三维超声标准化管壁指数评价颈动脉斑块药物疗效临床研究

Clinical study of three-dimensional ultrasound standardized wall index in evaluating the efficacy of carotid plaque drug therapy

目的探讨三维超声标准化管壁指数(NWI)在定量评价颈动脉斑块药物治疗效果中的应用价值。方法收集2015年5月至2019年3月于我院神经内科就诊,首次诊断为颈动脉斑块拟行药物治疗81例患者,所有患者均将接受阿托伐他汀治疗(20 mg/d)。治疗前1周内完成颈动脉三维超声、3.0T MRI检查和总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)检测,应用超声图像分析软件计算出各组斑块的NWI值。根据MRI及三维超声检查数据将斑块分为低风险组、中等风险组和高风险组。服用药物6~12个月后再次行颈动脉三维超声检查获取NWI值,分析药物治疗后NWI值变化及其与血脂的相关性。结果55例患者共计62枚斑块纳入随访,平均随访时间为10.8个月。高风险组药物治疗后NWI值明显降低[(0.40±0.08)vs.(0.44±0.07),P<0.05],而中等风险组及低风险组NWI值治疗前后变化不明显[(0.43±0.09)vs.(0.43±0.09)];[(0.46±0.10)vs.(0.45±0.07),P>0.05]。各组治疗后TC和LDL-C水平明显降低(P<0.05),药物治疗后NWI变化和血脂(TC、TG、LDL-C、HDL-C)变化呈正相关(P>0.05)。结论三维超声标准化管壁指数(NWI)对于高风险组斑块药物治疗效果评价短期随访具有一定临床意义。

Objective To explore the value of carotid three-dimensional ultrasound normalized wall index(NWI)in quantitatively evaluating the effect of carotid plaque drug therapy.Methods Eighty one patients who visited the Department of Neurology in our hospital from May 2015 to March 2019 and were first diagnosed with carotid plaque who were scheduled to be treated with drugs were included.All patients will be treated with atorvastatin(20 mg/d).Three dimensional ultrasound of carotid arteries,3.0T MRI,and serum lipid(TC,TG,LDL-C,HDL-C)measurements were completed within a week before treatment,and NWI values of plaques in each group were calculated by using ultrasonic image analysis software.Plaques were classified into low,intermediate,and high risk groups based on MRI and 3D ultrasonography data.NWI values were acquired by carotid three-dimensional ultrasonography again 6-12 months after taking the drugs,and changes in NWI values and their correlation with blood lipids were analyzed after the drug treatment.Results A total of 62 plaques in 55 patients were included in the follow-up,with an average follow-up time of 10.8 months.1.The NWI value of the high-risk group was significantly decreased after drug therapy than before(0.40±0.08 vs.0.44±0.07,P<0.05),medium-risk and low-risk groups had no significant change(0.43±0.09 vs.0.43±0.09,0.46±0.10 vs.0.45±0.07,P>0.05).2.There was no significant difference in serum TC,TG,LDL-C,and HDL-C levels among the groups before treatment.After treatment,the serum TC and LDL-C levels were significantly lower than before(P<0.05),the difference between TG and HDL-C levels was not significant,and the LDL-C levels in the high-risk group were significantly lower than those in other groups(P<0.05).Conclusion Three-dimensional ultrasound normalized wall index(NWI)has certain clinical significance for short-term follow-up evaluation of plaque drug therapy effects in high-risk groups.