超声造影晚期增强评价颈动脉粥样硬化斑块内的炎症水平

Evaluating the inflammation levels of carotid atherosclerotic plaques by late-phase contrast-enhanced ultrasound

目的:颈动脉粥样硬化斑块内炎症反应与脑血管事件的发生密切相关,研究表明利用超声造影技术可以评估斑块内的炎症水平,但尚无与病理学相关的研究。本研究应用超声造影评估颈动脉内膜剥脱术(carotid endarterectomy,CEA)患者斑块内炎症水平并分析超声造影参数与临床症状及组织病理的相关性。方法:选取中南大学湘雅三医院神经外科拟行CEA的患者54例,其中3例患者双侧颈动脉均行CEA,共有57个目标斑块。根据中华医学会颈动脉狭窄诊治指南将患者分为症状组(33例)与无症状组(21例)。所有患者术前均行颈动脉斑块超声造影晚期增强(late-phase contrast-enhanced ultrasound,LP-CEUS)检查,应用定量分析观察斑块晚期增强程度及晚期相对增强强度比。术后对颈动脉斑块进行CD68组织病理学检测,观察斑块内巨噬细胞的情况,计算巨噬细胞浸润个数,采用Pearson相关分析探讨超声造影参数与临床症状及组织病理的相关性。结果:症状组斑块晚期增强强度及晚期相对增强强度比均明显高于非症状组,差异均有统计学意义(均P<0.05)。症状组斑块内巨噬细胞个数明显多于非症状组,差异具有统计学意义(P<0.05)。斑块晚期增强强度和晚期相对增强强度比均与巨噬细胞个数呈正相关(分别r=0.69,r=0.65,均P<0.05)。结论:LP-CEUS参数有助于评估颈动脉斑块内的炎症水平;有症状的患者斑块内炎症细胞浸润程度高于无症状的患者。

Objective:Inflammation in carotid atherosclerotic plaques is closely related to the occurrence of cerebrovascular events.Studies have shown that the use of contrast-enhanced ultrasound technology can assess the level of inflammation in the plaques,but there is no pathological-relevant research.In this study,contrast-enhanced ultrasound was used to assess the level of inflammation in the plaques of patients undergoing carotid endarterectomy(CEA)and to discuss the correlation among ultrasound parameters and clinical symptoms and histopathology.Methods:Fifty-four patients were selected to receive CEA due to carotid artery stenosis in Department of Neurosurgery,Third Xiangya Hospital,among which 3 patients received CEA surgery for bilateral carotid artery.The patients were divided into a symptomatic group(33 cases)and an asymptomatic group(21 cases)according to the diagnosis and treatment guideline of carotid stenosis of Chinese Medical Association.All patients received late-phase contrast-enhanced ultrasound(LP-CEUS)examination,and quantitative analysis was applied to observe the intensity of late-phase plaque enhancement and the relative intensity ratio of late-phase plaque enhancement.CD68 histopathological examination was performed on carotid artery plaque after surgery,the number of macrophage infiltration was calculated,and the correlation between ultrasound parameters and histopathology was analyzed by Pearson correlation.Results:The intensity of late-phase plaque enhancement and the relative intensity ratio of late-phase plaque enhancement in the symptomatic group were significantly higher than those in the asymptomatic group,with statistically significant differences(P<0.05).The number of macrophages in the plaque in the symptom group was significantly higher than that in the asymptomatic group,and the difference was statistically significant(P<0.05).The intensity of late-phase enhancement and the relative intensity of late-phase plaque enhancement were positively correlated with the number of macrophages(r=0.69,r=0.65,respectively,both P<0.05).Conclusion:The parameters of LP-CEUS are helpful in assessing inflammation in carotid plaque.The degree of macrophage infiltration in plaque of patients with symptoms was higher than that of asymptomatic patients.