血管结构特征与颈动脉内膜切除术后再狭窄的相关性研究

Correlation between carotid artery structure and restenosis after carotid endarterectomy

目的应用彩色多普勒血流显像(CDFI)评估颈动脉内膜切除术(CEA)前、术后颈动脉血管结构特征,并分析其与CEA术后再狭窄发生的相关性。方法回顾性连续纳入2014年1月至2019年2月于首都医科大学宣武医院神经外科及血管外科行CEA的颈动脉狭窄患者931例。于术前及术后1周、3个月、6个月、12个月行颈动脉CDFI检查,在术前及术后1周检测并记录颈总动脉远段、颈动脉球部、颈内动脉近段的原始管径,计算颈动脉球部与颈总动脉远段原始管径比值、颈动脉球部与颈内动脉近段原始管径比值。计算所有患者参数的平均值,作为纳入回归分析变量的分组标准。根据术后3个月及以上是否存在轻度(狭窄率30%~<50%)及以上首发再狭窄分为再狭窄组与无再狭窄组。采用单因素分析方法分析再狭窄组与无再狭窄组患者的一般及临床影像学资料,采用多因素Logistic回归分析影响CEA术后血管再狭窄的独立危险因素。结果931例患者中位随访12个月后,101例(10.8%)患者发生血管再狭窄。单因素分析结果显示,再狭窄组中女性患者显著多于无再狭窄组[26.7%(27/101)比12.5%(104/830),P<0.01]。再狭窄组患者术前球部原始管径、术前颈内动脉近段管径小于无再狭窄组[分别为:(6.8±0.9)mm比(7.1±1.0)mm,P=0.001;(4.0±0.8)mm比(4.2±0.7)mm,P=0.006]。再狭窄组患者术后首次颈总动脉远段管径、颈内动脉近段管径均小于无再狭窄组[分别为:(5.6±1.4)mm比(6.9±1.1)mm、(4.3±1.1)mm比(4.9±0.8)mm,均P<0.01];两组患者在术后颈动脉球部与颈总动脉远段管径比值、颈动脉球部与颈内动脉近段管径比值之间差异有统计学意义[分别为:(1.35±0.60)比(1.00±0.41)、(1.7±0.8)比(1.4±0.4),均P<0.01]。多因素Logistic回归分析结果显示,女性(OR=1.938,95%CI:1.117~3.363,P=0.019)、术后颈总动脉远段管径<6.8 mm(OR=3.551,95%CI:1.886~6.687,P<0.01)、术后球部与颈总动脉远段管径比值>1.0(OR=6.683,95%CI:3.322~13.441,P<0.01)是CEA术后血管再狭窄的独立危险因素。结论采用CDFI评估CEA患者术前及术后血管结构特征,可早期预测CEA术后再狭窄的发生,对提高患者远期疗效具有重要的临床参考价值。

Objective To evaluate the vascular structure of carotid artery before and after carotid endarterectomy(CEA)by color Doppler flow imaging(CDFI),and to analyze their correlations with restenosis after CEA.Methods From January 2014 to February 2019,931 patients who received CEA in the Departments of Neurosurgery and Vascular Surgery of Xuanwu Hospital,Capital Medical University were included.Patients received CDFI examinations before and after CEA(1 week,3 months,6 months and 12 months postoperatively).Before and 1 week after the operation,original diameter of distal common carotid artery(CCA),carotid bulb,and proximal internal carotid artery(ICA)were measured and recorded separately.The ratio of carotid bulb to distal CCA and the ratio of carotid bulb to proximal ICA were calculated.The mean values of all patient parameters were calculated and used as grouping criteria for variables included in the regression analysis.The patients were divided into restenosis group and non-restenosis group according to whether having mild restenosis(30%-<50%)or higher at least 3 months after operation.The general and clinical imaging data of the restenosis group and the non-restenosis group were analyzed by univariate analysis,and the independent risk factors for vascular restenosis after CEA were analyzed by multivariate Logistic regression.Results There were 931 cases with a median follow up of 12 months,and 101 cases(10.8%)developed restenosis.Univariate analysis showed that more female patients were in restenosis group than non-restenosis group(26.7%[27/101]vs.12.5%[104/830],P<0.01).The original diameter of carotid bulb and the diameter of ICA in restenosis group before CEA was significantly smaller than that of non-restenosis group,respectively([6.8±0.9]mm vs.[7.1±1.0]mm,P=0.001;[4.0±0.8]mm vs.[4.2±0.7]mm,P=0.006).The diameter of distal CCA and proximal ICA in restenosis group after CEA was significantly smaller than that of non-restenosis group,respectively([5.6±1.4]mm vs.[6.9±1.1]mm;[4.3±1.1]mm vs.[4.9±0.8]mm,both P<0.01).There were significant differences between the two groups in the ratio of carotid bulb to distal CCA after operation and the ratio of carotid bulb to proximal ICA after operation([1.35±0.60]vs.[1.00±0.41];[1.7±0.8]vs.[1.4±0.4],both P<0.01).Multivariate Logistic analysis identified that female(OR,1.938,95%CI 1.117-3.363,P<0.01),diameter of distal CCA after operation<6.8 mm(OR,3.551,95%CI 1.886-6.687,P<0.01)and the ratio of carotid bulb to distal CCA>1.0 after operation(OR,6.683,95%CI 3.322-13.441,P<0.01)were independent risk factors of postoperative restenosis after CEA.Conclusion The CDFI assessment of the carotid artery structure before and after CEA can predict the occurrence of restenosis after CEA in an early stage,and have important clinical reference value for improving the long-term efficacy of patients.