颈内动脉起始段动脉粥样硬化性斑块的超声影像研究

Study of ultrasonogram in detecting the stenosis of internal carotid artery initial segment

目的探讨超声检查对颈内动脉起始段粥样硬化斑块的诊断价值。方法随机选择我院2008年12月至2012年12月健康查体的120例作为对照组，选择同期在我院就诊的240例缺血性脑血管病患者作为缺血性脑血管病组。采用超声和数字减影血管造影（DSA）检查缺血性脑血管病组患者颈内动脉狭窄及斑块发生情况并加以比较。结果对照组斑块阳性率为35．O％（42／120），明显低于缺血性脑血管病组阳性率[90．8％（218／240）]（P〈0．05）。对照组及缺血性脑血管病组颈内动脉总狭窄率分别为33．3％（40／120）、74．2％（178／240），组间差异有统计学意义（P〈0．05）。超声检查的灵敏度为87．7％，特异度92．3％，约登指数0．80。对颈内动脉轻度、中度狭窄的诊断上，DSA和超声检出率间差异无统计学意义（P〉0．05）。颈内动脉重度狭窄和斑块的诊断上，DSA与超声检查方法检出率差异有统计学意义[重度狭窄：25．6％（20／78）比6．4％（5／78），斑块：76．9％（60／78）比52．6％（41／78），均P〈0．05]。结论超声检查具有较高的灵敏度、特异度，可以早期发现颈内动脉病变，能作为无症状人群健康查体的有效手段。

Objective To investigate the value of ultrasonogram in detecting the stenosis of internal carotid artery initial segment in health examination. Methods In our hospital, 360 cases were selected and compared. Re- suits The positive rate of control group was 35.0% （42/120） and that of ischemic cerebrovascular disease group was 90.8% （218/240）. The positive rate of ischemic cerebrovascular disease group was significantly higher than that of control group（P 〈0.05 ）. The total stenosis rate of the internal carotid artery of control group was 33.3% （40/120） and ischemic cerebrovascular disease group was 74.2% （178/240）. The total rate of ischemic cerebro- vascular disease group was significantly higher than that of control group（ P 〈 0.05 ）. The sensitivity of ultrasound was 87.7% and specificity was 92.1%. Youden index was 0.80. Digital subtraction angiography（DSA） and ultra- sound had no significant difference in diagnosis of mild, moderate stenosis and occlusion of the internal carotid artery （P 〉 0.05）. DSA and ultrasound had significant difference in diagnosis of severe stenosis carotid artery and athero- sclerotic plaque （ P 〈 0.05 ）. Conclusions Ultrasonography has high sensitivity and specificity. It can early show the stenosis of carotid artery and be used as the effective means in the health examination of asymptomatic population.