【摘要】：目的:通過(guò)多排螺旋CT血管造影技術(shù)(Multi Director Computed Tomography Angiography,MDCTA)獲取頸動(dòng)脈粥樣硬化性斑塊的形態(tài)學(xué)特征,結(jié)合斑塊的成分特征,探討其與腦梗塞及腦出血發(fā)生的相關(guān)性,為頸動(dòng)脈粥樣硬化性斑塊的風(fēng)險(xiǎn)評(píng)估和腦梗塞及腦出血患者的防治提供參考。材料與方法:收集高密市人民醫(yī)院自2013年11月至2016年11月收住的頸動(dòng)脈粥樣硬化引起動(dòng)脈狹窄的400例患者,排除非動(dòng)脈粥樣硬化性血管病,如心源性腦梗塞、糖尿病、煙霧病、動(dòng)脈炎等。采用Philips 64排128層螺旋CT進(jìn)行MDCTA檢查。通過(guò)CT后處理技術(shù)測(cè)量斑塊體積、CT值、管腔狹窄程度等指標(biāo),并按CT值進(jìn)行分類(lèi),收集相關(guān)臨床資料。分析各斑塊臨床特點(diǎn)、腦出血與腦梗塞患者斑塊組分特征,以及管腔狹窄度與腦梗塞發(fā)生的相關(guān)性。結(jié)果:1.根據(jù)斑塊類(lèi)型共包含纖維斑塊型52例,脂肪斑塊型60例,鈣化斑塊型80例,混合斑塊型208例。所有病例中合并潰瘍的斑塊129例,82%的合并潰瘍斑塊出現(xiàn)在腦梗塞患者中。同時(shí),腦梗塞患者的血糖、三酰甘油及總膽固醇的含量顯著高于對(duì)照組。2.有60%的鈣化斑塊出現(xiàn)在腦出血患者中。腦出血患者中鈣化斑塊比例顯著高于腦梗塞患者(P0.05),出現(xiàn)鈣化斑塊的腦出血患者的血壓水平顯著升高。3.脂肪斑塊、纖維斑塊與混合斑塊的分布在腦出血及腦梗塞中無(wú)顯著差異(P0.05)。4.在輕度頸動(dòng)脈狹窄組中,脂肪斑塊體積/斑塊體積百分比(以下簡(jiǎn)稱(chēng)脂肪斑塊體積百分比)與腦梗塞發(fā)生呈正相關(guān)(OR=2.24,95%CI:1.17-4.67;P0.001),而鈣化斑塊體積/斑塊體積百分比(以下簡(jiǎn)稱(chēng)鈣化斑塊體積百分比)與腦梗塞發(fā)生呈負(fù)相關(guān)(OR=0.36,95%CI:0.29-0.83;P=0.007)。在中重度頸動(dòng)脈狹窄組中,脂肪斑塊體積百分比亦與腦梗塞發(fā)生呈正相關(guān)(OR=1.63,95%CI:1.13-4.15;P=0.005),而鈣化斑塊體積百分比與腦梗塞發(fā)生無(wú)顯著關(guān)系(OR=0.89,95%CI:0.53-2.17;P=0.31)。結(jié)論:脂肪斑塊體積百分比與腦梗塞的發(fā)生率呈正相關(guān),潰瘍斑塊導(dǎo)致腦梗塞的發(fā)生率明顯高于其它斑塊,鈣化斑塊多容易出現(xiàn)在腦出血患者群體中。MDCTA可以對(duì)頸動(dòng)脈粥樣硬化斑塊的組分特征進(jìn)行分析,對(duì)其易損性、不穩(wěn)定性進(jìn)行評(píng)估,對(duì)頸動(dòng)脈粥樣硬化性斑塊的風(fēng)險(xiǎn)評(píng)估和腦梗塞及腦出血患者的防治具有積極參考價(jià)值。
[Abstract]:Objective: to obtain the morphological characteristics of carotid atherosclerotic plaques by multi-slice spiral CT angiography (Multi Director Computed Tomography Angiography,MDCTA), and to explore the correlation between carotid atherosclerotic plaques and cerebral infarction and cerebral hemorrhage, so as to provide reference for risk assessment of carotid atherosclerotic plaques and prevention and treatment of cerebral infarction and cerebral hemorrhage. Materials and methods: 400 patients with carotid atherosclerosis caused by atherosclerosis in Gaomi people's Hospital from November 2013 to November 2016 were collected and excluded from non-atherogenic vascular diseases, such as cardiogenic cerebral infarction, diabetes mellitus, moyamoya disease, arteritis and so on. Philips 64-row 128-slice spiral CT was used for MDCTA examination. Plaque volume, CT value and lumen stenosis were measured by CT post-processing technique, and classified according to CT value, and the related clinical data were collected. The clinical characteristics of each plaque, the characteristics of plaque components in patients with cerebral hemorrhage and cerebral infarction, and the correlation between lumen stenosis and the occurrence of cerebral infarction were analyzed. Result: 1. According to the plaque type, there were 52 cases of fiber plaque type, 60 cases of fat plaque type, 80 cases of calcified plaque type and 208 cases of mixed plaque type. In all cases, 129 cases were complicated with ulcer plaques, 82% of them were complicated with ulcer plaques in patients with cerebral infarction. At the same time, the contents of blood glucose, triacylglycerol and total cholesterol in patients with cerebral infarction were significantly higher than those in the control group. 2. 60% of calcified plaques occurred in patients with cerebral hemorrhage. The proportion of calcified plaques in patients with cerebral hemorrhage was significantly higher than that in patients with cerebral infarction (P 0.05). The blood pressure level in patients with cerebral hemorrhage with calcified plaques was significantly higher than that in patients with cerebral infarction. There was no significant difference in the distribution of fat plaques, fibroplaques and mixed plaques in cerebral hemorrhage and cerebral infarction (P 0.05). 4. In mild carotid stenosis group, fat plaque volume / plaque volume percentage (hereinafter referred to as fat plaque volume percentage) was positively correlated with cerebral infarction (OR=2.24,95%CI:1.17-4.67;P0.001), while calcified plaque volume / plaque volume percentage (hereinafter referred to as calcified plaque volume percentage) was negatively correlated with cerebral infarction (OR=0.36,95%CI:0.29-0.83;P=0.007). In moderate and severe carotid stenosis group, the percentage of fat plaque volume was also positively correlated with the occurrence of cerebral infarction (OR=1.63,95%CI:1.13-4.15;P=0.005), but the percentage of calcified plaque volume was not significantly correlated with the occurrence of cerebral infarction (OR=0.89,95%CI:0.53-2.17;P=0.31). Conclusion: the percentage of fat plaques is positively correlated with the incidence of cerebral infarction. The incidence of cerebral infarction caused by ulcer plaques is significantly higher than that of other plaques. Calcified plaques are more likely to appear in the group of patients with cerebral hemorrhage. MDCTA can analyze the component characteristics of carotid atherosclerotic plaques and evaluate its vulnerability and instability. It has positive reference value for risk assessment of carotid atherosclerotic plaques and prevention and treatment of cerebral infarction and cerebral hemorrhage.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R743.3

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