三维超声测定灰阶中位数值定量评价颈动脉斑块药物治疗效果的研究

Quantitative evaluation of changes in carotid plaques during drug treatment using three-dimensional ultrasoundgray scale median

目的应用三维颈动脉超声（3D-US）获取颈动脉斑块灰阶中位数值（GSM），对比分析药物治疗前后斑块GSM的变化，以探讨GSM值在定量评价斑块药物治疗效果中的应用价值。方法收集2015年5-10月我院神经内科就诊的颈动脉斑块患者81例共计93枚斑块，治疗前接受颈动脉3D-US、3．0TMRI和血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）和高密度脂蛋白胆固醇（HDL—c）水平检测。接受阿托伐他汀治疗（20mg／d）6～12个月后进行3D-US和血脂的随访。共有55例患者共计62枚斑块纳入随访，平均随访时间10．8个月。根据治疗前MRI及3D-US的GSM值将患者分为低风险组、中等风险组和高风险组，比较治疗前后各组内、组间血脂和GSM值的变化并分析二者间的关系。结果①治疗前血清TC、TG、LDL—C、I-IDL—C水平各组间差异无统计学意义，治疗后TC和LDL-C水平明显减低（P〈0．05），TG、HDL—C水平元显著变化；治疗后高风险组LDL—C水平明显低于低风险、中等风险组，差异有统计学意义（Pd0．05）。②高风险组和中等风险组GSM值治疗后较治疗前显著升高（33．87±6．53对27．50±7．82，47．35±5．42对44．56±4．36，P〈0．05），而低风险组斑块GSM值升高不显著（63．13±10．41对62．01±10．68，P〉0．05）；治疗前后各组GSM的差值与治疗前后LDL—C差值呈负相关（r=-0．28，P=0．03）。结论3D-US所获GsM值可以作为临床评价颈动脉斑块药物治疗效果的可靠指标，尤其对于中等风险及高风险的颈动脉斑块应用价值更大。

Objective To explore the value of threedimensional ultrasound （3D-US） gray scale median （GSM） in quantitative evaluation of the drug treatment of carotid plaques. Methods Eighty-one patients with 93 carotid plaques were enrolled from May 2015 to October 2015. Patients were received 3D- US, 3.0T MRI and blood lipid examination including total cholesterol（TC）, triglyceride （TG）, low-density lipoprotein cholesterol （LDL-C）, and high-density lipoprotein cholesterol（HI）L-C） before drug treatment. After atorvastatin therapy with a daily dose of 20mg for 6- 12 months, 3D-US and blood lipid examination were repeated, and 55 patients were followed successfully with a total of 62 plaques obtained. According to data acquired by MRI and 3DUS before treatment, the patients were divided into low-risk group, medium- risk group, and high-risk group. The differences of GSM value and blood lipid levels were compared among groups and the changes of these parameters before and after the treatment in each group were compared. Results There was no significantly difference in serum TC, TG, LDL-C and HDL-C levels among the groups before treatment. After treatment, the serum TC and LDL-C levels were significantly lower than those before（ P d0.05）, the differences of TG and HDL-C levels were not significant, and the LDL-C level in high-risk group was significantly lower than those in other groups（ P d0.05）. The GSM values in of high-risk and medium-risk group were significantly increased after drug treatment than those of before （33.87 ± 6.53 vs 27.50 ± 7.82,47.35 ± 5.42 vs 44.56 ± 4.36, P〈O. 05）, and had no significantly changein low-risk group（62.01 ± 10.68 vs 63.13± 10.41, P 〈0.05）. The difference of GSM between before and after treatment in each group was negatively correlated with the difference of LDL-C （ r = - 0.28, P = 0.03）. Conclusions Three-Dimensional ultrasound （3D-US） gray scale median （GSM） can be a reliable parameter in clinic quantitative evaluation drug treatment of carotid plaques, and has a better value especially for high-risk and medium-risk plaques.