实时剪切波弹性成像和彩色脉搏波成像对颈动脉弹性的研究

发布时间：2018-05-06 03:07

本文选题：颈总动脉 + 剪切波弹性成像　；参考：《昆明医科大学》2017年硕士论文

【摘要】：第一部分实时剪切波弹性成像和彩色脉搏波成像对正常颈动脉的研究[目的]运用实时剪切波弹性成像和彩色脉搏波成像对正常颈总动脉血管壁的硬度进行定量分析,得出正常颈总动脉纵向和环向的血管壁硬度范围。[方法]选取2016年2月至2016年12月于昆明医科大学第四附属医院体检双侧颈部血管正常者120例,年龄20-70岁,平均(48.94±13.32)岁。其中男性58例,平均(49.33±13.28)岁,女性62例,平均(48.58±13.46)岁。研究对象按年龄分为4组:N1 组:32人40岁平均(30.81±5.57)岁;N2 组:28人 41-50岁平均(45.79±2.01)岁;N3 组:30人 51-60岁平均(55.07±2.35)岁;N4 组:30人 61-70岁平均(65.10±2.12)岁;采用法国Supersonic Imagine公司的Aix-plorer型彩色多普勒超声诊断仪,启动剪切波弹性成像(SWE)模式,测量颈总动脉前壁、后壁的弹性模量平均值(Mean)、最大值(Max)、最小值(Min)、弥散度(SD)。启动脉搏波成像(PWV)模式,测量颈总动脉收缩期开始时脉搏波速度(PWVBS)、收缩期结束时脉搏波速度(PWVES)及PWVBS、PWVES相对应的标准差(△±)。[结果]1实时剪切波弹性成像双侧正常颈总动脉前壁、后壁的弹性模量平均值、最大值、最小值、弥散度均没有显著差异(P0.05)。按性别分为男组、女组,男组与女组颈总动脉前壁、后壁的弹性模量平均值、最大值、最小值、弥散度均没有显著性差异(P0.05)。正常颈总动脉前壁、后壁之间的弹性模量平均值、最大值、最小值有显著性差异(P0.05)。各年龄组间颈总动脉前壁总的弹性模量平均值、最大值、最小值有显著性差异(P0.05),各年龄组间颈总动脉后壁总的弹性模量平均值、最大值、最小值有显著性差异(P0.05)。正常颈总动脉前壁弹性模量平均值与年龄呈正相关(r=0.476,P0.01),正常颈总动脉前壁弹性模量最大值与年龄呈正相关(r=0.554,P0.01),正常颈总动脉前壁弹性模量最小值与年龄呈正相关(r=0.512,P0.01)。正常颈总动脉后壁弹性模量平均值与年龄呈正相关(r=0.502,P0.01),正常颈总动脉后壁弹性模量最大值与年龄呈正相关(r=0.498,P0.01),正常颈总动脉后壁弹性模量最小值与年龄呈正相关(r=0.498,P0.01)。2彩色脉搏波成像双侧正常颈总动脉收缩期开始时脉搏波速度、收缩期结束时脉搏波速度均没有显著性差异(P0.05)。按性别分为男组、女组,男组与女组颈总动脉收缩期开始时脉搏波速度、收.缩期结束时脉搏波速度均没有显著性差异(P0.05)。各年龄组间颈总动脉总的收缩期开始时脉搏波速度、收缩期结束时脉搏波速度有显著性差异(P0.05)。正常颈总动脉收缩期开始时脉搏波速度与年龄呈正相关(r=0.349,P0.01),正常颈总动脉收缩期结束时脉搏波速度与年龄呈正相关(r=0.593,P0.01)。[结论]实时剪切波弹性成像条件下颈总动脉后壁的硬度低于前壁。两种超声成像条件下:颈总动脉血管壁的硬度与年龄有一定的相关性,60-70岁的颈总动脉血管壁硬度明显高于小于40岁的血管壁硬度,随着年龄的增长,血管壁硬度呈增加的趋势,41-50岁与51-60岁的颈总动脉血管壁硬度相差不大。颈总动脉血管壁硬度与性别不相关。颈总动脉环向和纵向的血管壁硬度具有一致性。第二部分实时剪切波弹性成像和彩色脉搏波成像对高血压患者颈动脉的研究[目的]运用实时剪切波弹性成像和彩色脉搏波成像对高血压患者颈总动脉血管壁的硬度进行分析,探讨不同级别高血压颈总动脉血管壁硬度的差异,并与正常组进行比较,以此来评价这两种超声成像技术对高血压患者颈总动脉血管壁的应用价值。[方法]选取经临床确诊的113例高血压患者,年龄35-70岁,平均(52.54±13.41)岁,其中男性60例,女性53例。1级高血压组(HBP1组)38例,2级高血压组(HBP2组)38例,3级高血压组(HBP3组)37例。将第一部分120例正常颈总动脉设为正常组。启动剪切波弹性成像(SWE)模式,检测高血压患者颈总动脉前壁、后壁的弹性模量平均值(Mean)、最大值(Max)、最小值(Min)、弥散度(SD)。启动脉搏波成像(PWV)模式,检测颈总动脉收缩期开始时脉搏波速度(PWVBS)、收缩期结束时脉搏波速度(PWVES)及PWVBS、PWVES相对应的标准差(△±)。[结果]1实时剪切波弹性成像高血压组双侧颈总动脉前壁、后壁的弹性模量平均值、最大值、最小值、弥散度均没有显著性差异(P0.05)。高血压组颈总动脉前壁、后壁之间的弹性模量平均值、最大值、最小值有显著性差异(P0.05)。正常组与HBP1组、HBP2组、HBP3组的颈总动脉前壁弹性模量平均值、最大值、最小值有显著性差异(P0.05),正常组与HBP1组、HBP2组、HBP3组的颈总动脉后壁弹性模量平均值、最大值、最小值有显著性差异(P0.05)。高血压颈总动脉前壁:HBP3组与HBP2组的弹性模量平均值、最大值、最小值有显著性差异(P0.05),HBP2组与HBP1组的弹性模量平均值、最大值、最小值有显著性差异(P0.05),HBP3组与HBP1组的弹性模量平均值、最大值、最小值有显著性差异(P0.05)。高血压颈总动脉后壁:HBP3组与HBP2组的弹性模量平均值、最大值、最小值有显著性差异(P0.05),HBP2组与HBP1组的弹性模量平均值、最大值、最小值有显著性差异(P0.05),HBP3组与HBP1组的弹性模量平均值、最大值、最小值有显著性差异(P0.05)。2彩色脉搏波成像高血压组双侧颈总动脉收缩期开始时脉搏波速度、收缩期结束时脉搏波速度均没有显著性差异(P0.05)。正常组与HBP1组、HBP2组、HBP3组颈总动脉收缩期开始时脉搏波速度、收缩期结束时脉搏波速度有显著性差异(P0.05)。HBP3组与HBP2组的收缩期开始时脉搏波速度、收缩期结束时脉搏波速度有显著性差异(P0.05),HBP2组与HBP1组的收缩期开始时脉搏波速度、收缩期结束时脉搏波速度有显著性差异(P0.05),HBP3组与HBP1组的收缩期开始时脉搏波速度、收缩期结束时脉搏波速度有显著性差异(P0.05)。[结论]实时剪切波弹性成像条件下高血压组颈总动脉后壁的硬度低于前壁。两种超声成像条件下:随着高血压级数的增高,血管壁硬度呈增高的趋势。高血压颈总动脉的血管壁硬度高于正常颈总动脉血管壁硬度。高血压颈总动脉环向和纵向的血管壁硬度具有一致性。
[Abstract]:Part 1 the study of normal carotid artery with real time shear wave elastic imaging and color pulse wave imaging [Objective] to quantitatively analyze the hardness of normal carotid artery wall by real time shear wave elastic imaging and color pulse wave imaging, and to obtain the hardness range of the longitudinal and circumferential vascular walls of the normal common carotid artery. [method] select the 2016 2. From month to December 2016, 120 cases of normal cervical vessels were examined at the Fourth Affiliated Hospital of Kunming Medical University. The average age was 20-70 years old. The average age was (48.94 + 13.32) years old. Among them, the average age was 58, the average (49.33 + 13.28) years, and the female 62, average (48.58 + 13.46) years old. The subjects were divided into 4 groups at the age of year: N1 group: 32 people average years of age; group N2: Persons The average age of 41-50 years (45.79 + 2.01) years old; group N3: 30 people with an average of 51-60 years (55.07 + 2.35) years of age (55.07 + 2.35) years old; group N4: 30 people, 61-70 years old (65.10 +) years of age (65.10 + 2.12) years; using the Aix-plorer color Doppler ultrasound diagnostic instrument of French Supersonic Imagine, starting shear wave elastic imaging (SWE) model, measuring the anterior wall of the common carotid artery and the average modulus of elasticity of the posterior wall. Value (Mean), the maximum value (Max), the minimum value (Min), dispersion (SD). The pulse wave velocity (PWVBS) at the beginning of the systolic phase of the common carotid artery (PWV), the pulse wave velocity (PWVES) and PWVBS, and the standard deviation of PWVES (delta) at the end of the systole. [results]1 real time shear wave elastic imaging of the anterior wall of the normal carotid artery. The average value, the maximum value, the minimum value and the dispersion of the wall had no significant difference (P0.05). The average value of the anterior wall of the common carotid artery was divided into male, female, male and female, the average value of modulus of elasticity of the posterior wall, the maximum value, the minimum value and the diffusion degree were not significant (P0.05). The average elastic modulus between the normal carotid artery and the posterior wall was average. There were significant differences in value, maximum value and minimum value (P0.05). There was a significant difference in the average, maximum and minimum values of the total elastic modulus of the anterior cervical artery in each age group (P0.05). There was a significant difference in the average value, maximum and minimum of the posterior wall of the common carotid artery (P0.05). The elastic modulus of the anterior wall of the normal carotid artery. The mean value was positively correlated with age (r=0.476, P0.01). The maximum elastic modulus of normal carotid artery anterior wall was positively correlated with age (r=0.554, P0.01). The minimum elastic modulus of normal carotid artery anterior wall was positively correlated with age (r=0.512, P0.01). The average value of the posterior wall elastic modulus of normal carotid artery was positively correlated with age (r=0.502, P0.01), normal. The maximum elastic modulus of the posterior wall of the common carotid artery was positively correlated with age (r=0.498, P0.01). The minimum elastic modulus of the posterior wall of the normal carotid artery was positively correlated with age (r=0.498, P0.01).2 color pulse wave imaging at the beginning of the systole of bilateral normal carotid artery, and there was no significant difference between the pulse wave velocity at the end of systole (P0. 05). The pulse wave velocity at the beginning of the systolic phase of the common carotid artery was divided into male, female, male and female. There was no significant difference between the pulse wave velocity at the end of the contraction period (P0.05). The pulse wave velocity at the beginning of the total systolic phase of the common carotid artery in each age group and the pulse wave velocity at the systolic junction were significantly different (P0.05). The pulse wave velocity is positively correlated with age at the beginning of arterial systole (r=0.349, P0.01). The pulse wave velocity is positively correlated with age at the end of the normal common carotid artery systole (r=0.593, P0.01). [Conclusion] the hardness of the posterior wall of the common carotid artery is lower than that of the anterior wall under the condition of real time shear wave elastic imaging. Two kinds of ultrasound imaging conditions: the vascular wall of the common carotid artery The hardness of the carotid artery wall of the 60-70 year old was significantly higher than that of the vascular wall less than 40 years old. The hardness of the vascular wall increased with the age of 40. The hardness of the vascular wall of the common carotid artery at the age of 41-50 and 51-60 years was not similar. The neck wall hardness was not related to sex. The hardness of the vascular wall is consistent with the longitudinal and vertical. Second part of the study of carotid artery in hypertensive patients by real time shear wave elastic imaging and color pulse wave imaging (Objective] to analyze the stiffness of the vascular wall of the common carotid artery in hypertensive patients by using real time shear wave elastic imaging and color pulse wave imaging, and to explore the different levels of hypertension. The difference in the hardness of the vascular wall of the common carotid artery was compared with that of the normal group in order to evaluate the value of the two ultrasound imaging techniques for the vascular wall of the common carotid artery in hypertensive patients. [Methods] 113 cases of hypertension, aged 35-70 years, average (52.54 + 13.41) years of age, were selected to be clinically diagnosed as hypertensive patients, including 60 males and 53.1 grade hypertension in women. Group (group HBP1) (group HBP1), grade 2 hypertension group (group HBP2) 38 cases, 3 grade hypertension group (group HBP3) 37 cases. 120 normal common carotid arteries were set as normal group in the first part. Starting shear wave elastic imaging (SWE) model was used to detect the anterior wall of the common carotid artery and the average modulus of elasticity of the posterior wall (Mean), the maximum value (Max), the minimum value (Min), dispersion degree (SD). The pulse wave velocity (PWVBS) at the beginning of the systolic phase of the common carotid artery (PWV), the standard deviation of the pulse wave velocity (PWVES) and PWVBS, and PWVES at the end of the systole period (delta). [results the average value of the anterior wall of the common carotid artery and the modulus of elasticity of the posterior wall, the maximum value, minimum value, the mass, and the mass of the]1 real-time shear wave elastic imaging hypertension group There was no significant difference in divergence (P0.05). The average value, maximum and minimum of the anterior wall of the common carotid artery in the hypertension group had significant difference (P0.05). The average value, the maximum value, the minimum value of the anterior wall of the common carotid artery in the normal group and the HBP1 group, the HBP2 group and the HBP3 group had significant difference (P0.05), the normal group and the HBP1 group, HBP2, HBP2. The average value, maximum and minimum value of the posterior wall of the common carotid artery in group HBP3 had significant difference (P0.05). The average value, maximum and minimum of the elastic modulus of the carotid artery in the HBP3 group and the HBP2 group had significant difference (P0.05). There was a significant difference between the average value, the maximum value, and the minimum of the HBP2 group and the HBP1 group (P0.05). The average value, the maximum value, the minimum value of the HBP3 group and the HBP1 group had significant difference (P0.05). The posterior wall of the common carotid artery of hypertension: the average value, the maximum value, the minimum value of the HBP3 group and the HBP2 group had significant difference (P0.05), the average value, the maximum value and the minimum value of the HBP2 group and the HBP1 group had significant difference (P0.05), HBP3 group. The average value, the maximum, the minimum of the HBP1 group had significant difference (P0.05) the pulse wave velocity at the beginning of the systole of bilateral common carotid artery in the.2 color pulse wave imaging group and the pulse wave velocity at the end of the systole (P0.05). The normal group and the HBP1 group, the HBP2 group, and the HBP3 group had the beginning of the systolic vein of the common carotid artery. Pulse wave velocity and pulse wave velocity at the end of systole were significantly different (P0.05) and pulse wave velocity at the beginning of systolic phase in group.HBP3 and HBP2 group, and the pulse wave velocity was significantly different at the end of systole (P0.05). The pulse wave velocity at the beginning of systolic phase in group HBP2 and HBP1 group was significantly different (P0.05), H at the end of systolic phase (P0.05). The pulse wave velocity at the beginning of systole and the pulse wave velocity at the end of systole in group BP3 and HBP1 group were significantly different (P0.05). [Conclusion] under the condition of real time shear wave elastic imaging, the hardness of the posterior wall of the common carotid artery in the hypertension group is lower than that in the anterior wall. With the increase of high blood pressure progression, the hardness of the vessel wall increases with the increase of high blood pressure. The hardness of the vascular wall of the common carotid artery was higher than that of the normal carotid artery wall. The hardness of the circumferential and longitudinal vascular walls of the common carotid artery was consistent.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R543.4

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