疗后HDL-C较治疗前有所增大,具有显著统计学差异(P0.05)。4、A组与B2组治疗前长度及厚度分别相比,均无统计学差异。A组与B2组的△L相比,有显著统计学差异(P0.01),A组与B2组的△T相比,有显著统计学差异(P0.05)。5、A组与B2组的△L百分比相比,有显著统计学差异(P0.05),A组与B2组的△T百分比相比,有显著统计学差异(P0.01)。6、采用多因素线性回归分析示Tb对△L及△T均有影响(P0.01)。性别、年龄、BMI、糖尿病史、高血压病史、脑梗死病史、吸烟史、TC、FIB、TG、、Hcy、HDL-C、D-二聚体、LDL-C、Hs-CRP对治疗前后斑块的大小变化无显著影响。结论1、经皮超声治疗可以减小颈动脉粥样硬化斑块的大小。2、经皮超声辅助药物治疗斑块的效果更佳。3、治疗前斑块的厚度是经皮超声治疗疗效的影响因素。性别、年龄、体重指数、糖尿病史、高血压史、脑梗死病史、吸烟史、总胆固醇、纤维蛋白原、甘油三酯、同型半胱氨酸、高密度脂蛋白胆固醇、D-二聚体、低密度脂蛋白胆固醇、超敏C反应蛋白等水平对疗效无显著影响。
[Abstract]:Objective to study the changes in the size of plaque in the carotid atherosclerotic plaque (Carotid atherosclerotic plaque) before and after percutaneous ultrasound therapy, as well as the relationship between the risk factors for the formation of carotid atherosclerotic plaques and the changes in the size of carotid atherosclerotic plaque before and after percutaneous ultrasound therapy. Methods according to the inclusion and exclusion criteria, the methods were collected. A total of 60 patients, 29 men, 31 women, 40-85 years old and 65.07 + 8.74 years old, were divided into two groups, group A (n=30), that is, the A group (n=30), that is, the unilateral plaque group, from the inpatients of the neurology department of Dalian Central Hospital in May 2015. Patients with unilateral carotid atherosclerotic plaques were treated with ultrasound; B group (n=30), bilateral plaque group, mainly bilateral carotid atherosclerotic plaques or mild to moderate stenosis, was divided into two subgroups: group B1: one side was given a single drug treatment (Atorvastatin Calcium Tablets 20mg+ Aspirin Enteric-coated Tablets 100mg); the other side was in the other side of the drug. Combined percutaneous ultrasound therapy (Atorvastatin Calcium Tablets 20mg+ Aspirin Enteric-coated Tablets 100mg+ ultrasound). All patients recorded age, sex, weight, height, smoking history, hypertension history, diabetes history, cerebral infarction history and other general data, and recorded the total cholesterol (total cholesterol, TC), fibrous eggs before and after treatment. Bai Yuan (Fibrinogen, FIB), triglyceride (triacylgly-cerol, TG), D- two polymer, high density lipoprotein cholesterol (high-density lipoprotein-cholesterol, HDL-C), homocysteine (homocysteine, Hcy), low density lipoprotein cholesterol (Low-density lipoprotein-cholesterol), hypersensitive reactive protein Otein, Hs-CRP) level of blood indexes and the length of carotid atherosclerotic plaques before treatment (Length before treatment, Lb) and thickness (Thickness before treatment, Tb). The length of plaque after treatment (Length after) and thickness And the thickness change (Tb-Ta, Delta T). Using SPSS 20 statistical analysis software to deal with the data, P0.05 was statistically significant. Results 1, the general data of group A and B group, namely, sex, age, diabetes history, cerebral infarction history, body mass index (BMI), smoking history, hypertension history, and FIB, D- two polymer before treatment, Hs-CRP, Hcy, TC, TC Compared to -C and Lb, compared with Lb and Ta and Tb, A group and B2 group decreased, and there was significant statistical difference (P0.01), there was no significant reduction in plaque size after treatment in.B1 group (P0.01), no statistical difference was observed before treatment, and there was no statistical difference before treatment, but there was no statistical difference. Before treatment, the HDL-C, D- two polymer increased, and all had significant statistical difference (P0.05).B1, B2 two groups after treatment, TC, Hcy, TG, FIB, LDL-C, D- two polymer, Hs-CRP and before treatment, there was no statistical difference. There was no significant difference in the length and thickness of the.A group compared with the B2 group (P0.01). Compared with the B2 group, there were significant statistical differences (P0.05).5 compared with the B2 group (P0.05), and there were significant differences in the delta L percentage between the A group and the B2 group (P0.05), and there were significant differences in the percentage of delta L between the.A group and the B2 group. 1).6, using multiple factor linear regression analysis showed that Tb had effect on Delta L and delta T (P0.01). Sex, age, BMI, diabetes history, hypertension history, cerebral infarction history, smoking history, TC, FIB, TG, Hcy, HDL-C, D- two polymer, there was no significant effect on the change of plaque size before and after treatment. Conclusion 1, percutaneous ultrasound therapy can reduce carotid porridge The size of the atherosclerotic plaque is.2, the effect of the percutaneous ultrasound assisted drug therapy is better.3. The thickness of the plaque before treatment is the influencing factor of the percutaneous ultrasound therapy. Sex, age, body mass index, diabetes history, hypertension history, history of cerebral infarction, smoking history, total cholesterol, fibrinogen, triglyceride, homocysteine, high density Lipoprotein cholesterol, D- two dimer, low density lipoprotein cholesterol and high sensitivity C reactive protein had no significant effect on the curative effect.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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