本文選題：超聲 + 頸動脈硬化斑塊　； 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的通過利用超聲評估頸動脈粥樣硬化斑塊卒中風(fēng)險等級評分與冠狀動脈病變嚴(yán)重程度的相關(guān)性研究,探討憑借頸動脈斑塊易損性預(yù)測冠狀動脈病變嚴(yán)重程度的臨床價值,達(dá)到“心腦血管疾病同防、同治、同康復(fù)”的目的。方法選取2014年9月至2016年11月于首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院心內(nèi)科、心外科經(jīng)選擇性冠狀動脈造影檢查的住院患者117名,按冠狀動脈造影結(jié)果分為冠狀動脈輕、中、重度狹窄組;根據(jù)患者冠狀動脈病變累及支數(shù)將上述患者分為單支、雙支組和三支病變組。利用常規(guī)超聲檢測患者頸動脈斑塊回聲類型、形態(tài)及大小及頸動脈管腔狹窄程度;微血流成像技術(shù)(SMI)聯(lián)合超聲造影技術(shù)(CEUS)檢測頸動脈斑塊內(nèi)新生血管情況,按照頸動脈斑塊性質(zhì)將上述患者分為易損斑塊組與穩(wěn)定斑塊組,按照頸動脈管腔狹窄程度將上述患者分為輕度狹窄組與中度以上狹窄組,分別比較兩組患者冠狀動脈狹窄嚴(yán)重程度的Gensini評分差異性。評價每位患者頸動脈斑塊卒中風(fēng)險等級,比較不同風(fēng)險等級組患者冠狀動脈狹窄嚴(yán)重程度的Gensini評分差異性。結(jié)果1、頸動脈易損斑塊檢出情況:117名冠心病患者經(jīng)頸動脈超聲檢查,共檢出頸動脈易損斑塊45個,其中新生血管形成頸動脈斑塊40個,含脂質(zhì)壞死核心斑塊5個,潰瘍斑8個,水母斑3個,纖維帽破裂斑塊1個,斑塊表面細(xì)小血栓形成1個。冠狀動脈輕、中、重度狹窄組頸動脈易損斑塊檢出率分別為21.05%%、26.92%、47.22%。冠狀動脈單支、雙支、三支病變組頸動脈易損斑塊檢出率分別為25.71%、28.57%、55.31%。2、頸動脈易損斑塊組冠狀動脈狹窄嚴(yán)重程度Gensini評分明顯高于頸動脈穩(wěn)定斑塊組(p0.05)。3、頸動脈管腔輕度狹窄組(30%)與中度以上狹窄組(≥30%)的冠狀動脈狹窄嚴(yán)重程度Gensini評分差異無統(tǒng)計學(xué)意義。4、頸動脈斑塊高度、極高度風(fēng)險等級組患者冠脈Gensini積分明顯高于低度、中度風(fēng)險組,有統(tǒng)計學(xué)意義(p0.05)。結(jié)論冠狀動脈硬化病變程度越重,其頸動脈易損斑塊發(fā)生率越高;超聲評估頸動脈斑塊卒中風(fēng)險等級越高,冠狀動脈病變越嚴(yán)重。頸動脈斑塊性質(zhì)及斑塊發(fā)生缺血性腦卒中風(fēng)險等級在一定程度上能夠推測冠狀動脈硬化狹窄嚴(yán)重程度,預(yù)示其急性冠脈綜合征發(fā)生、發(fā)展風(fēng)險相應(yīng)增加。
[Abstract]:Objective to evaluate the clinical value of carotid plaque vulnerability in predicting the severity of coronary artery disease by using ultrasound to evaluate the correlation between the risk score of carotid atherosclerotic plaque stroke and the severity of coronary artery disease. To achieve the purpose of "cardio-cerebrovascular disease with prevention, treatment and rehabilitation". Methods from September 2014 to November 2016, 117 inpatients who underwent selective coronary angiography in Department of Cardiology, Beijing Anzhen Hospital, affiliated to Capital Medical University, were divided into mild and moderate coronary arteries according to the results of coronary angiography. According to the number of coronary artery involvement, the patients were divided into single vessel group, double vessel group and three vessel group. The types, shape and size of carotid plaques and the degree of carotid stenosis were detected by conventional ultrasound, and the angiogenesis in carotid plaques was detected by microflow imaging (SMI) and contrast-enhanced ultrasonography (CEUSS). According to the nature of carotid plaques, the patients were divided into vulnerable plaque group and stable plaque group. According to the degree of carotid artery stenosis, the patients were divided into mild stenosis group and moderate stenosis group. The Gensini scores of the severity of coronary artery stenosis were compared between the two groups. To evaluate the risk of carotid plaque stroke in each patient and compare the Gensini scores of coronary artery stenosis severity in different risk groups. Results 1. Carotid vulnerable plaques were detected in 117 patients with coronary heart disease by carotid ultrasound. A total of 45 carotid vulnerable plaques were detected, including 40 carotid plaques formed by neovascularization, 5 core plaques with lipid necrosis and 8 ulcer plaques. There were 3 spots of jellyfish, 1 plaque of rupture of fibrous cap and 1 small thrombus on plaque surface. The detection rate of vulnerable plaque of carotid artery in patients with mild, moderate and severe coronary artery stenosis was 21.05 and 26.92, respectively. Single coronary artery, double coronary artery, The detection rate of carotid artery vulnerable plaque in the three vessel lesion group was 25.71 and 28.577.The Gensini score of coronary artery stenosis in the carotid artery vulnerable plaque group was significantly higher than that in the carotid artery stable plaque group (P 0.05. 3 and 30% in the mild carotid artery stenosis group) and more than moderate in the carotid artery vulnerable plaque group (P < 0.05) and the severity of coronary artery stenosis in the carotid artery vulnerable plaque group was significantly higher than that in the carotid artery stable plaque group. There was no significant difference in Gensini score of severity of coronary artery stenosis in narrow group (鈮，

本文編號：1799428