本文選題：頸動脈斑塊　切入點(diǎn)：三維超聲(3D-US)　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:應(yīng)用三維頸動脈超聲(Three dimensional ultrasound,3D-US)獲取頸動脈斑塊患者三維圖像數(shù)據(jù),應(yīng)用三維超聲斑塊定量分析軟件(vessel plaque quantification,VPQ)得出:斑塊灰階中位數(shù)值(Gray scale median,GSM)、標(biāo)準(zhǔn)化管壁指數(shù)(Normalized wall index,NWI)以及斑塊體積(Plaque volume,PV)等定量參數(shù),對比分析藥物治療前后斑塊各參數(shù)的變化情況,旨在探討基于3D-US的GSM、NWI以及PV參數(shù)在定量評價(jià)頸動脈斑塊藥物治療效果中的應(yīng)用價(jià)值,并分析GSM、NWI及PV與血脂(TC、TG、LDL-C、HDL-C)、吸煙等危險(xiǎn)因素的關(guān)系。方法:1.研究對象:收集2015年5-10月陸軍總醫(yī)院神經(jīng)內(nèi)科就診的頸動脈斑塊患者81例共計(jì)93枚斑塊,治療前接受頸動脈3D-US、3.0T MRI和血清總膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL-C)和高密度脂蛋白膽固醇(HDL-C)水平檢測。接受阿托伐他汀治療(20mg/d)6~12個(gè)月進(jìn)行3D-US和血脂的隨訪。共有55例患者共計(jì)62枚斑塊納入隨訪,平均隨訪時(shí)間10.8個(gè)月。2.患者分組:(1)根據(jù)治療前MRI及3D-US的GSM值將斑塊分為低風(fēng)險(xiǎn)組(28例)、中等風(fēng)險(xiǎn)組(13例)和高風(fēng)險(xiǎn)組(21例);(2)根據(jù)患者藥物治療期間是否戒煙分為:戒煙組(52例)和未戒煙組(10例)。3.應(yīng)用三維超聲VPQ分析軟件獲取各組斑塊的灰階中位數(shù)值(GSM)、標(biāo)準(zhǔn)化管壁指數(shù)(NWI)以及斑塊體積(PV)參數(shù),對比分析藥物治療前后各組內(nèi)、組間血脂和各參數(shù)的變化并分析他們之間的關(guān)系。結(jié)果:1.治療前血清TC、TG、LDL-C、HDL-C水平各組間無顯著差異,治療后TC和LDL-C水平明顯減低(P0.05),TG、HDL-C水平無顯著變化;治療后高風(fēng)險(xiǎn)組LDL-C水平明顯低于低風(fēng)險(xiǎn)、中等風(fēng)險(xiǎn)組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.高風(fēng)險(xiǎn)組和中等風(fēng)險(xiǎn)組GSM值治療后較治療前顯著升高(33.87±6.53 vs27.50±7.82、47.35±5.42 vs 44.56±4.36,P0.05)而低風(fēng)險(xiǎn)組斑塊GSM值升高不顯著(63.13±10.41 vs 62.01±10.68,P0.05);高風(fēng)險(xiǎn)組NWI治療后較治療前顯著降低(0.40±0.08 vs 0.44±0.07,P0.05),而中等風(fēng)險(xiǎn)組及低風(fēng)險(xiǎn)組NWI值藥物治療前后變化不明顯(0.43±0.09 vs 0.43±0.09、0.46±0.10 vs 0.45±0.07,P0.05);高風(fēng)險(xiǎn)組PV治療后較治療前顯著降低(0.25±0.09 vs 0.29±0.08,P0.05),而中等風(fēng)險(xiǎn)組及低風(fēng)險(xiǎn)組NWI值藥物治療前后變化不明顯(0.28±0.18 vs 0.28±0.18、0.27±0.17 vs 0.26±0.16,P0.05)。3.治療前后三組GSM的差值與治療前后LDL-C差值呈負(fù)相關(guān)(r=-0.28,p=0.03),而與TC、TG、HDL-C不相關(guān)。治療前后三組NWI、PV的差值與血脂(TC、TG、LDL-C、HDL-C)差值均不相關(guān)(P0.05)。4.戒煙組GSM值治療后較治療前顯著升高(51.14±15.64 vs 46.85±18.47,P0.05),而未戒煙組GSM值治療后較治療前顯著降低(43.34±12.96 vs 45.58±12.76,P0.05)。戒煙組NWI值治療后較治療前顯著降低(0.42±0.08 vs 0.44±0.07,P0.05),而未戒煙組NWI值治療后較治療前顯著升高(0.54±0.09 vs0.46±0.09,P0.05)。戒煙組PV值治療后較治療前顯著降低(0.28±0.17 vs0.30±0.15,P0.05),而未戒煙組NWI值治療后較治療前顯著升高(0.31±0.09vs 0.23±0.10,P0.05)。結(jié)論:3D-US所獲GSM、NWI以及PV值可以作為臨床評價(jià)頸動脈斑塊藥物治療效果的可靠指標(biāo),尤其對于中等風(fēng)險(xiǎn)及高風(fēng)險(xiǎn)的頸動脈斑塊應(yīng)用價(jià)值更大。三項(xiàng)指標(biāo)中,GSM的敏感性更好,具有更好的臨床運(yùn)用價(jià)值。戒煙組和未戒煙組三項(xiàng)參數(shù)均出現(xiàn)了反方向的變化,表明吸煙在斑塊藥物治療過程中具有負(fù)面影響。
[Abstract]:Objective: the application of three-dimensional ultrasound of carotid artery (Three dimensional ultrasound, 3D-US) for carotid plaque in three-dimensional image data analysis software, using 3D ultrasound plaque (vessel plaque quantification, quantitative VPQ) that a plaque in the gray scale numerical (Gray scale median, GSM), the standard wall index (Normalized wall index, NWI) and the plaque volume (Plaque volume, PV) and other quantitative parameters change comparative analysis before and after drug treatment of different patch parameters, to investigate 3D-US based on GSM, the application value of NWI and PV parameter in quantitative assessment of carotid plaque in drug therapy, and analysis of GSM, NWI and PV (TC, TG, and blood lipid LDL-C, HDL-C), the relationship between smoking and other risk factors. Methods: 1. subjects: from 2015 5-10 months the Army General Hospital neurology clinic of the carotid plaque in 81 patients a total of 93 gold plaque underwent carotid artery before treatment 3D-US, 3.0T, MRI and serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) levels were detected. Treated with atorvastatin (20mg/d) of 3D-US and serum lipids in 6~12 months of follow-up. There were 55 cases of patients with a total of 62 gold plaque in the follow-up, the mean follow-up time was 10.8 months.2. patients were divided into two groups: (1) according to MRI before treatment and 3D-US GSM values were divided into low risk group (28 cases), moderate risk group (13 cases) and high risk group (21 cases); (2) according to the patients during the medication would stop smoking points as smoking cessation group (52 cases) and non smoking group (10 cases) a numerical application of three dimensional ultrasound gray scale.3. VPQ analysis software to obtain each plaque in (GSM), standard wall index (NWI) and plaque volume (PV) parameters, comparative analysis of before and after treatment in each group, and analyze the changes between the groups blood lipids and parameters between them Results: 1.. Serum TC, TG, LDL-C, HDL-C had no significant difference between groups TC and LDL-C level, was significantly reduced after treatment (P0.05, TG), no significant changes in HDL-C levels after treatment; the high risk group of LDL-C were significantly lower than those of low risk, medium risk group, the difference was statistically significant (P0.05.2.) high risk group and moderate risk group GSM value after treatment was significantly higher than that before treatment (33.87 + 6.53 vs27.50 + 44.56 7.82,47.35 + 5.42 vs + 4.36, P0.05) and low risk group GSM plaque is not significantly increased (63.13 + 10.41 vs 62.01 + 10.68, P0.05); high risk group NWI after treatment reduced (0.40 + 0.08 vs 0.44 + 0.07, P0.05), and moderate risk group and low risk group NWI value before and after drug treatment did not change significantly (0.43 + 0.09 vs 0.43 + 0.09,0.46 + 0.10 vs 0.45 + 0.07, P0.05); high risk group PV after treatment were significantly lower than those before treatment (0.25 + 0.09 vs 0.29 + 0.08 ,P0.05),鑰屼腑絳夐闄╃粍鍙?qiáng)浣庨闄┚l凬WI鍊艱嵂鐗╂不鐤楀墠鍚庡彉鍖栦笉鏄庢樉(0.28鹵0.18 vs 0.28鹵0.18,0.27鹵0.17 vs 0.26鹵0.16,P0.05).3.娌葷枟鍓嶅悗涓夌粍GSM鐨勫樊鍊間笌娌葷枟鍓嶅悗LDL-C宸，

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