血流向量成像技术探讨颈动脉斑块患者血管壁剪应力与心脑血管疾病的相关性分析

Exploration of the Correlation Analysis between Vascular Wall Shear Stress and Cardiovascular and Cerebrovascular Diseases in Patients With Carotid Artery Plaque Using Flow Vector Imaging

目的探讨颈动脉斑块人群的血管壁剪应力(wall shearstress,WSS)的分布特点及与心脑血管疾病发生的相关性。方法选择2018年9月至12月期间在我科行颈部血管超声检查存在斑块且血生化检查及病史资料完整者228例,按照有无冠心病(CHD)或脑梗分为两组:无冠心病和脑梗组,记为无病组;有冠心病或脑梗组,记为患病组。比较血管斑块处与其近端、远端的血管壁剪应力有无统计学差异。93例患病组(实验组)和135例无病组(对照组)行对比试验,分别行单因素和多因素分析研究血管壁剪应力对于心脑血管疾病发生的独立影响。结果双侧颈动脉分叉斑块处的WSS明显低于其近端及远端的WSS,有显著统计学差异(P<0.05);TC(OR=0.19,95%CL为0.04~0.81,P<0.05)、脉压差(OR=1.10,95%CL为1.03~1.18,P<0.05)和LCCABIF前壁WSS值(OR=5.855,95%CL为1.007~34.053,P<0.05)为心脑血管疾病发生的独立危险因素。结论血管壁剪应力的改变与颈动脉斑块的形成密切相关;LCCABIF前壁WSSa值或许可以作为前瞻性"指标物",对颈动脉斑块患者的心脑血管疾病发病风险进行早期预判,从而减少心脑血管恶性事件的发生,降低其致死率。

Objective To investigate the distribution characteristics of wall shear stress( WSS) in patients with carotid artery plaques and its correlation with the occurrence of cardiovascular and cerebrovascular diseases.Methods A total of 228 cases with plaques in the cervical vascular ultrasound examination and complete blood biochemical examination and medical history data were enrolled in our department from September to December 2018.They were divided into two groups according to the presence of coronary heart disease( CHD) or cerebral infarction: the group without coronary heart disease and cerebral infarction,recorded as the disease-free group;the group with coronary heart disease or cerebral infarction,recorded as the diseased group.The statistical differences in the vascular wall shear stress between the vascular plaque and its proximal and distal ends were compared.A comparative study was conducted in 93 patients in the diseased group( experimental group) and 135 patients in the disease-free group( control group),and the independent effects of vascular wall shear stress on the occurrence of cardiovascular and cerebrovascular diseases were analyzed by single-factor and multi-factor analysis,respectively.Results The WSS of bilateral carotid bifurcation plaques was significantly lower than that of proximal and distal ends,with statistically significant difference( P<0.05).TC( OR= 0.19,95% CL= 0.04~ 0.81,P<0.05),pulse pressure difference( OR= 1.10,95%CL= 1.03~ 1.18,P<0.05) and the WSSa value of the anterior wall of LCCABIF( OR= 5.855,95%CL= 1.007~ 34.053,P<0.05) are independent risk factors for cardiovascular and cerebrovascular diseases.Conclusion The change of vascular wall shear stress is closely related to the formation of carotid plaque.The WSSa value of the anterior wall of LCCABIF may be used as a prospective " indicator" to early predict the risk of cardiovascular and cerebrovascular diseases in patients with carotid artery plaque,so as to reduce the occurrence of cardiovascular and cerebrovascular malignant events and reduce the mortality.