超声评估颈动脉粥样硬化斑块性质与病理对照分析

Ultrasonic evaluation of the property of carotid atherosclerotic plaques and comparison with pathology

目的探讨超声对颈动脉粥样硬化(CAS)斑块性质判定的准确性及临床应用价值。方法 61例CAS斑块患者均行颈动脉超声检查及颈动脉内膜剥脱术(CEA),标本送病理分析。超声评估血管管腔直径狭窄率,斑块性质(低回声斑块、混合回声斑块、强回声斑块),并与相应的颈动脉内膜病理改变进行对照分析。结果 61例患者中,混合回声斑块34例,低回声斑块25例,强回声斑块2例。93.4%(57/61)的斑块病理改变为脂质坏死池形成。混合回声斑块和低回声斑块的病理改变中的慢性炎细胞浸润的比例分别为42.6%(26/61)、37.7%(23/61),混合回声斑块的慢性炎细胞浸润较低回声斑块比例高。不连续性纤维帽的斑块比例(52.5%,32/61)较连续性纤维帽的斑块比例高(37.7%,23/61)。钙化是强回声斑块的主要病理改变。结论超声可直观评价CAS斑块性质。超声评价CAS斑块性质为临床诊断提供了客观依据,具有重要的应用价值。

Objective To assess the characteristic of carotid atherosclerosis（CAS） plaque by ultrasography, and to compare with pathological findings in order to evaluate the clinical value of ultrasound examination. Methods Sixty-one patients with CAS plaque underwent carotid artery ultrasound examination and carotid endarterectomy（CEA）. Ultrasound measured the diameter with stenosis rate and plaque thickness and the characteristic of carotid artery plaque（soft, hard, mixed plaque）.The pathology results were compared with the ultrasound examination. Results In 61 subjects, 34 were mixed plaques, 25 were soft plaque and 2 were hard plaque. The proportion of chronic inflammatory cell infiltration in mixed plaques（42.6%） was higher than in soft plaques（37.7%）. The proportion of the discontinuity of fibrous cap（52.5%, 32/61） was higher than the continuity of the fibrous cap（37.7%, 23/61）. The calcification was the main pathological change in hard plaque. Conclusion Ultrasonography can directly evaluate the characteristic of plaque. Ultrasonography is a non-invasive assessment of the characteristic of the CAS plaque, which provides accurate and objective basis for clinical diagnosis and treatment.