血管造影与超声对诊断老年人颈动脉粥样硬化的价值

Value of angiography and ultrasonography in diagnosis of elderly carotid atherosclerosis

目的对比颈动脉超声与数字减影血管造影术(DSA)对诊断颈动脉粥样硬化(AS)的差异,探讨颈动脉超声在诊断颈AS的临床价值以及颈动脉造影的最佳适应证。方法选择有≥2项AS危险因素的患者126例,依据DSA检查结果分为颈动脉硬化组(硬化组)68例和颈动脉正常组(正常组)58例,行颈动脉超声及DSA检查,观察动脉管腔内径、颈动脉内膜中层厚度(IMT)、有无斑块及其性质、部位、有无狭窄并计算狭窄率。结果硬化组纤维蛋白元和C反应蛋白明显高于正常组(P=0.000)。DSA检测出68例190支血管斑块和(或)狭窄,总检出率为53.97%;超声检测出76例173支血管斑块和(或)狭窄,总检出率为60.32%,两者检出率比较,差异无统计学意义(P>0.05)。超声与DSA诊断颈动脉狭窄率比较,差异无统计学意义[(43.5±0.6)%vs(46.5±0.7)%,P>0.05]。以DSA为诊断标准,超声诊断颈AS的敏感性、特异性、阳性预测值和阴性预测值分别为83.82%、67.24%、78.89%和78.00%。结论超声对颈动脉粥样斑块检出率高于DSA,2种检查方法各有优劣,对需要行颈动脉内膜剥脱术及支架成形术的患者联合应用对其诊断及治疗更有价值。

Objective To study the clinical value of ultrasonography and DSA in diagnosis of carotid atherosclerosis （CAS） and the best indications for carotid angiography by comparing their advantages and disadvantages.Methods One hundred and twenty-six patients with 2 or more risk factors for CAS were divided into CAS group （n=68） and normal carotid artery group （n=58）.The patients underwent ultrasonography and DSA.Their carotid diameter,IMT,plaques and stenosis and their location and nature were recorded,and their stenosis rate was calculated.Results DSA showed plaques and/or stenosis in 190 blood vessels of 68 patients with a detection rate of 53.97％ and ultrasonography revealed plaques and/or stenosis in 173 blood vessels of 76 patients with a detection rate of 60.32％ （P＞0.05）.No significant difference was found in the detection rate of plaques and/or stenosis by ultrasonography and DSA （43.5％±0.6％ vs 46.5％ ±0.7％,P＞0.05）.Taking DSA as a golden standard,the sensitivity,specificity,positive and negative predictive value of ultrasonography in diagnosis of CAS were 83.82％,67.24％,78.89％ and 78.00％,respectively.Conclusion The detection rate of CAS is higher by DSA than by ultrasonography.DSA and ultrasonography have their advantages and disadvantages in diagnosis of CAS.The diagnostic and treatment value is greater for those who need to undergo exfoliation operation of carotid intima-media and stenting if they are used in combination.