颈动脉狭窄程度的超声诊断及其与斑块回声、形态和病理特征的关系

Ultrasound Diagnosis of Carotid Artery Stenosis Severity and Its Correlation with Echo,Morphology and Pathological Characteristics of Plaque

目的:探讨超声探查颈动脉狭窄程度的效果,分析颈动脉狭窄程度与斑块回声、形态和病理特征之间的关系。方法:选取2019年1月—2021年1月在南京医科大学第二附属医院行内膜剥脱术的颈动脉斑块伴狭窄患者32例作为研究对象,记录狭窄处斑块的回声、形态,以数字减影血管造影诊断结果为诊断“金标准”,评价超声检查诊断管腔狭窄程度的符合率,分析不同狭窄程度患者斑块回声、斑块形态、斑块病理情况。结果:超声检查诊断管腔狭窄程度的符合率为93.8%。重度狭窄患者不均质斑块占比高于中度狭窄患者,中度狭窄患者低回声斑块占比高于重度狭窄患者,差异有统计学意义(P<0.05)。重度狭窄和中度狭窄患者斑块形态情况比较,差异无统计学意义(P>0.05)。重度狭窄患者溃疡伴出血斑块占比高于中度狭窄患者,差异有统计学意义(P=0.03)。结论:颈动脉斑块回声及形态的不同可能会影响狭窄程度,颈动脉超声能明确斑块的性质及稳定性,评估狭窄程度。

Objective:To explore the effect of ultrasonography in carotid artery stenosis severity,and analyze the correlation of carotid artery stenosis severity with echo,morphology and pathological characteristics of plaque.Methods:From January 2019 to January 2021,32 patients with carotid plaques and stenosis who underwent endarterectomy in the Second Affiliated Hospital of Nanjing Medical University were selected as the study subjects.The echo and morphology of plaques at the stenosis were recorded.and hemodynamic analysis was performed,the pathological characteristics of the plaques after surgery were analyzed.The diagnosis results of digital subtraction angiography were used as the"gold standard"for diagnosis,the coincidence rate of ultrasonography in the diagnosis of luminal stenosis was evaluated,and the plaque echo,plaque morphology and plaque pathology of patients with different severities of stenosis were analyzed.Results:The coincidence rate of ultrasonography in the diagnosis of luminal stenosis was 93.8%.The proportion of heterogeneous plaques in severe stenosis patients was higher than that in moderate stenosis patients,the proportion of hypoechoic plaques in moderate stenosis patients was higher than that in severe stenosis patients,with statistically significant difference(P<0.05).There was no statistically significant difference in the plaque morphology between severe stenosis patients and moderate stenosis patients(P>0.05).The proportion of ulcer with hemorrhagic plaques in severe stenosis patients was higher than that in moderate stenosis patients,and the difference was statistically significant(P=0.03).Conclusion:Different echoes and morphologies of carotid artery plaques may affect the stenosis severity,and carotid artery ultrasound can identify the nature and stability of plaques,and evaluate the severity of stenosis.