多发性大动脉炎颈动脉受累的超声表现及活动性评估

Ultrasound Features in the Diagnosis of Takayasu's Arteritis with Carotid Artery Involvement and Evaluation of Disease Activity

目的总结多发性大动脉炎(Takayasu's arteritis,TA)颈动脉受累的声像图特点并评价超声在TA诊断及活动性评估中的作用。方法对58例TA患者的颈动脉进行常规超声检查,测量受累颈总动脉管壁厚度。将TA患者分为活动期和非活动期两组,以58名正常人作为对照,比较各组间颈动脉管壁厚度的差异,并使用受试者工作特征曲线分析管壁厚度对TA活动性的评估效果。结果 58例TA患者共106条颈动脉受累,其中76条(71.7%)管壁超声表现为弥漫性、均匀性增厚,增厚管壁呈中等或中低回声。35条(33.0%)管壁呈通心粉征,67条(63.2%)呈靶环征。TA活动期组管壁厚度大于非活动期组,且均大于对照组(P均<0.05)。以管壁厚度来判断TA活动状态,最佳诊断阈值为2.25 mm,敏感性为71.4%,特异性66.0%。按照有无管腔狭窄进一步分组,分别确立诊断阈值后,非狭窄组中特异性提高为81.5%,狭窄组中敏感性提高为90.0%。结论靶环征是TA受累颈动脉除通心粉征外的另一超声新征象,有助于TA的超声诊断。管壁厚度对于评估TA活动性有一定帮助。

Objective To investigate the ultrasonographic characteristics of the Takayasu＇s arteritis （TA） with carotid artery involvement and explore the role of carotid wall thickness in the assessment of disease activity. Methods Totally 58 consecutive TA patients in our hospital were examined by carotid ultrasonography. The sonographic features were investigated and the wall thicknesses were measured. They were further divided into active TA group and inactive TA group. In addition, 58 healthy subjects were enrolled as the control group. The wall thicknesses of the carotid arteries were compared among the active TA group, inactive TA group, and control group. The receiver operating characteristic （ROC） curve was drawn to evaluate the efficacy of the wall thickness of carotid artery in the assessment of disease activity. Results Of these 116 common carotid arteries （CCAs） in 58 patients, 106 CCAs were affected. A characteristic homogeneous isoechoic/hypoechoic, circumferential thickening was shown in 76 involved CCAs （71.7%）. In addition, 35 CCAs （33.0%） showed a typical ＂macaroni＂ sign, while 67 （63.2%） showed quadri-layer changes and a ＂target＂ sign in cross section. The CCA wall was significantly thicker in the TA patients than that in control group （ P 〈 0. 001 ）, and it was also thicker in the active TA group than in inactive TA group （P 〈 0. 05 ）. When the ROC analysis was performed with 2. 25 mm taken as the cutoff value of wall thickness to evaluate TA activity, the sensitivity was 71.4% and specificity was 66.0%. In stenosis group, the sensitivity rose to 90.0% when 2.40 mm was used as the cutoff value; in non-stenosis group, the specificity rose to 81.5% when 2. 25 mm was used as the cutoff value. Conclusions The target sign may become a new sonographic feature for the diagnosis of TA in carotid uhrasonography, and increased wall thickness may be a useful indicator of active disease.