超声评价青老年颈动脉粥样硬化斑块临床价值

Clinical Value of Ultrasound in the Evaluation of Carotid Atherosclerotic Plaques in Young and Elderly Patients

目的分析存在颈动脉粥样硬化斑块青老年患者的斑块超声表现特征并探讨其临床价值。方法回顾性分析2017年1~12月在笔者科室确诊颈动脉粥样硬化斑块的青年患者297例为青年组,选择同期确诊颈动脉粥样硬化斑块的老年患者302例为老年组,同期颈动脉超声检查无斑块青年50例为空白对照组。对比分析各组的血压、空腹血糖、血脂及颈动脉粥样硬化斑块的分布位置、回声特征、Crouse积分等参数。结果青年组收缩/舒张压明显高于空白对照组,青年组舒张压、甘油三酯及总胆固醇值均高于老年组(P<0.05)。青年组斑块Crouse积分、颈动脉中度以上狭窄发生率均低于老年组(P<0.05)。青年组及老年组均以不稳定斑块为主,青年组以均质低回声斑块为主,且比例高于老年组(79.6%vs 36.3%,P=0.000),而老年组以不均质回声斑块为主,占56.0%。青年组斑块分布以颈动脉分叉部为主,其他部位相对少见。老年组颈动脉分叉部斑块比例低于青年组(42.8%vs 70.7%,P=0.000)。青年组脑梗死患者多见均质低回声斑块,占87.10%,以颈动脉分叉部多见,占74.19%。老年脑梗死患者以不均质回声斑块为主,占41.67%,分布以颈动脉分叉处合并其他多部位为主,占62.5%。结论青老年患者颈动脉硬化斑块的超声表现特点及伴发脑梗死等情况存在差异,对于临床诊治具有一定的指导意义和参考价值。

Objective To analyze the ultrasound features of carotid atherosclerotic plaques in young and elderly patients and to evaluate its clinical value.Methods The clinical data of 297 young patients(<44y;young group)and 302 elderly patients(>60y;elderly group)diagnosed with carotid atherosclerotic plaque by ultrasound in author′s hospital from January to December 2017 were reviewed.A total of 50 young adults who had ultrasound examination of the carotid artery but had no plaques were included in the blank control group.Parameters including blood pressure(HP),fasting glucose(GLU),triglyceride(TG),total cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL),and distribution,echo characteristics and crouse score of the carotid atherosclerotic plaques were compared among the groups.Results The young group had significantly higher systolic and diastolic blood pressure than the blank control group,and higher diastolic blood pressure,TG and TC than the elderly group(all P<0.05).The crouse score of plaques and the incidence rate of moderate to severe stenosis(>50%)of the carotid artery were significantly lower in the young group than in the elderly group(P<0.05).Both the young group and elderly group were predominated by unstable plaques.The proportion of homogeneous hypoechoic plaques was significantly higher in the young group(79.6%)than in the elderly group(36.3%,P=0.000),while the proportion of heterogeneous plaques was higher in the elderly group(56.0%).Young patients had significantly higher number of plaques in the common carotid artery(CCA)bifurcation than the elderly patients(70.7%vs 42.8%,P=0.000).Furthermore,homogeneous hypoechoic plaques were predominant(87.10%)in young patients with cerebral infarction and were mostly found in the CCA bifurcation(74.19%).In contrast,heterogeneous echoic plaques were predominant(41.67%)in elderly patients with cerebral infarction and were mainly found in the CCA bifurcation and other regions of the artery(62.5%).Conclusion The ultrasonographic features of carotid atherosclerotic plaques and complication with cerebral infarction are different between young and elderly patients,which may provide guidance and insights to the clinical diagnosis and treatment of the disease.