实时剪切波弹性成像及彩色脉搏波成像技术评估不同级别高血压患者颈总动脉弹性

Evaluating the elasticity of carotid artery in patients with different grades of hypertension using real-time shear wave elastography and color pulse wave imaging

目的应用实时剪切波弹性成像及彩色脉搏波成像技术分析高血压患者颈总动脉纵向及环向血管壁硬度,比较不同级别高血压患者颈总动脉血管壁硬度差异,探讨2种技术在高血压分级诊断中的应用价值。方法选取2016年2至12月云南省第二人民医院收治的临床确诊的高血压患者120例。根据中国高血压防治指南(2010年版)分级分为1、2、3级高血压组3组各40例。另选取同期云南省第二人民医院体检无高血压病史的健康志愿者40名作为健康对照组。应用实时剪切波弹性成像技术获得所有研究对象颈总动脉前壁及后壁的弹性模量值(Mean、Max、Min),得到颈动脉的纵向血管壁硬度;应用彩色脉搏波成像技术获得所有研究对象颈总动脉壁的脉搏波速度,包括收缩期开始时的脉搏波速度(PWVBS)、收缩期结束时的脉搏波速度(PWVES),得到颈动脉的环向血管壁硬度。采用单因素方差分析比较不同级别高血压组患者与健康对照组受试者颈总动脉壁硬度值(Mean、Max、Min、PWVBS、PWVES),进一步组间两两比较采用LSD-t检验;采用Pearson相关分析法分析高血压患者颈动脉壁硬度值(Mean、Max、Min、PWVBS、PWVES)与高血压级数的相关性。结果颈总动脉(前壁及后壁)的弹性模量值(Mean、Max、Min)均为高血压3级组>高血压2级组>高血压1级组>健康对照组,且任意2组间比较差异均有统计学意义。Pearson相关分析结果显示,颈总动脉(前壁及后壁)的弹性模量值(Mean、Max、Min)与高血压级数均有相关性(r=0.817、0.767、0.796,P均<0.05)。随着高血压级数的增高,高血压患者颈总动脉(前壁及后壁)的弹性模量值(Mean、Max、Min)呈增高趋势。颈总动脉脉搏波速度(PWVBS、PWVES)均为高血压3组>高血压2组>高血压1组>健康对照组,且任意2组间比较差异均有统计学意义。Pearson相关分析结果显示,脉搏波速度(PWVES、PWVBS)与高血压级数均有相关性(r=0.650、0.585,P <0.05)。随着高血压级数的增高,高血压患者脉搏波速度(PWVBS、PWVES)呈增高趋势。结论实时剪切波弹性成像及彩色脉搏波成像技术为高血压分级诊断提供了一种有价值的参考。随着高血压级数的增高,高血压患者颈总动脉壁的纵向及环向血管壁硬度均呈增高趋势,且两者具有一致性。

ObjectiveUsing real-time shear wave elastography and color pulse wave imaging to analyze the longitudinal and circumferential hardness of the common carotid artery in patients with hypertension and the differences of the hardness of the common carotid artery between patients with different levels of hypertension, and to explore the value of two techniques in the diagnosis of hypertension. Methods120 patients with hypertension were selected as study group. In the meantime, 40 patients with normal blood pressure were selected as control group. The real-time shear wave elasticity was performed toobtain the elastic modules （Mean、Max、Min） of the anterior and posterior wall of all the common carotid artery of the patients, as the longitudinal hardness range of the common carotid artery wall. The color pulse wave imaging was performed to obtain the pulse wave velocity of hypertensive carotid artery, including the pulse wave velocity in the beginning of the systol and the pulse wave velocity in the end of the systol of normal carotid artery, as the circumferential hardness range of the common carotid artery wall. ResultsThe elastic modulus values of the anterior wall of the common carotid artery in hypertensive patients were： Mean （65.46±8.81） kPa, Max （68.92±9.58） kPa, Min（60.73±8.58） kPa. The elastic modulus values of the posterior wall of the common carotid artery in hypertensive patients were： Mean （61.43±8.92） kPa, Max （65.56±9.12） kPa, Min （56.98±9.14） kPa. The pulse wave velocity of the common carotid artery wall in hypertensive patients were： PWVBS （6.85±1.08） m/s, PWVES （9.48±1.48） m/s. The elastic modulusvalues （Mean, Max, Min） of the anterior and posterior wall of the common carotid artery in hypertensive patients were higher than those with normal blood pressure （P 〈 0.05）, so does the pulse wave velocity （PWVBS and PWVES） （P〈 0.05）. The elastic modulus values （Mean, Max and Min） of the carotid artery wall （anterior and posterior wall） in patients with hypertension were statistically significant in different levels, and positively correlated with the progression of hypertension （P 〈 0.05）. The difference of pulse wave velocity （PWVBS and PWVES） of carotid artery wall in patients with hypertension at different levels were statistically significant, and positively correlated with the progression of hypertension （P 〈 0.05）. ConclusionReal-time shear wave elastography and color pulse wave imaging provide a valuable reference for grading diagnosis of hypertension. With the increase of the progression of hypertension, the longitudinal and circumferential hardness of common carotid artery in hypertensive patients showed an increasing trend,and two techniques had consistency.