症状性颈动脉狭窄支架置入术患者不同疗效的术前超声指标分析
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摘要
目的探讨症状性颈动脉狭窄支架置入术患者不同疗效的术前超声指标的差异及其与年龄的关系。方法选择2008年1月~2016年6月在河南科技大学第一附属医院住院的症状性颈动脉狭窄支架置入术患者57例,根据年龄分为青年组7例,中年组25例,老年组25例。又根据术后美国国立卫生研究院卒中量表评分改善率≥75%为显效组18例,25%~74%为有效组33例,<25%为无效组6例。比较和分析各组患者术前3d内颈动脉超声指标的差异性。结果显效组、有效组及无效组不稳定斑块积分比值、斑块最大偏心比值、狭窄处峰值流速、搏动指数、阻力指数、颈动脉僵硬度指数、扩张系数及顺应系数比较,差异有统计学意义(P<0.01)。老年组颈动脉僵硬度指数明显高于青年组和中年组(3.762±1.048 vs 2.313±0.409,2.707±0.656,P<0.01)。颈动脉僵硬度与年龄呈正相关(r=0.670,P=0.000),且两者存在线性回归方程(y=0.075x-1.537,R2=0.448,F=44.727,P=0.000)。结论不同疗效患者术前颈动脉不稳定斑块积分比值、斑块最大偏心比值、狭窄处峰值流速、阻力指数、搏动指数、颈动脉僵硬度指数、扩张系数及顺应系数存在差异,颈动脉僵硬度指数与患者年龄存在线性关系。
Objective To study the preoperative ultrasonographic parameters and their relationship with age in symptomatic CAS patients with different curative effects of stenting.Methods Fiftyseven symptomatic CAS patients admitted to our hospital for stenting were divided into young age group(n=7),middle age group(n=25),old age group(n=25)according to their age,and into very good curative effect group(n=18),good curative effect group(n=33)and no curative effect group(n=6)according to their postoperative NIHSS score.The carotid ultrasonographic parameters in different groups were compared and analyzed within 3 days before operation.Results A significant difference was found in the ratio of UPT,maximal ER of plaques,PV of stenosis,PI,resistance index(RI),carotid artery stiffness index(SI),distensibility coefficient(Dc)and compliance coefficient(Cc)in different curative effect groups(P<0.01).The carotid artery SI was significantly higher in old age group than in young age group and middle age group(P<0.01).A linear regression equation was established between carotid stiffness and age(y=0.075 x-1.537,R2=0.448,F=44.727,P=0.000).Conclusion The ratio of UPT,maximal ER of plaques,PV of stenosis,PI,RI,carotid artery SI,Dc and Cc are different in patients with different curative effects of stenting,and a linear relationship is found between carotid artery SI and age of patients.
Objective To study the preoperative ultrasonographic parameters and their relationship with age in symptomatic CAS patients with different curative effects of stenting.Methods Fiftyseven symptomatic CAS patients admitted to our hospital for stenting were divided into young age group(n=7),middle age group(n=25),old age group(n=25)according to their age,and into very good curative effect group(n=18),good curative effect group(n=33)and no curative effect group(n=6)according to their postoperative NIHSS score.The carotid ultrasonographic parameters in different groups were compared and analyzed within 3 days before operation.Results A significant difference was found in the ratio of UPT,maximal ER of plaques,PV of stenosis,PI,resistance index(RI),carotid artery stiffness index(SI),distensibility coefficient(Dc)and compliance coefficient(Cc)in different curative effect groups(P<0.01).The carotid artery SI was significantly higher in old age group than in young age group and middle age group(P<0.01).A linear regression equation was established between carotid stiffness and age(y=0.075 x-1.537,R2=0.448,F=44.727,P=0.000).Conclusion The ratio of UPT,maximal ER of plaques,PV of stenosis,PI,RI,carotid artery SI,Dc and Cc are different in patients with different curative effects of stenting,and a linear relationship is found between carotid artery SI and age of patients.
引文
[1]Olivato S,Nizzoli S,Cavazzuti M,et al.e-NIHSS:an expanded National Institutes of Health Stroke Scale weighted for anterior and posterior circulation strokes[J].J Stroke Cerebrovasc Dis,2016,25(12):2953-2957.DOI:10.1016/j.jstrokecerebrovasdis.2016.08.011.
[2]Ribeiro PW,Cola PC,Gatto AR,et al.Relationship between dysphagia,National Institutes of Health Stroke Scale score,and predictors of pneumonia after ischemic stroke[J].J Stroke Cerebrovasc Dis,2015,24(9):2088-2094.DOI:10.1016/j.jstrokecerebrovasdis.2015.05.009.
[3]中华医学会放射学分会介入学组.颈动脉狭窄介入治疗操作规范(专家共识)[J].中华放射学杂志,2010,44(9):995-998.DOI:10.3760/cma.j.issn.1005-1201.2010.09.025.
[4]郭志宏,王健,徐琨,等.应用超声射频血管内中膜分析和血管硬度定量技术评价睡眠呼吸暂停患者颈动脉结构和功能[J].中华超声影像学杂志,2012,21(10):846-850.DOI:10.3760/cma.j.issn.1004-4477.2012.10.005.
[5]陈胜江,段广才,陈梅,等.早期神经功能恶化急性卒中患者的颈动脉粥样硬化超声特征[J].国际脑血管病杂志,2010,18(4):254-258.DOI:10.3760/cma.j.issn.1673-4165.2010.04.004.
[6]王陇德,王金环,彭斌,等.《中国脑卒中防治报告2016》概要[J].中国脑血管病杂志,2017,14(4):217-224.DOI:10.3969/j.issn.1672-5921.2017.04.010.
[7]霍颖超,严家川,周华东.颅外颈动脉和椎动脉狭窄支架置入术围术期并发症及危险因素分析[J].中华老年心脑血管病杂志,2016,18(11):1124-1128.DOI:10.3969/j.issn.1009-0126.2016.11.002.
[8]Kotsugi M,Takayama K,Myouchin K,et al.Carotid artery stenting:investigation of plaque protrusion incidence and prognosis[J].JACC Cardiovasc Interv,2017,10(8):824-831.DOI:10.1016/j.jcin.2017.01.029.
[9]Müller MD,Ahlhelm FJ,von Hessling A,et al.Vascular anatomy predicts the risk of cerebral ischemia in patients randomized to carotid stenting versus endarterectomy[J].Stroke,2017,48(5):1285-1292.DOI:10.1161/STROKEAHA.116.014612.
[10]吴启兵,舒红,罗善和,等.彩色多普勒超声对颈动脉斑块易损性与脑血管意外相关性的评估价值[J].卒中与神经疾病,2017,24(2):139-141.DOI:10.3969/j.issn.1007-0478.2017.02.015.
[11]Lin CM,Su JC,Chang YJ,et al.Is carotid sonography a useful tool for predicting functional capabilities in ischemic stroke patients following carotid artery stenting[J]?Medicine(Baltimore),2017,96(12):e6363.DOI:10.1097/MD.0000000000006363.
[12]Wasser K,Karch A,Gr9schel S,et al.Plaque morphology detected with duplex ultrasound before carotid angioplasty and stenting(CAS)is not a predictor of carotid artery in-stent restenosis,a case control study[J].BMC Neurol,2013,13:163.DOI:10.1186/1471-2377-13-163.
[13]Nederkoorn PJ,Brown MM.Optimal cut-off criteria for duplex ultrasound for the diagnosis of restenosis in stented carotid arteries:review and protocol for a diagnostic study[J].BMC Neurol,2009,9:36.DOI:10.1186/1471-2377-9-36.
[14]Safian RD.Asymptomatic carotid artery stenosis:revascularization[J].Prog Cardiovasc Dis,2017,59(6):591-600.DOI:10.1016/j.pcad.2017.04.006.
[15]Jia L,Hua Y,Li J,et al.Optimal ultrasound criteria for defining the severity of vertebral artery in-stent restenosis[J].Ultrasound Med Biol,2015,41(3):775-780.DOI:10.1016/j.ultrasmedbio.2014.10.009.
[16]王凯华,陈鹏,林苗.等.高频超声评价颈动脉支架术后血管重构以及血流动力学的改变[J].中国超声医学杂志,2009,25(4):392-395.DOI:10.3969/j.issn.1002-0101.2009.04.017.
[2]Ribeiro PW,Cola PC,Gatto AR,et al.Relationship between dysphagia,National Institutes of Health Stroke Scale score,and predictors of pneumonia after ischemic stroke[J].J Stroke Cerebrovasc Dis,2015,24(9):2088-2094.DOI:10.1016/j.jstrokecerebrovasdis.2015.05.009.
[3]中华医学会放射学分会介入学组.颈动脉狭窄介入治疗操作规范(专家共识)[J].中华放射学杂志,2010,44(9):995-998.DOI:10.3760/cma.j.issn.1005-1201.2010.09.025.
[4]郭志宏,王健,徐琨,等.应用超声射频血管内中膜分析和血管硬度定量技术评价睡眠呼吸暂停患者颈动脉结构和功能[J].中华超声影像学杂志,2012,21(10):846-850.DOI:10.3760/cma.j.issn.1004-4477.2012.10.005.
[5]陈胜江,段广才,陈梅,等.早期神经功能恶化急性卒中患者的颈动脉粥样硬化超声特征[J].国际脑血管病杂志,2010,18(4):254-258.DOI:10.3760/cma.j.issn.1673-4165.2010.04.004.
[6]王陇德,王金环,彭斌,等.《中国脑卒中防治报告2016》概要[J].中国脑血管病杂志,2017,14(4):217-224.DOI:10.3969/j.issn.1672-5921.2017.04.010.
[7]霍颖超,严家川,周华东.颅外颈动脉和椎动脉狭窄支架置入术围术期并发症及危险因素分析[J].中华老年心脑血管病杂志,2016,18(11):1124-1128.DOI:10.3969/j.issn.1009-0126.2016.11.002.
[8]Kotsugi M,Takayama K,Myouchin K,et al.Carotid artery stenting:investigation of plaque protrusion incidence and prognosis[J].JACC Cardiovasc Interv,2017,10(8):824-831.DOI:10.1016/j.jcin.2017.01.029.
[9]Müller MD,Ahlhelm FJ,von Hessling A,et al.Vascular anatomy predicts the risk of cerebral ischemia in patients randomized to carotid stenting versus endarterectomy[J].Stroke,2017,48(5):1285-1292.DOI:10.1161/STROKEAHA.116.014612.
[10]吴启兵,舒红,罗善和,等.彩色多普勒超声对颈动脉斑块易损性与脑血管意外相关性的评估价值[J].卒中与神经疾病,2017,24(2):139-141.DOI:10.3969/j.issn.1007-0478.2017.02.015.
[11]Lin CM,Su JC,Chang YJ,et al.Is carotid sonography a useful tool for predicting functional capabilities in ischemic stroke patients following carotid artery stenting[J]?Medicine(Baltimore),2017,96(12):e6363.DOI:10.1097/MD.0000000000006363.
[12]Wasser K,Karch A,Gr9schel S,et al.Plaque morphology detected with duplex ultrasound before carotid angioplasty and stenting(CAS)is not a predictor of carotid artery in-stent restenosis,a case control study[J].BMC Neurol,2013,13:163.DOI:10.1186/1471-2377-13-163.
[13]Nederkoorn PJ,Brown MM.Optimal cut-off criteria for duplex ultrasound for the diagnosis of restenosis in stented carotid arteries:review and protocol for a diagnostic study[J].BMC Neurol,2009,9:36.DOI:10.1186/1471-2377-9-36.
[14]Safian RD.Asymptomatic carotid artery stenosis:revascularization[J].Prog Cardiovasc Dis,2017,59(6):591-600.DOI:10.1016/j.pcad.2017.04.006.
[15]Jia L,Hua Y,Li J,et al.Optimal ultrasound criteria for defining the severity of vertebral artery in-stent restenosis[J].Ultrasound Med Biol,2015,41(3):775-780.DOI:10.1016/j.ultrasmedbio.2014.10.009.
[16]王凯华,陈鹏,林苗.等.高频超声评价颈动脉支架术后血管重构以及血流动力学的改变[J].中国超声医学杂志,2009,25(4):392-395.DOI:10.3969/j.issn.1002-0101.2009.04.017.