發(fā)布時(shí)間：2018-06-27 00:45

  本文選題：體層攝影術(shù) + 血管造影術(shù)　； 參考：《河北醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：除頸動(dòng)脈狹窄的嚴(yán)重程度外，斑塊的穩(wěn)定性也是預(yù)測(cè)缺血性腦血管病事件的重要因素，不穩(wěn)定性斑塊已被證實(shí)是缺血性腦血管病的獨(dú)立危險(xiǎn)因素。本文通過(guò)應(yīng)用256層螺旋CTA來(lái)評(píng)價(jià)頸動(dòng)脈粥樣硬化斑塊的形態(tài)特點(diǎn)，統(tǒng)計(jì)潰瘍斑塊的發(fā)生率，并進(jìn)一步分析研究斑塊的形態(tài)特點(diǎn)與頸動(dòng)脈狹窄程度、不同腦缺血癥狀之間的關(guān)系。 方法：回顧性分析了386例病人的256層螺旋CTA影像資料，并將斑塊的表面形態(tài)分為光滑、不規(guī)則和潰瘍?nèi)齻�(gè)類型。按臨床癥狀表現(xiàn)不同，將所有病人分為四組，即一過(guò)性黑朦組（AF）、短暫性腦缺血發(fā)作組（TIA）、腦梗死組及無(wú)癥狀組（對(duì)照組）。并在Portal工作站采用MIP、VR、MPR、CPR及高級(jí)血管分析（advanced vessel analysis，AVA）等后處理軟件，測(cè)量管腔狹窄率，并記錄斑塊形態(tài)特點(diǎn)。由兩名長(zhǎng)期從事神經(jīng)影像診斷的副主任及以上的放射科醫(yī)師采用盲法分別對(duì)頸動(dòng)脈狹窄程度、斑塊形態(tài)特點(diǎn)進(jìn)行評(píng)價(jià)，意見(jiàn)不一時(shí)通過(guò)討論達(dá)成一致。應(yīng)用SPSS13.0統(tǒng)計(jì)分析軟件，分析斑塊形態(tài)特點(diǎn)與頸動(dòng)脈狹窄程度及不同腦缺血癥狀之間的相關(guān)性及不同組別之間有無(wú)統(tǒng)計(jì)學(xué)差異。 結(jié)果： 1386例患者中男性258例，女性128例，年齡范圍37-87歲，平均年齡61.15歲。 2386例患者中共發(fā)現(xiàn)頸動(dòng)脈病變274例；所觀察的頸動(dòng)脈共1544條，有頸動(dòng)脈病變658條（42.61%），其中包括閉塞34條；除34條閉塞的頸動(dòng)脈外，共發(fā)現(xiàn)頸動(dòng)脈斑塊624個(gè)，其中斑塊表面光滑的為394個(gè)（63.15%），不規(guī)則斑塊161個(gè)（25.80%），潰瘍斑塊69個(gè)（11.05%）。 3386例觀察對(duì)象中，有不同程度腦缺血癥狀者356例，其中表現(xiàn)為一過(guò)性黑朦者35例，TIA178例，腦梗死143例（39.61%）；有30例無(wú)明顯腦缺血癥狀。 4在所有病例中，存在頸動(dòng)脈病變并且有腦缺血癥狀者260例，無(wú)頸動(dòng)脈病變但有腦缺血癥狀者96例，經(jīng)統(tǒng)計(jì)學(xué)分析得出，頸動(dòng)脈病變和腦缺血癥狀之間存在統(tǒng)計(jì)學(xué)關(guān)聯(lián)（OR值為3.095）。 5當(dāng)頸動(dòng)脈狹窄率大于30%時(shí)，潰瘍斑塊的發(fā)生率19.4%，均明顯高于狹窄率小于30%的頸動(dòng)脈（3.12%），經(jīng)統(tǒng)計(jì)學(xué)分析P值均小于0.05，說(shuō)明兩者之間有統(tǒng)計(jì)學(xué)差異。當(dāng)頸動(dòng)脈狹窄率超過(guò)70%時(shí)，，潰瘍斑塊的發(fā)生率提高至31.66%。進(jìn)一步分析不同狹窄程度間潰瘍斑塊的發(fā)生率有無(wú)差別，發(fā)現(xiàn)除狹窄程度在III級(jí)和VI級(jí)兩組之間潰瘍斑塊發(fā)生率無(wú)差別外，其余各兩組之間均存在統(tǒng)計(jì)學(xué)差異，并且潰瘍斑塊的發(fā)生率隨著狹窄程度的增加而增加。 6腦梗死組潰瘍斑塊的發(fā)生率為13.06%，高于TIA組（10.26%）、一過(guò)性黑朦組（6.55%）和無(wú)癥狀組（9.37%），采用行×列表卡方檢驗(yàn)不同腦缺血癥狀組之間潰瘍斑塊的發(fā)生率有無(wú)差別，結(jié)果顯示無(wú)統(tǒng)計(jì)學(xué)差異，說(shuō)明還不能認(rèn)為不同臨床癥狀組間潰瘍斑塊的發(fā)生率有差別。 769個(gè)潰瘍斑塊中，有20個(gè)責(zé)任病灶，而在555個(gè)非潰瘍斑塊中，責(zé)任病灶為69個(gè)，經(jīng)統(tǒng)計(jì)學(xué)分析，P值小于0.05，說(shuō)明潰瘍斑塊和非潰瘍斑塊中引起腦梗死的責(zé)任病變發(fā)生率之間有差別，并且潰瘍斑塊和腦梗死之間存在統(tǒng)計(jì)學(xué)關(guān)聯(lián)（OR值為2.875）。 8顱內(nèi)出現(xiàn)腦梗死并且同側(cè)頸動(dòng)脈（癥狀側(cè)頸動(dòng)脈）同時(shí)存在病變的為99例，占所有腦梗死病例的69.2%（99/143），癥狀側(cè)頸動(dòng)脈潰瘍斑塊的發(fā)生率為22.47%大于對(duì)側(cè)頸動(dòng)脈（16.88%），經(jīng)統(tǒng)計(jì)學(xué)分析，P值大于0.05，即還不能認(rèn)為兩者之間有統(tǒng)計(jì)學(xué)差異。 結(jié)論： 1256層螺旋CTA不僅能準(zhǔn)確判斷頸動(dòng)脈的狹窄程度，而且能對(duì)頸動(dòng)脈粥樣硬化斑塊的形態(tài)特點(diǎn)做出準(zhǔn)確全面的評(píng)價(jià)，具有較高的臨床應(yīng)用價(jià)值。 2在不同頸動(dòng)脈狹窄程度間，潰瘍斑塊的發(fā)生率存在統(tǒng)計(jì)學(xué)差異，并且隨狹窄程度的增加而逐漸增高。 3潰瘍斑塊和腦梗死的發(fā)生存在統(tǒng)計(jì)學(xué)意義，說(shuō)明潰瘍斑塊的存在和腦梗死的發(fā)生密切相關(guān)。 4目前國(guó)內(nèi)外應(yīng)用256層螺旋CT對(duì)動(dòng)脈硬化斑塊的形態(tài)進(jìn)行評(píng)價(jià)研究較少，對(duì)于臨床醫(yī)生來(lái)說(shuō)，了解斑塊形態(tài)特點(diǎn)的信息對(duì)患者選擇何種治療方案及預(yù)后起關(guān)鍵性提示作用，因此在以后的臨床工作中，不僅要對(duì)動(dòng)脈粥樣硬化所致的管腔狹窄程度進(jìn)行準(zhǔn)確測(cè)量，還要對(duì)頸動(dòng)脈硬化斑塊的形態(tài)特點(diǎn)進(jìn)行準(zhǔn)確描述，尤其在書(shū)寫(xiě)報(bào)告時(shí)應(yīng)對(duì)潰瘍斑塊進(jìn)行描述，為臨床醫(yī)生選擇治療方案及評(píng)價(jià)預(yù)后提供一定的參考價(jià)值。
[Abstract]:Objective : In addition to the severity of carotid stenosis , the stability of plaque is an important factor to predict ischemic cerebrovascular disease . The plaque has been proved to be an independent risk factor for ischemic cerebrovascular disease .

Methods : The data of 256 slice spiral CTA images of 386 patients were analyzed retrospectively , and the surface morphology of plaque was divided into three types : smooth , irregular and ulcer . All patients were divided into four groups according to clinical symptoms , namely , transient ischemic attack group ( AF ) , transient ischemic attack group ( TIA ) , cerebral infarction group and asymptomatic group ( control group ) .

Results :

Among the 1386 patients , 258 were male and 128 were female . The age ranged from 37 to 87 years . The mean age was 61.15 years .

Among the 2386 cases , 274 cases of carotid artery disease were found .
There were a total of 1544 carotid arteries and 658 carotid artery lesions ( 42.61 % ) , including 34 occlusion ;
Out of the 34 occluded carotid arteries , 624 carotid plaques were found , with a smooth plaque surface 394 ( 63.15 % ) , irregular plaque 161 ( 25.80 % ) , and an ulcer plaque of 69 ( 11.05 % ) .

Among the 3386 cases , 356 cases with cerebral ischemic symptoms were observed , including 35 cases of transient amaurosis , 178 cases of TIA178 and 143 cases of cerebral infarction ( 39.61 % ) .
There were 30 cases with no obvious cerebral ischemia symptoms .

4 In all cases , there were 260 cases of carotid artery disease with cerebral ischemia symptoms and 96 cases without carotid artery disease but with cerebral ischemia symptoms . Statistical analysis showed that there was statistical correlation between carotid artery disease and cerebral ischemia symptoms ( OR value was 3.095 ) .

5 When the stenosis rate of carotid artery was more than 30 % , the incidence of ulcer plaque was 19.4 % , which was significantly higher than that of carotid artery ( 3.12 % ) with stenosis rate of less than 30 % . The incidence of ulcer plaque was increased to 31.66 % when the stenosis rate of carotid artery was over 70 % .

The incidence of plaque in patients with cerebral infarction was 13.06 % , higher than TIA group ( 10.26 % ) , transient group ( 6.55 % ) and asymptomatic group ( 9.37 % ) .

Of the 769 ulcer patches , there were 20 responsible lesions , whereas in 555 non - ulcer plaques , the lesion was 69 , statistically analyzed , with a P value of less than 0.05 , indicating a difference in the incidence of responsible lesions in the plaque and non - ulcer plaques causing cerebral infarction , and there was a statistical correlation between the ulcer patch and the cerebral infarction ( OR value 2.875 ) .

At the same time , there were 99 patients with cerebral infarction and ipsilateral carotid artery ( symptomatic side carotid artery ) , accounting for 69.2 % ( 99 / 143 ) of all cases of cerebral infarction , 22.47 % of symptomatic side carotid artery ulcer plaque was greater than that of contralateral carotid artery ( 16.88 % ) , P value was more than 0.05 , that is , there was no statistical difference between them .

Conclusion :

The 1256 slice spiral CTA not only can accurately judge the stenosis degree of the carotid artery , but also can accurately and comprehensively evaluate the morphological characteristics of the carotid atherosclerosis plaque , and has higher clinical application value .

2 In different degree of carotid stenosis , the incidence of ulcer plaque was statistically different and gradually increased with the degree of stenosis .

The incidence of plaque and cerebral infarction was statistically significant , which indicated that the presence of ulcer patch and the occurrence of cerebral infarction were closely related .

At present , the evaluation of the morphology of atherosclerotic plaques by using 256 - slice spiral CT at home and abroad is less . For clinicians , it is important to understand the characteristics of plaque morphology . Therefore , it is important not only to accurately measure the degree of stenosis caused by atherosclerosis , but also to describe the morphological characteristics of carotid atherosclerotic plaques , especially when writing reports , to provide some reference value for clinicians to select treatment plan and evaluate the prognosis .
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R816.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李書(shū)劍;方佳;;64排螺旋CT血管成像對(duì)癥狀性頸動(dòng)脈狹窄患者診斷價(jià)值的研究[J];CT理論與應(yīng)用研究;2011年03期

2 乞文旭;郭文力;馬躍;郭啟勇;;256層螺旋CT血管造影術(shù)評(píng)價(jià)頸動(dòng)脈潰瘍斑塊[J];中國(guó)介入影像與治療學(xué);2012年05期

3 周建軍;周康榮;陳祖望;吳東;陳惠明;陳剛;陳錦;繆熙音;張利軍;陸秀良;劉豪;;大范圍頸動(dòng)脈MDCTA與DSA的對(duì)照研究[J];臨床放射學(xué)雜志;2006年01期

4 雷子喬;韓萍;田志梁;劉永華;于群;陳艷;;16層螺旋CT后處理方法在評(píng)價(jià)冠狀動(dòng)脈狹窄中的應(yīng)用價(jià)值[J];臨床放射學(xué)雜志;2006年02期

5 史恒峰;韓萍;吳發(fā)銀;桂廣華;陳平;余佑高;;64層螺旋CT數(shù)字減影后造影對(duì)頭頸部血管狹窄性疾病診斷價(jià)值[J];臨床放射學(xué)雜志;2011年09期

6 王桂紅,王擁軍,姜衛(wèi)劍,杜彬,何耀,金e

本文編號(hào)：2072034