心绞痛患者颈动脉粥样硬化斑块内新生微血管超声造影特征的临床研究

Clinical Study of Characteristics of Carotid Artery Atherosclerotic on the Neovascularization of Plaques in Patients with Angina by Contrast-Enhanced Ultrasonography

目的:比较稳定型和不稳定型心绞痛患者颈动脉粥样硬化(CAS)斑块内新生微血管超声造影(CEUS)特征及其临床价值。方法:经心电图、动态心电图或平板运动试验心电图诊断的心绞痛患者111例,分为稳定型心绞痛组(SA组,n=53)和不稳定型心绞痛组(UA组,n=58),平行颈动脉彩色多普勒超声及CEUS检查后,采用声学定量分析软件分析两组斑块数量、类型,斑块内新生微血管等级评分和Crous积分,以及斑块达峰时间、最大峰值强度比、曲线下面积,同时测定血清超敏C反应蛋白(hs-CRP)水平,统计学比较两组上述指标差异。结果:UA组发现斑块187个,SA组176个,均以软斑块为主,两组不同类型斑块分布差异有统计学意义(P<0.01);两组斑块发生部位主要在颈动脉分叉处。UA组较SA组的软斑内新生微血管等级评分和Crous积分、最大峰值强度比升高,曲线下面积增大,达峰时间缩短;UA组hs-CRP水平均明显高于SA组;差异均有统计学意义(P<0.05,P<0.01)。结论:CAS斑块内新生血管等级评分等特征性改变,可为心绞痛的筛选类型鉴别及据此早期干预提供客观依据。

Objective：To study the imaging characteristics on the neovascularization in plaques of carotid artery atherosclerotic（CAS）in patients with angina by contrast-enhanced ultrasonography（CEUS）.Method：111cases of the angina patients diagnosed by ECG,Holter or treadmill exercise test ECG were divided into stable angina（SA）group（n=53）and unstable annia（UA）group（n=58）.The routine ultrasound and CEUS for CAS plagucs were examined.Acoustic quantitative analysis software-SonoLiver was used for offline analysis of image in neovascularization within CAS plaques：the peak time,the peak intensity,the areas under the curve of various plaques.And the level of serum high sensitive C-reactive protein（hs-CRP）were detected.Results：The total 187 carotid atherosclerotic plaque were found in patients with UA group,176 plaques in patients with SA group.The soft plaques were found more common in two groups,and at the ramification of the carotid artery,there was significant different（P〈0.01）.The shorter peak time,the higher maximum peak intensity,the more areas under the curve,the more grade score of the neovascularization,the higher level of serum hs-CRP in UA group than SA group,the two groups had a significant difference（P〈0.05）.The level of hs-CRP in UA group was obviously higher than that of SA group C（P〈0.01）.Conclusion：The imaging characteristics and the grade score of the neovascularization in plaques of CAS by CEUS could filter the type and used to be objective evidence of early treatment for patients with angina.