超声造影评估脑卒中患者治疗前后颈动脉粥样硬化斑块变化的价值

Role of contrast-enhanced ultrasound in evaluating the changes of carotid atherosclerotic plaque in stroke patients before and after treatment

目的探讨超声造影对瑞舒伐他汀联合拜阿司匹林治疗前后脑卒中患者颈动脉粥样硬化斑块变化的评估价值。方法缺血性脑卒中患者80例为缺血组,出血性脑卒中患者40例为出血组,2组均给予瑞舒伐他汀联合拜阿司匹林治疗,连续3个月。分别于治疗前及治疗3个月后检测血清三酰甘油(triacylglycerol, TG)、总胆固醇(total cholesterol, TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)水平,行超声造影检测颈动脉粥样硬化斑块面积、内中膜厚度(intima thickness, IMT)、基础强度(base intensity, BI)、增强强度(enhanced intensity, EI);Pearson相关法分析治疗前及治疗3个月后血脂指标及颈动脉粥样硬化斑块面积、颈动脉IMT差值与BI、EI差值的相关性。结果出血组、缺血组治疗3个月后血清LDL-C[(2.64±0.91)、(2.68±0.81)mmol/L]、TG[(0.99±0.51)、(0.91±0.63)mmol/L]、TC[(4.43±0.56)、(4.44±0.61)mmol/L]水平均低于治疗前[LDL-C:(3.55±0.78)、(3.51±0.81)mmol/L;TG:(2.09±0.56)、(2.11±0.64)mmol/L;TC:(5.22±0.93)、(5.19±0.67)mmol/L](P<0.05),HDL-C[(1.64±0.56)、(1.62±0.66)mmol/L]水平高于治疗前[(1.18±0.34)、(1.19±0.65)mmol/L](P<0.05),治疗前及治疗3个月后组间比较差异均无统计学意义(P>0.05);出血组、缺血组治疗3个月后颈动脉粥样硬化斑块面积[(0.58±0.16)、(0.60±0.19)cm^2]、IMT[(1.20±0.45)、(1.22±0.51)mm]、EI[(13.22±1.83)、(13.09±2.14)dB]、BI[(11.93±3.58)、(18.10±2.48)dB]均低于治疗前[斑块面积:(0.98±0.16)、(0.99±0.21)cm^2;IMT:(1.65±0.45)(1.66±0.32)mm;EI:(16.13±2.98)、(16.28±1.19)dB;BI:(18.20±3.21)、(12.21±0.44)dB](P<0.05),治疗前及治疗3个月后组间比较差异均无统计学意义(P>0.05);120例患者治疗前与治疗3个月后EI、BI差值与颈动脉粥样硬化斑块面积差值(r=0.410,P=0.023;r=0.387,P=0.028)及IMT差值(r=0.395,P=0.027;r=0.432,P=0.021)均呈正相关,与TG、TC、LDL-C、HDL-C差值无线性相关。结论瑞舒伐他汀联合拜阿司匹林治疗出血性、缺血性脑卒中颈动脉粥样硬化效果满意,超声造影可评估颈动脉粥样硬化斑块稳定性,反映治疗效果。

Objective To investigate the clinical value of contrast-enhanced ultrasound to the evaluation of the changes of carotid atherosclerotic plaque before and after treatment with rosuvastatin combined with aspirin in patients with stroke. Methods Eighty patients with ischemic stroke(ischemic group) and 40 patients with hemorrhagic stroke(hemorrhagic group) were orally administrated with rosuvastatin and aspirin for 3 months. The levels of serum triacylglycerol(TG), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol(HDL-C) were detected, and the carotid plaque area, intima thickness(IMT), base intensity(BI) and enhanced intensity(EI) were measured before and after 3-month treatment. Pearson correlation method was adopted to analyze the correlations of blood lipid indexes, carotid plaque area and carotid IMT difference with BI and EI difference before and after 3-month treatment. Results The levels of LDL-C((2.64±0.91),(2.68±0.81) mmol/L), TG((0.99±0.51),(0.91±0.63) mmol/L) and TC((4.43±0.56),(4.44±0.61) mmol/L) after 3-month treatment in hemorrhagic group and ischemic group were significantly lower than those before treatment(LDL-C:(3.55±0.78),(3.51±0.81) mmol/L; TG:(2.09±0.56),(2.11±0.64) mmol/L; TC:(5.22±0.93),(5.19±0.67) mmol/L)(P<0.05), the HDL-C levels((1.64±0.56),(1.62±0.66) mmol/L) were significantly higher than those before treatment((1.18±0.34),(1.19±0.65) mmol/L)(P<0.05), and all above indexes showed no significant differences between two groups both before and after 3-month treatment(P>0.05).The areas of carotid plaque((0.58±0.16),(0.60±0.19)cm2),IMT((1.20±0.45),(1.22±0.51)mm),EI((13.22±1.83),(13.09±2.14)dB)and BI((11.93±3.58),(18.10±2.48)dB)after 3-month treatment in hemorrhagic group and ischemic group were significantly lower than those before treatment(plaque area:(0.98±0.16),(0.99±0.21)cm2;IMT:(1.65±0.45)(1.66±0.32)mm;EI:(16.13±2.98),(16.28±1.19)dB;BI:(18.20±3.21)(12.21±0.44)dB)(P<0.05),and showed no significant differences between two groups both before and after 3-month treatment(P>0.05).The differences of EI and BI were positively correlated with carotid plaque area difference(r=0.410,P=0.023;r=0.387,P=0.028)and IMT difference before and after 3-month treatment(r=0.395,P=0.027;r=0.432,P=0.021),and were not linearly correlated with the differences of TG,TC,LDL-C and HDL-C in two groups.Conclusion Rosuvastatin combined with aspirin is effective for carotid atherosclerosis plaque in patients with ischemic and hemorrhagic stroke.Contrast-enhanced ultrasound can evaluate the stability of plaque and reflect the therapeutic effect.