16层螺旋CT血管成像评价颈动脉斑块性质与载脂蛋白A-Ⅰ/载脂蛋白B关系的研究

16-slice Spiral CT Angiography in Evaluation of Relationship of Carotid Artery Plaque to Apolipoprotein A-Ⅰ/Apolipoprotein B

目的应用16层螺旋CT颈部血管成像技术,探讨不同性质的斑块与载脂蛋白A-Ⅰ/载脂蛋白B(ApoA-Ⅰ/ApoB)的关系。方法选择60例缺血性脑卒中患者,常规血糖、血脂、肝肾功能、ApoA-Ⅰ、ApoB等检查,ApoA-Ⅰ/ApoB<1为观察组,ApoA-Ⅰ/ApoB≥1为对照组。均经颈部彩色多普勒检查(CDS)初步筛选颈部有无斑块。在经踝静脉注入对比剂行颈部16层螺旋CT血管造影(CTA)检查,进行后处理,观察颈部血管斑块情况,依据CT值判定斑块性质,同时与ApoA-Ⅰ/ApoB分析。结果 60例患者共发现208块斑块。颈动脉不同部位斑块性质的分布间差异有统计意义(χ2=28.62,P<0.01)。颈动脉不同部位的狭窄程度比较,差异均有统计学意义(Hc=28.62,P<0.01),其中颈总动脉起始段与颈总动脉分叉部、颈总动脉中段与颈内动脉起始段、颈总动脉分叉与颈内动脉起始段的狭窄程度比较,差异均有统计学意义(t值分别为-4.62、-3.38、2.51,P<0.01)。观察组与对照组分别比较责任病灶与非责任病灶侧血管内软斑块、中间斑块、硬斑块分布,差异均有统计学意义(Hc=3.17,Hc=3.32,P<0.05);两组责任病灶侧斑块分布比较,差异有统计学意义(Hc=15.00,P<0.01);两组非责任病灶侧斑块分布比较,差异无统计学意义(Hc=1.67,P>0.05)。结论 16层螺旋CT能够较大范围地发现颈动脉粥样斑块的分布,可对其性质、狭窄程度进行判定。ApoA-Ⅰ/ApoB<1可视为颈动脉不稳定斑块的危险度评估,作为降脂治疗的指导指标。

Objective To explore,by 16-slice spiral CT angiography（SCTA）,the relationship of carotid artery plaque to apolipoprotein A-I/Apolipoprotein B（ApoA-Ⅰ /ApoB）.Methods Sixty ischemic stroke patients received examinations of routine blood glucose,blood lipids,kidney function,ApoA-I and ApoB.Patients with ApoA-Ⅰ/ApoB1 were divided into observation group,ApoA-Ⅰ/ApoB≥1 into control group.Cervical plaques were confirmed preliminarily by neck color Doppler screening（CDS）.Constrast medium（CM）was injected through ankle vein to perform neck SCTA and postprocessing.Neck vascular plaques were observed and their natures determined based on CT values,and ApoA-Ⅰ/ApoB analyzed.Results A total of 208 plaques were sceened out.There was significant difference in distribution of plaques between different parts in carotid artery（χ^2=28.62,P〈0.01）,in carotid artery stenosis（Hc=28.62,P〈0.01）.There was significant difference in distribution of soft plaques,intermediate plaques and hard plaques in vascellum laterale between responsible or non-responsible lesions in 2 groups（Hc=3.17,Hc=3.32,P〈0.05）,and there was difference in distribution of lateral plaques of responsible lesions between 2 groups（Hc=15.00,P〈0.01）,but not in distribution of lateral plaques non-responsible lesions（Hc=1.67,P〈0.05）.Conclusion 16-slice SCTA can find distribution of carotid atheromatous plaques in a greater scope and judge their natures and stenosis degree.ApoA-Ⅰ/ApoB1 can evaluate the risks of unstable carotid plaques and be used as a guidance indicator for lipid-lowering therapy.