超声造影成像技术评价脑梗死患者颈动脉斑块新生血管与血脂的相关性

Relationship between serum lipids and carotid plaque neovascularization detected by contrast enhanced ultrasound in patients with cerebral infarction

目的探讨超声造影成像技术评价急性脑梗死患者颈动脉斑块内新生血管及其与血脂指标的关系。方法选取急性脑梗死伴颈动脉粥样斑块的住院患者106例(脑梗死组),无临床脑梗死表现的颈动脉粥样斑块患者40例(非脑梗死组),经超声造影检查获得斑块的造影参数并进行定量分析,检测两组患者血脂指标包括:三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)并进行比较。结果脑梗死组超声造影增强率为81.1%,明显高于非脑梗死组的40.0%(P<0.01),峰值强度比值(P)、曲线下面积(AUC)明显高于非脑梗死组,达峰时间(Tp)小于非脑梗死组(P<0.05)。两组血脂指标中TG、TC、LDL有统计学差异(P<0.05)。两组中,有增强病例LDL指标均高于无增强病例(P<0.05)。脑梗死组血脂指标与超声造影参数的相关性分析显示,TG与P、Tp、AUC、平均渡越时间(MTT)均明显相关(P<0.01),LDL与P、AUC明显相关(P<0.01),与Tp、MTT无明显相关(P>0.05),TC、HDL与超声造影参数无明显相关(P>0.05)。结论超声造影能方便地检测斑块内新生血管并进行定量分析,可以灵敏、客观地反映斑块的稳定性,对客观地预测和评价脑梗死的发生具有重要的临床价值。

Objective To investigate the correlation between the degree of plaque enhancement with contrast-enhanced ultrasound （CEUS） and serum lipids in acute cerebral infarction patients. Methods A total of 106 inpatients with acute cerebral infarction complicated with carotid atberosclerotic plaque were compared with 40 carotid atherosclerotic plaque patients who had never suffered from any cerebral infarction symptoms. The plaques of all the subjects were studied with CEUS for quantitative analysis and the levels of serum lipids （TG, TC, LDL HDL） were measured. Results Among the 104 cerebral infarction subjects, plaque enhancement was found in 81.1% , and only 40.0% of the 40 subjects without cerebral infarction were enhanced （P 〈0.01 ）. The peak intensity （P） and area under curve （AUC） of the carotid plaque in the subjects with cerebral infarction were significantly greater than that in those without cerebral infarction, and the time to peak （Tp） was significant smaller （P 〈 0.05 or P 〈 0.01 ）. There were significant differences in TG, TC and LDL between the two groups （P 〈 0.05 or P 〈 0.01 ）. LDL index was higher for the enhanced ones than for the non-enhanced in the two groups （P 〈 0.05 or P 〈 0.01 ）. The correlation analysis between the contrast parameters and serum lipids showed that TG was closely related to P, Tp, AUC and mean transit time （MTY） （P 〈 0.01 ）, and LDL was closely related to P and AUC （P 〈 0.01 ） and poor related to Tp and MTT （P 〉 0.05 ）, There were poor correlations between contrast parameters and any of TC and HDL. Conclusion CEUS may show neovascularization in the plaque and make quantitative analysis for the evaluation of the plaque stability. It can be used to predict and assess the incidence of cerebral infarction.