MDCTA对颈动脉粥样硬化性斑块的组分特征分析及临床意义

发布时间：2019-06-12 11:30

【摘要】：目的:通过多排螺旋CT血管造影技术(Multi Director Computed Tomography Angiography,MDCTA)获取颈动脉粥样硬化性斑块的形态学特征,结合斑块的成分特征,探讨其与脑梗塞及脑出血发生的相关性,为颈动脉粥样硬化性斑块的风险评估和脑梗塞及脑出血患者的防治提供参考。材料与方法:收集高密市人民医院自2013年11月至2016年11月收住的颈动脉粥样硬化引起动脉狭窄的400例患者,排除非动脉粥样硬化性血管病,如心源性脑梗塞、糖尿病、烟雾病、动脉炎等。采用Philips 64排128层螺旋CT进行MDCTA检查。通过CT后处理技术测量斑块体积、CT值、管腔狭窄程度等指标,并按CT值进行分类,收集相关临床资料。分析各斑块临床特点、脑出血与脑梗塞患者斑块组分特征,以及管腔狭窄度与脑梗塞发生的相关性。结果:1.根据斑块类型共包含纤维斑块型52例,脂肪斑块型60例,钙化斑块型80例,混合斑块型208例。所有病例中合并溃疡的斑块129例,82%的合并溃疡斑块出现在脑梗塞患者中。同时,脑梗塞患者的血糖、三酰甘油及总胆固醇的含量显著高于对照组。2.有60%的钙化斑块出现在脑出血患者中。脑出血患者中钙化斑块比例显著高于脑梗塞患者(P0.05),出现钙化斑块的脑出血患者的血压水平显著升高。3.脂肪斑块、纤维斑块与混合斑块的分布在脑出血及脑梗塞中无显著差异(P0.05)。4.在轻度颈动脉狭窄组中,脂肪斑块体积/斑块体积百分比(以下简称脂肪斑块体积百分比)与脑梗塞发生呈正相关(OR=2.24,95%CI:1.17-4.67;P0.001),而钙化斑块体积/斑块体积百分比(以下简称钙化斑块体积百分比)与脑梗塞发生呈负相关(OR=0.36,95%CI:0.29-0.83;P=0.007)。在中重度颈动脉狭窄组中,脂肪斑块体积百分比亦与脑梗塞发生呈正相关(OR=1.63,95%CI:1.13-4.15;P=0.005),而钙化斑块体积百分比与脑梗塞发生无显著关系(OR=0.89,95%CI:0.53-2.17;P=0.31)。结论:脂肪斑块体积百分比与脑梗塞的发生率呈正相关,溃疡斑块导致脑梗塞的发生率明显高于其它斑块,钙化斑块多容易出现在脑出血患者群体中。MDCTA可以对颈动脉粥样硬化斑块的组分特征进行分析,对其易损性、不稳定性进行评估,对颈动脉粥样硬化性斑块的风险评估和脑梗塞及脑出血患者的防治具有积极参考价值。
[Abstract]:Objective: to obtain the morphological characteristics of carotid atherosclerotic plaques by multi-slice spiral CT angiography (Multi Director Computed Tomography Angiography,MDCTA), and to explore the correlation between carotid atherosclerotic plaques and cerebral infarction and cerebral hemorrhage, so as to provide reference for risk assessment of carotid atherosclerotic plaques and prevention and treatment of cerebral infarction and cerebral hemorrhage. Materials and methods: 400 patients with carotid atherosclerosis caused by atherosclerosis in Gaomi people's Hospital from November 2013 to November 2016 were collected and excluded from non-atherogenic vascular diseases, such as cardiogenic cerebral infarction, diabetes mellitus, moyamoya disease, arteritis and so on. Philips 64-row 128-slice spiral CT was used for MDCTA examination. Plaque volume, CT value and lumen stenosis were measured by CT post-processing technique, and classified according to CT value, and the related clinical data were collected. The clinical characteristics of each plaque, the characteristics of plaque components in patients with cerebral hemorrhage and cerebral infarction, and the correlation between lumen stenosis and the occurrence of cerebral infarction were analyzed. Result: 1. According to the plaque type, there were 52 cases of fiber plaque type, 60 cases of fat plaque type, 80 cases of calcified plaque type and 208 cases of mixed plaque type. In all cases, 129 cases were complicated with ulcer plaques, 82% of them were complicated with ulcer plaques in patients with cerebral infarction. At the same time, the contents of blood glucose, triacylglycerol and total cholesterol in patients with cerebral infarction were significantly higher than those in the control group. 2. 60% of calcified plaques occurred in patients with cerebral hemorrhage. The proportion of calcified plaques in patients with cerebral hemorrhage was significantly higher than that in patients with cerebral infarction (P 0.05). The blood pressure level in patients with cerebral hemorrhage with calcified plaques was significantly higher than that in patients with cerebral infarction. There was no significant difference in the distribution of fat plaques, fibroplaques and mixed plaques in cerebral hemorrhage and cerebral infarction (P 0.05). 4. In mild carotid stenosis group, fat plaque volume / plaque volume percentage (hereinafter referred to as fat plaque volume percentage) was positively correlated with cerebral infarction (OR=2.24,95%CI:1.17-4.67;P0.001), while calcified plaque volume / plaque volume percentage (hereinafter referred to as calcified plaque volume percentage) was negatively correlated with cerebral infarction (OR=0.36,95%CI:0.29-0.83;P=0.007). In moderate and severe carotid stenosis group, the percentage of fat plaque volume was also positively correlated with the occurrence of cerebral infarction (OR=1.63,95%CI:1.13-4.15;P=0.005), but the percentage of calcified plaque volume was not significantly correlated with the occurrence of cerebral infarction (OR=0.89,95%CI:0.53-2.17;P=0.31). Conclusion: the percentage of fat plaques is positively correlated with the incidence of cerebral infarction. The incidence of cerebral infarction caused by ulcer plaques is significantly higher than that of other plaques. Calcified plaques are more likely to appear in the group of patients with cerebral hemorrhage. MDCTA can analyze the component characteristics of carotid atherosclerotic plaques and evaluate its vulnerability and instability. It has positive reference value for risk assessment of carotid atherosclerotic plaques and prevention and treatment of cerebral infarction and cerebral hemorrhage.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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