超声造影评价颈动脉粥样硬化斑块的新生血管与冠心病的关系

Evaluation of the relationship between carotid plaque instability and coronary heart disease by contrastenhanced ultrasound

目的 应用超声造影评价颈动脉粥样斑块的稳定性与冠心病的相关关系.方法 冠心病伴颈动脉粥样斑块患者67例,斑块厚度均＞2.0 mm,其中急性冠状动脉综合征（ACS）组35例,稳定性冠心病（sCAD）组32例.行颈动脉常规及超声造影检查,肉眼观测及定量分析斑块造影增强情况.结果 ACS组软斑的例数高于sCAD组,差异有统计学意义（P＜0.001）.ACS组斑块造影增强比例显著高于sCAD组（P=0.037）,ACS组斑块增强强度显著高于sCAD组（P＜0.001）,ACS组斑块增强强度与颈动脉管腔内增强强度比值显著高于sCAD组（P=0.026）.斑块增强强度预测ACS的灵敏度和特异度分别为74%和60%,斑块增强强度与颈动脉管腔内增强强度比值预测ACS的灵敏度和特异度分别为86%和67%.结论 ACS组斑块造影增强显著高于sCAD组.超声造影为评价颈动脉粥样斑块的稳定性与冠心病的相关关系及斑块的危险度分级提供了一种较为可靠的方法.

Objective To evaluate the relationship between carotid plaque instability and coronary heart disease by contrast-enhanced ultrasound. Methods Thirty-five patients with acute coronary syndrome （ACS） and 32 patients with stable coronary artery disease（sCAD） were included. Inclusion criteria were at least 1 carotid atherosclerotic plaque with thickness larger than 2.0 mm. Contrast-agent enhancement in the plaque was evaluated by visual interpretation and quantitative analysis. Results The percentage of soft plaque in ACS group was significantly higher than that in sCAD group （ P 〈0.001 ）. The proportion of contrast-agent enhancement in patients with ACS was significantly than that in patients with sCAD（ P =0. 037）. The enhanced intensity in the plaque and the ratio of enhanced intensity in the plaque to that in the carotid artery lumen in patients with ACS were significantly larger than those in patients with sCAD （ P 〈0.001, P = 0.026, respectively）. Sensitivity and specificity of prediction ACS were 74% and 60%,respectively,for enhanced intensity in the plaque and 86% and 67%, respectively, for ratio of enhanced intensity in the plaque to that in the lumen of the carotid artery. Conclusions The subjects with ACS had more intense contrast-agent enhancement than the subjects with sCAD. Contrast-enhanced ultrasound can be used to evaluate the relationship between carotid plaque instability and coronary heart disease.