256层螺旋CT血管造影对颈动脉粥样硬化斑块形态与颈动脉狭窄程度、脑缺血症状的相关性研究

发布时间：2018-06-27 00:45

本文选题：体层摄影术 + 血管造影术　；参考：《河北医科大学》2013年硕士论文

【摘要】：目的：除颈动脉狭窄的严重程度外，斑块的稳定性也是预测缺血性脑血管病事件的重要因素，不稳定性斑块已被证实是缺血性脑血管病的独立危险因素。本文通过应用256层螺旋CTA来评价颈动脉粥样硬化斑块的形态特点，统计溃疡斑块的发生率，并进一步分析研究斑块的形态特点与颈动脉狭窄程度、不同脑缺血症状之间的关系。方法：回顾性分析了386例病人的256层螺旋CTA影像资料，并将斑块的表面形态分为光滑、不规则和溃疡三个类型。按临床症状表现不同，将所有病人分为四组，即一过性黑朦组（AF）、短暂性脑缺血发作组（TIA）、脑梗死组及无症状组（对照组）。并在Portal工作站采用MIP、VR、MPR、CPR及高级血管分析（advanced vessel analysis，AVA）等后处理软件，测量管腔狭窄率，并记录斑块形态特点。由两名长期从事神经影像诊断的副主任及以上的放射科医师采用盲法分别对颈动脉狭窄程度、斑块形态特点进行评价，意见不一时通过讨论达成一致。应用SPSS13.0统计分析软件，分析斑块形态特点与颈动脉狭窄程度及不同脑缺血症状之间的相关性及不同组别之间有无统计学差异。结果： 1386例患者中男性258例，女性128例，年龄范围37-87岁，平均年龄61.15岁。 2386例患者中共发现颈动脉病变274例；所观察的颈动脉共1544条，有颈动脉病变658条（42.61%），其中包括闭塞34条；除34条闭塞的颈动脉外，共发现颈动脉斑块624个，其中斑块表面光滑的为394个（63.15%），不规则斑块161个（25.80%），溃疡斑块69个（11.05%）。 3386例观察对象中，有不同程度脑缺血症状者356例，其中表现为一过性黑朦者35例，TIA178例，脑梗死143例（39.61%）；有30例无明显脑缺血症状。 4在所有病例中，存在颈动脉病变并且有脑缺血症状者260例，无颈动脉病变但有脑缺血症状者96例，经统计学分析得出，颈动脉病变和脑缺血症状之间存在统计学关联（OR值为3.095）。 5当颈动脉狭窄率大于30%时，溃疡斑块的发生率19.4%，均明显高于狭窄率小于30%的颈动脉（3.12%），经统计学分析P值均小于0.05，说明两者之间有统计学差异。当颈动脉狭窄率超过70%时，，溃疡斑块的发生率提高至31.66%。进一步分析不同狭窄程度间溃疡斑块的发生率有无差别，发现除狭窄程度在III级和VI级两组之间溃疡斑块发生率无差别外，其余各两组之间均存在统计学差异，并且溃疡斑块的发生率随着狭窄程度的增加而增加。 6脑梗死组溃疡斑块的发生率为13.06%，高于TIA组（10.26%）、一过性黑朦组（6.55%）和无症状组（9.37%），采用行×列表卡方检验不同脑缺血症状组之间溃疡斑块的发生率有无差别，结果显示无统计学差异，说明还不能认为不同临床症状组间溃疡斑块的发生率有差别。 769个溃疡斑块中，有20个责任病灶，而在555个非溃疡斑块中，责任病灶为69个，经统计学分析，P值小于0.05，说明溃疡斑块和非溃疡斑块中引起脑梗死的责任病变发生率之间有差别，并且溃疡斑块和脑梗死之间存在统计学关联（OR值为2.875）。 8颅内出现脑梗死并且同侧颈动脉（症状侧颈动脉）同时存在病变的为99例，占所有脑梗死病例的69.2%（99/143），症状侧颈动脉溃疡斑块的发生率为22.47%大于对侧颈动脉（16.88%），经统计学分析，P值大于0.05，即还不能认为两者之间有统计学差异。结论： 1256层螺旋CTA不仅能准确判断颈动脉的狭窄程度，而且能对颈动脉粥样硬化斑块的形态特点做出准确全面的评价，具有较高的临床应用价值。 2在不同颈动脉狭窄程度间，溃疡斑块的发生率存在统计学差异，并且随狭窄程度的增加而逐渐增高。 3溃疡斑块和脑梗死的发生存在统计学意义，说明溃疡斑块的存在和脑梗死的发生密切相关。 4目前国内外应用256层螺旋CT对动脉硬化斑块的形态进行评价研究较少，对于临床医生来说，了解斑块形态特点的信息对患者选择何种治疗方案及预后起关键性提示作用，因此在以后的临床工作中，不仅要对动脉粥样硬化所致的管腔狭窄程度进行准确测量，还要对颈动脉硬化斑块的形态特点进行准确描述，尤其在书写报告时应对溃疡斑块进行描述，为临床医生选择治疗方案及评价预后提供一定的参考价值。
[Abstract]:Objective : In addition to the severity of carotid stenosis , the stability of plaque is an important factor to predict ischemic cerebrovascular disease . The plaque has been proved to be an independent risk factor for ischemic cerebrovascular disease .

Methods : The data of 256 slice spiral CTA images of 386 patients were analyzed retrospectively , and the surface morphology of plaque was divided into three types : smooth , irregular and ulcer . All patients were divided into four groups according to clinical symptoms , namely , transient ischemic attack group ( AF ) , transient ischemic attack group ( TIA ) , cerebral infarction group and asymptomatic group ( control group ) .

Results :

Among the 1386 patients , 258 were male and 128 were female . The age ranged from 37 to 87 years . The mean age was 61.15 years .

Among the 2386 cases , 274 cases of carotid artery disease were found .
There were a total of 1544 carotid arteries and 658 carotid artery lesions ( 42.61 % ) , including 34 occlusion ;
Out of the 34 occluded carotid arteries , 624 carotid plaques were found , with a smooth plaque surface 394 ( 63.15 % ) , irregular plaque 161 ( 25.80 % ) , and an ulcer plaque of 69 ( 11.05 % ) .

Among the 3386 cases , 356 cases with cerebral ischemic symptoms were observed , including 35 cases of transient amaurosis , 178 cases of TIA178 and 143 cases of cerebral infarction ( 39.61 % ) .
There were 30 cases with no obvious cerebral ischemia symptoms .

4 In all cases , there were 260 cases of carotid artery disease with cerebral ischemia symptoms and 96 cases without carotid artery disease but with cerebral ischemia symptoms . Statistical analysis showed that there was statistical correlation between carotid artery disease and cerebral ischemia symptoms ( OR value was 3.095 ) .

5 When the stenosis rate of carotid artery was more than 30 % , the incidence of ulcer plaque was 19.4 % , which was significantly higher than that of carotid artery ( 3.12 % ) with stenosis rate of less than 30 % . The incidence of ulcer plaque was increased to 31.66 % when the stenosis rate of carotid artery was over 70 % .

The incidence of plaque in patients with cerebral infarction was 13.06 % , higher than TIA group ( 10.26 % ) , transient group ( 6.55 % ) and asymptomatic group ( 9.37 % ) .

Of the 769 ulcer patches , there were 20 responsible lesions , whereas in 555 non - ulcer plaques , the lesion was 69 , statistically analyzed , with a P value of less than 0.05 , indicating a difference in the incidence of responsible lesions in the plaque and non - ulcer plaques causing cerebral infarction , and there was a statistical correlation between the ulcer patch and the cerebral infarction ( OR value 2.875 ) .

At the same time , there were 99 patients with cerebral infarction and ipsilateral carotid artery ( symptomatic side carotid artery ) , accounting for 69.2 % ( 99 / 143 ) of all cases of cerebral infarction , 22.47 % of symptomatic side carotid artery ulcer plaque was greater than that of contralateral carotid artery ( 16.88 % ) , P value was more than 0.05 , that is , there was no statistical difference between them .

Conclusion :

The 1256 slice spiral CTA not only can accurately judge the stenosis degree of the carotid artery , but also can accurately and comprehensively evaluate the morphological characteristics of the carotid atherosclerosis plaque , and has higher clinical application value .

2 In different degree of carotid stenosis , the incidence of ulcer plaque was statistically different and gradually increased with the degree of stenosis .

The incidence of plaque and cerebral infarction was statistically significant , which indicated that the presence of ulcer patch and the occurrence of cerebral infarction were closely related .

At present , the evaluation of the morphology of atherosclerotic plaques by using 256 - slice spiral CT at home and abroad is less . For clinicians , it is important to understand the characteristics of plaque morphology . Therefore , it is important not only to accurately measure the degree of stenosis caused by atherosclerosis , but also to describe the morphological characteristics of carotid atherosclerotic plaques , especially when writing reports , to provide some reference value for clinicians to select treatment plan and evaluate the prognosis .
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.2

【参考文献】