超声造影对颈动脉大动脉炎活动性的评估

Assessment of activity of Takayasu arteritis by contrast-enhanced ultrasonography

目的探讨超声造影对颈动脉多发性大动脉炎(TA)病变活动期的评估价值。方法回顾性纳入2019年1月至2020年1月于首都医科大学宣武医院临床诊断为颈动脉TA的患者37例,将患者分为临床活动期17例与非活动期20例。2组均采用二维灰阶超声与超声造影联合检查,比较TA患者活动期与非活动期的常规超声及超声造影特征,并分析超声造影各相关参数与炎性因子的相关性。结果37例患者共计62支颈动脉出现TA病变,其中活动期组28支,非活动期组34支。活动期患者红细胞沉降率(ESR)、C反应蛋白(CRP)均明显高于非活动期患者(Z=-2.12,P=0.03;t=2.54,P=0.02)。2组患者颈动脉病变管壁厚度及狭窄程度差异均无统计学意义(t=0.60,P=0.55;χ^(2)=0.63,P=0.43)。超声造影示活动期动脉血管壁内新生血管明显多于非活动期颈动脉病变组(χ^(2)=10.42,P<0.01),活动期组与非活动期组相比,增强曲线斜率(Z=1.75,P<0.01)、达峰时间(t=−4.24,P<0.01)、峰值增强强度(Z=1.62,P=0.03)、曲线下面积(Z=2.01,P<0.01)组间差异均存在统计学意义。CRP与增强曲线斜率(r=0.51,P<0.01)、峰值增强强度(r=0.49,P<0.01)及曲线下面积(r=0.49,P<0.01)均呈正相关关系,但是CRP与达峰时间之间呈负相关性(r=-0.63,P<0.01);ESR与增强曲线斜率(r=0.51,P<0.01)、峰值增强强度(r=0.47,P<0.01)及曲线下面积(r=0.55,P<0.01)存在正相关性,而ESR与达峰时间(r=-0.72,P<0.01)存在负相关性。结论新生血管可以有效反映TA活动性,且管壁增强强度与炎性因子水平明显相关。应用颈动脉超声造影动态观察TA患者病变活动情况,可为临床医师选择最佳治疗方案提供客观依据。

Objective To investigate the correlation between clinical activity and the enhancement of vessel wall acquired by contrast-enhanced ultrasound sonography(CEUS)in patients with Takayasu arteritis(TA),and to evaluate whether CEUS can be used to assess the disease activity of TA.Methods A total of 37 TA patients with 62 carotid arteries affected were enrolled form January 2019 to January 2020 retrospectively at Xuanwu Hospital of Capital Medical University.The patients were divided into either an active group(17 patients)or an inactive group(20 patients)for statistical analysis.Contrastenhanced ultrasound combined with clinical manifestations and laboratory results were used to analyze the characteristics of carotid artery wall structure in the two groups,as well as the correlation of parameters of contrast-enhanced ultrasound and inflammatory factors.Results In the 37 patients,a total of 62 carotid arteries were involved,including 28 carotid arteries in the active group and 34 in the inactive group.Erythrocyte sedimentation rate(ESR)(Z=-2.12,P=0.03)and C-reactive protein(CRP)(t=2.54,P=0.02)in the active group were significantly higher than those in the inactive group.The carotid wall thickness(t=0.60,P=0.55)and stenotic severity(χ^(2)=0.63,P=0.43)assessed had no significant difference between the two groups(P>0.05).The neovascularization detected by CEUS in the active group was significantly higher than that in the inactive group(χ^(2)=10.42,P<0.01).The slope of CEUS time-intensity curve(Z=1.75,P<0.01),peak intensity(Z=1.62,P=0.03),and area under curve(Z=2.01,P<0.01)in the active group were significantly increased,and the time to peak(t=-4.24,P<0.01)in the active group was significantly shorter than that in the inactive group.CRP was positively correlated with slope(r=0.51,P<0.01),PI(r=0.49,P<0.01),and AUC(r=0.49,P<0.01),and negatively correlated with TTP(r=-0.63,P<0.01).ESR was also positively correlated with slope(r=0.51,P<0.01),PI(r=0.47,P<0.01)and AUC(r=0.55,P<0.01),and negatively correlated with TTP(r=-0.72,P<0.01).Conclusion The neovascularization assessed by CEUS is highly related to the TA activity,and peak intensity of CEUS is significantly correlated with inflammatory factors.CEUS could be used as an alternative imaging method to assess disease activity for TA patients,and can provide a basis for clinicians to formulate the best treatment plan.