本文選題：頸總動(dòng)脈 + 剪切波彈性成像��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：第一部分實(shí)時(shí)剪切波彈性成像和彩色脈搏波成像對正常頸動(dòng)脈的研究[目的]運(yùn)用實(shí)時(shí)剪切波彈性成像和彩色脈搏波成像對正常頸總動(dòng)脈血管壁的硬度進(jìn)行定量分析,得出正常頸總動(dòng)脈縱向和環(huán)向的血管壁硬度范圍。[方法]選取2016年2月至2016年12月于昆明醫(yī)科大學(xué)第四附屬醫(yī)院體檢雙側(cè)頸部血管正常者120例,年齡20-70歲,平均(48.94±13.32)歲。其中男性58例,平均(49.33±13.28)歲,女性62例,平均(48.58±13.46)歲。研究對象按年齡分為4組:N1 組:32人40歲 平均(30.81±5.57)歲;N2 組:28人 41-50歲 平均(45.79±2.01)歲;N3 組:30人 51-60歲 平均(55.07±2.35)歲;N4 組:30人 61-70歲 平均(65.10±2.12)歲;采用法國Supersonic Imagine公司的Aix-plorer型彩色多普勒超聲診斷儀,啟動(dòng)剪切波彈性成像(SWE)模式,測量頸總動(dòng)脈前壁、后壁的彈性模量平均值(Mean)、最大值(Max)、最小值(Min)、彌散度(SD)。啟動(dòng)脈搏波成像(PWV)模式,測量頸總動(dòng)脈收縮期開始時(shí)脈搏波速度(PWVBS)、收縮期結(jié)束時(shí)脈搏波速度(PWVES)及PWVBS、PWVES相對應(yīng)的標(biāo)準(zhǔn)差(△±)。[結(jié)果]1實(shí)時(shí)剪切波彈性成像雙側(cè)正常頸總動(dòng)脈前壁、后壁的彈性模量平均值、最大值、最小值、彌散度均沒有顯著差異(P0.05)。按性別分為男組、女組,男組與女組頸總動(dòng)脈前壁、后壁的彈性模量平均值、最大值、最小值、彌散度均沒有顯著性差異(P0.05)。正常頸總動(dòng)脈前壁、后壁之間的彈性模量平均值、最大值、最小值有顯著性差異(P0.05)。各年齡組間頸總動(dòng)脈前壁總的彈性模量平均值、最大值、最小值有顯著性差異(P0.05),各年齡組間頸總動(dòng)脈后壁總的彈性模量平均值、最大值、最小值有顯著性差異(P0.05)。正常頸總動(dòng)脈前壁彈性模量平均值與年齡呈正相關(guān)(r=0.476,P0.01),正常頸總動(dòng)脈前壁彈性模量最大值與年齡呈正相關(guān)(r=0.554,P0.01),正常頸總動(dòng)脈前壁彈性模量最小值與年齡呈正相關(guān)(r=0.512,P0.01)。正常頸總動(dòng)脈后壁彈性模量平均值與年齡呈正相關(guān)(r=0.502,P0.01),正常頸總動(dòng)脈后壁彈性模量最大值與年齡呈正相關(guān)(r=0.498,P0.01),正常頸總動(dòng)脈后壁彈性模量最小值與年齡呈正相關(guān)(r=0.498,P0.01)。2彩色脈搏波成像雙側(cè)正常頸總動(dòng)脈收縮期開始時(shí)脈搏波速度、收縮期結(jié)束時(shí)脈搏波速度均沒有顯著性差異(P0.05)。按性別分為男組、女組,男組與女組頸總動(dòng)脈收縮期開始時(shí)脈搏波速度、收.縮期結(jié)束時(shí)脈搏波速度均沒有顯著性差異(P0.05)。各年齡組間頸總動(dòng)脈總的收縮期開始時(shí)脈搏波速度、收縮期結(jié)束時(shí)脈搏波速度有顯著性差異(P0.05)。正常頸總動(dòng)脈收縮期開始時(shí)脈搏波速度與年齡呈正相關(guān)(r=0.349,P0.01),正常頸總動(dòng)脈收縮期結(jié)束時(shí)脈搏波速度與年齡呈正相關(guān)(r=0.593,P0.01)。[結(jié)論]實(shí)時(shí)剪切波彈性成像條件下頸總動(dòng)脈后壁的硬度低于前壁。兩種超聲成像條件下:頸總動(dòng)脈血管壁的硬度與年齡有一定的相關(guān)性,60-70歲的頸總動(dòng)脈血管壁硬度明顯高于小于40歲的血管壁硬度,隨著年齡的增長,血管壁硬度呈增加的趨勢,41-50歲與51-60歲的頸總動(dòng)脈血管壁硬度相差不大。頸總動(dòng)脈血管壁硬度與性別不相關(guān)。頸總動(dòng)脈環(huán)向和縱向的血管壁硬度具有一致性。第二部分實(shí)時(shí)剪切波彈性成像和彩色脈搏波成像對高血壓患者頸動(dòng)脈的研究[目的]運(yùn)用實(shí)時(shí)剪切波彈性成像和彩色脈搏波成像對高血壓患者頸總動(dòng)脈血管壁的硬度進(jìn)行分析,探討不同級別高血壓頸總動(dòng)脈血管壁硬度的差異,并與正常組進(jìn)行比較,以此來評價(jià)這兩種超聲成像技術(shù)對高血壓患者頸總動(dòng)脈血管壁的應(yīng)用價(jià)值。[方法]選取經(jīng)臨床確診的113例高血壓患者,年齡35-70歲,平均(52.54±13.41)歲,其中男性60例,女性53例。1級高血壓組(HBP1組)38例,2級高血壓組(HBP2組)38例,3級高血壓組(HBP3組)37例。將第一部分120例正常頸總動(dòng)脈設(shè)為正常組。啟動(dòng)剪切波彈性成像(SWE)模式,檢測高血壓患者頸總動(dòng)脈前壁、后壁的彈性模量平均值(Mean)、最大值(Max)、最小值(Min)、彌散度(SD)。啟動(dòng)脈搏波成像(PWV)模式,檢測頸總動(dòng)脈收縮期開始時(shí)脈搏波速度(PWVBS)、收縮期結(jié)束時(shí)脈搏波速度(PWVES)及PWVBS、PWVES相對應(yīng)的標(biāo)準(zhǔn)差(△±)。[結(jié)果]1實(shí)時(shí)剪切波彈性成像高血壓組雙側(cè)頸總動(dòng)脈前壁、后壁的彈性模量平均值、最大值、最小值、彌散度均沒有顯著性差異(P0.05)。高血壓組頸總動(dòng)脈前壁、后壁之間的彈性模量平均值、最大值、最小值有顯著性差異(P0.05)。正常組與HBP1組、HBP2組、HBP3組的頸總動(dòng)脈前壁彈性模量平均值、最大值、最小值有顯著性差異(P0.05),正常組與HBP1組、HBP2組、HBP3組的頸總動(dòng)脈后壁彈性模量平均值、最大值、最小值有顯著性差異(P0.05)。高血壓頸總動(dòng)脈前壁:HBP3組與HBP2組的彈性模量平均值、最大值、最小值有顯著性差異(P0.05),HBP2組與HBP1組的彈性模量平均值、最大值、最小值有顯著性差異(P0.05),HBP3組與HBP1組的彈性模量平均值、最大值、最小值有顯著性差異(P0.05)。高血壓頸總動(dòng)脈后壁:HBP3組與HBP2組的彈性模量平均值、最大值、最小值有顯著性差異(P0.05),HBP2組與HBP1組的彈性模量平均值、最大值、最小值有顯著性差異(P0.05),HBP3組與HBP1組的彈性模量平均值、最大值、最小值有顯著性差異(P0.05)。2彩色脈搏波成像高血壓組雙側(cè)頸總動(dòng)脈收縮期開始時(shí)脈搏波速度、收縮期結(jié)束時(shí)脈搏波速度均沒有顯著性差異(P0.05)。正常組與HBP1組、HBP2組、HBP3組頸總動(dòng)脈收縮期開始時(shí)脈搏波速度、收縮期結(jié)束時(shí)脈搏波速度有顯著性差異(P0.05)。HBP3組與HBP2組的收縮期開始時(shí)脈搏波速度、收縮期結(jié)束時(shí)脈搏波速度有顯著性差異(P0.05),HBP2組與HBP1組的收縮期開始時(shí)脈搏波速度、收縮期結(jié)束時(shí)脈搏波速度有顯著性差異(P0.05),HBP3組與HBP1組的收縮期開始時(shí)脈搏波速度、收縮期結(jié)束時(shí)脈搏波速度有顯著性差異(P0.05)。[結(jié)論]實(shí)時(shí)剪切波彈性成像條件下高血壓組頸總動(dòng)脈后壁的硬度低于前壁。兩種超聲成像條件下:隨著高血壓級數(shù)的增高,血管壁硬度呈增高的趨勢。高血壓頸總動(dòng)脈的血管壁硬度高于正常頸總動(dòng)脈血管壁硬度。高血壓頸總動(dòng)脈環(huán)向和縱向的血管壁硬度具有一致性。
[Abstract]:Part 1 the study of normal carotid artery with real time shear wave elastic imaging and color pulse wave imaging [Objective] to quantitatively analyze the hardness of normal carotid artery wall by real time shear wave elastic imaging and color pulse wave imaging, and to obtain the hardness range of the longitudinal and circumferential vascular walls of the normal common carotid artery. [method] select the 2016 2. From month to December 2016, 120 cases of normal cervical vessels were examined at the Fourth Affiliated Hospital of Kunming Medical University. The average age was 20-70 years old. The average age was (48.94 + 13.32) years old. Among them, the average age was 58, the average (49.33 + 13.28) years, and the female 62, average (48.58 + 13.46) years old. The subjects were divided into 4 groups at the age of year: N1 group: 32 people average years of age; group N2: Persons The average age of 41-50 years (45.79 + 2.01) years old; group N3: 30 people with an average of 51-60 years (55.07 + 2.35) years of age (55.07 + 2.35) years old; group N4: 30 people, 61-70 years old (65.10 +) years of age (65.10 + 2.12) years; using the Aix-plorer color Doppler ultrasound diagnostic instrument of French Supersonic Imagine, starting shear wave elastic imaging (SWE) model, measuring the anterior wall of the common carotid artery and the average modulus of elasticity of the posterior wall. Value (Mean), the maximum value (Max), the minimum value (Min), dispersion (SD). The pulse wave velocity (PWVBS) at the beginning of the systolic phase of the common carotid artery (PWV), the pulse wave velocity (PWVES) and PWVBS, and the standard deviation of PWVES (delta) at the end of the systole. [results]1 real time shear wave elastic imaging of the anterior wall of the normal carotid artery. The average value, the maximum value, the minimum value and the dispersion of the wall had no significant difference (P0.05). The average value of the anterior wall of the common carotid artery was divided into male, female, male and female, the average value of modulus of elasticity of the posterior wall, the maximum value, the minimum value and the diffusion degree were not significant (P0.05). The average elastic modulus between the normal carotid artery and the posterior wall was average. There were significant differences in value, maximum value and minimum value (P0.05). There was a significant difference in the average, maximum and minimum values of the total elastic modulus of the anterior cervical artery in each age group (P0.05). There was a significant difference in the average value, maximum and minimum of the posterior wall of the common carotid artery (P0.05). The elastic modulus of the anterior wall of the normal carotid artery. The mean value was positively correlated with age (r=0.476, P0.01). The maximum elastic modulus of normal carotid artery anterior wall was positively correlated with age (r=0.554, P0.01). The minimum elastic modulus of normal carotid artery anterior wall was positively correlated with age (r=0.512, P0.01). The average value of the posterior wall elastic modulus of normal carotid artery was positively correlated with age (r=0.502, P0.01), normal. The maximum elastic modulus of the posterior wall of the common carotid artery was positively correlated with age (r=0.498, P0.01). The minimum elastic modulus of the posterior wall of the normal carotid artery was positively correlated with age (r=0.498, P0.01).2 color pulse wave imaging at the beginning of the systole of bilateral normal carotid artery, and there was no significant difference between the pulse wave velocity at the end of systole (P0. 05). The pulse wave velocity at the beginning of the systolic phase of the common carotid artery was divided into male, female, male and female. There was no significant difference between the pulse wave velocity at the end of the contraction period (P0.05). The pulse wave velocity at the beginning of the total systolic phase of the common carotid artery in each age group and the pulse wave velocity at the systolic junction were significantly different (P0.05). The pulse wave velocity is positively correlated with age at the beginning of arterial systole (r=0.349, P0.01). The pulse wave velocity is positively correlated with age at the end of the normal common carotid artery systole (r=0.593, P0.01). [Conclusion] the hardness of the posterior wall of the common carotid artery is lower than that of the anterior wall under the condition of real time shear wave elastic imaging. Two kinds of ultrasound imaging conditions: the vascular wall of the common carotid artery The hardness of the carotid artery wall of the 60-70 year old was significantly higher than that of the vascular wall less than 40 years old. The hardness of the vascular wall increased with the age of 40. The hardness of the vascular wall of the common carotid artery at the age of 41-50 and 51-60 years was not similar. The neck wall hardness was not related to sex. The hardness of the vascular wall is consistent with the longitudinal and vertical. Second part of the study of carotid artery in hypertensive patients by real time shear wave elastic imaging and color pulse wave imaging (Objective] to analyze the stiffness of the vascular wall of the common carotid artery in hypertensive patients by using real time shear wave elastic imaging and color pulse wave imaging, and to explore the different levels of hypertension. The difference in the hardness of the vascular wall of the common carotid artery was compared with that of the normal group in order to evaluate the value of the two ultrasound imaging techniques for the vascular wall of the common carotid artery in hypertensive patients. [Methods] 113 cases of hypertension, aged 35-70 years, average (52.54 + 13.41) years of age, were selected to be clinically diagnosed as hypertensive patients, including 60 males and 53.1 grade hypertension in women. Group (group HBP1) (group HBP1), grade 2 hypertension group (group HBP2) 38 cases, 3 grade hypertension group (group HBP3) 37 cases. 120 normal common carotid arteries were set as normal group in the first part. Starting shear wave elastic imaging (SWE) model was used to detect the anterior wall of the common carotid artery and the average modulus of elasticity of the posterior wall (Mean), the maximum value (Max), the minimum value (Min), dispersion degree (SD). The pulse wave velocity (PWVBS) at the beginning of the systolic phase of the common carotid artery (PWV), the standard deviation of the pulse wave velocity (PWVES) and PWVBS, and PWVES at the end of the systole period (delta). [results the average value of the anterior wall of the common carotid artery and the modulus of elasticity of the posterior wall, the maximum value, minimum value, the mass, and the mass of the]1 real-time shear wave elastic imaging hypertension group There was no significant difference in divergence (P0.05). The average value, maximum and minimum of the anterior wall of the common carotid artery in the hypertension group had significant difference (P0.05). The average value, the maximum value, the minimum value of the anterior wall of the common carotid artery in the normal group and the HBP1 group, the HBP2 group and the HBP3 group had significant difference (P0.05), the normal group and the HBP1 group, HBP2, HBP2. The average value, maximum and minimum value of the posterior wall of the common carotid artery in group HBP3 had significant difference (P0.05). The average value, maximum and minimum of the elastic modulus of the carotid artery in the HBP3 group and the HBP2 group had significant difference (P0.05). There was a significant difference between the average value, the maximum value, and the minimum of the HBP2 group and the HBP1 group (P0.05). The average value, the maximum value, the minimum value of the HBP3 group and the HBP1 group had significant difference (P0.05). The posterior wall of the common carotid artery of hypertension: the average value, the maximum value, the minimum value of the HBP3 group and the HBP2 group had significant difference (P0.05), the average value, the maximum value and the minimum value of the HBP2 group and the HBP1 group had significant difference (P0.05), HBP3 group. The average value, the maximum, the minimum of the HBP1 group had significant difference (P0.05) the pulse wave velocity at the beginning of the systole of bilateral common carotid artery in the.2 color pulse wave imaging group and the pulse wave velocity at the end of the systole (P0.05). The normal group and the HBP1 group, the HBP2 group, and the HBP3 group had the beginning of the systolic vein of the common carotid artery. Pulse wave velocity and pulse wave velocity at the end of systole were significantly different (P0.05) and pulse wave velocity at the beginning of systolic phase in group.HBP3 and HBP2 group, and the pulse wave velocity was significantly different at the end of systole (P0.05). The pulse wave velocity at the beginning of systolic phase in group HBP2 and HBP1 group was significantly different (P0.05), H at the end of systolic phase (P0.05). The pulse wave velocity at the beginning of systole and the pulse wave velocity at the end of systole in group BP3 and HBP1 group were significantly different (P0.05). [Conclusion] under the condition of real time shear wave elastic imaging, the hardness of the posterior wall of the common carotid artery in the hypertension group is lower than that in the anterior wall. With the increase of high blood pressure progression, the hardness of the vessel wall increases with the increase of high blood pressure. The hardness of the vascular wall of the common carotid artery was higher than that of the normal carotid artery wall. The hardness of the circumferential and longitudinal vascular walls of the common carotid artery was consistent.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R543.4

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