颈动脉病变、血脂与脑血管的临床研究
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摘要
目 的：应用彩色多普勒血流声像仪检测颈总，颈内、外动脉血流动力学参数：收缩期最高流速（SPV），舒张末期最低流速（EDV），搏动指数（PI），阻力指数（RI）、颈总动脉主干内膜-中层厚度（IMT）、斑块超声检测结果联系血脂与载脂蛋白检查结果及各项心血管危险因素以探讨其与颈动脉病变及脑梗塞的关系，为临床诊断、判断预后提供参考指标，有助于对中风的早期预防和预后变化提供有价值的动态监测依据。材料和方法：研究对象为2000年1月至2003年4月到江西医学院第三附属医院超声科行彩超检查颈动脉病变患者共91例，年龄40～81岁，其中男67例，女24例。脑梗死组41例，男34例，女7例，最小年龄58岁，最大年龄81岁，平均年龄（65.2±7.5）岁，均经CT、MRI证实；使用仪器为美国ATL HDI 3000 彩色多普勒血流显像仪，探头频率L12-5MHz，其轴分辨率为0.1mm。用二维超声结合彩色多普勒，频谱多普勒，及能量多普勒测量颈总动脉（CCA）、颈内动脉（ICA）、颈外动脉（ECA）及椎动脉（VA）的血流动力学参数、颈动脉内膜-中层厚度（IMT）及斑块数目和位置，同时抽血检查血脂及载脂蛋白。结 果：⑴脑梗死组颈总动脉主干与分叉处IMT厚度较对照组明显增厚，发现粥样硬化斑块32例占78.0%；⑵有斑块者较无斑块者其颈动脉内膜中层厚度明显增加（0.83±0.16比0.64±0.12，P＜0.01）且随斑块的严重程度增加，其内膜中层厚度呈增加趋势；⑶脑梗死组颈总动脉，颈内动脉内径明显增宽；脑梗死组颈动脉和椎动脉颅外段舒张期末流速值、最高流速平均值较对照组明显降低；反映外周阻力的阻力指数脑梗死组明显高于对照组；⑷脑梗死组血apoAI较正常组下降6.3%具有非常显著性差异（P＜0.01）结 论：脑梗死与颈动脉、椎动脉粥样硬化有关；颈总动脉内膜中层厚度与颈动脉局限性动脉粥样硬化斑块明显相关，提示颈动脉内膜中层厚度可能是颈动脉粥样硬化的早期表现；颈动脉软斑及溃疡斑块是可能发生潜在老年脑梗死的原因之一；颈动脉硬化时血apoAI明显低于正常组，且这两项检测均为无创检查，对脑血管病变的预后，治疗有一定的临床价值。
Objective: Evaluate the intimal-medial thickness(IMT) and plaques of double sides common carotid artery , and the bore as well as the hemodynamics of carotid and vertebral arteries including SPV,EDV,PI,RI, et al and the correlation of carotid arteriosclerosis with plasma lipoprotein.Method:Btween January 2000 and April 2003, 91 patients including 41 patients with and 50 without hemispheric infarction were performed with HDI 3000 color Dopple ultrasound examination using combined B-mode ultrasound, two-dimensional color Dopple flow imaging and power Dopple imaging examination include measurement of CCA - IMT, the hemodynamics of carotid and vertebral arteries(CCA,ICA,ECA,VA) index,the sites of plaque mean-while plasma Lipoprotein and apolipoprotein were tested. Result:①The intimal-medial thickness of carotid thickenedin the position of trunk and its tributaries thickened in patients with hemispheric infarction as compared with those in the controls.Atherosclerotic plaques of carotid arteries occurred in 32 cases(32/41, 78.0%).②The prevalence of plaqueincreased from the lowest to the highest quintile of IMT(linear trend:P＜0.01)and the mean IMT was lower in subject without plaque than in subjects with plaques (0.64±0.12mm vs 0.83±0.16, P＜0.01）. ③Compared with controls, the plaque of common carotid artery and arteriae carotis interna widened significantly, and the end-diastolic velocity(EDV) and the time average velocity(Vmean) were evidently decreased and the resistive index(RI) as well as pulsatilityindex(PI) increased in carotid and vertedral arteries.Carotid arteriosclerosis was inversely correlated with apolipoprotein(apoAI).Conclusion: The atherosclerosis of carotid and vertedral arteries was related to the incidence of hemispheric infarction and the soft plaque in carotid arteries might be one of the potential cause for hemispheric infarction; Increasured in the CCA are clearly related to atherosclerotic plaque in the ICA; In carotid arteriosclerosis,apoAI result a more significant reduction than it does normally.Besides the two non-injury test techniques,it has clinicad value in prediction and treatment of cerebrovascular disease.
Objective: Evaluate the intimal-medial thickness(IMT) and plaques of double sides common carotid artery , and the bore as well as the hemodynamics of carotid and vertebral arteries including SPV,EDV,PI,RI, et al and the correlation of carotid arteriosclerosis with plasma lipoprotein.Method:Btween January 2000 and April 2003, 91 patients including 41 patients with and 50 without hemispheric infarction were performed with HDI 3000 color Dopple ultrasound examination using combined B-mode ultrasound, two-dimensional color Dopple flow imaging and power Dopple imaging examination include measurement of CCA - IMT, the hemodynamics of carotid and vertebral arteries(CCA,ICA,ECA,VA) index,the sites of plaque mean-while plasma Lipoprotein and apolipoprotein were tested. Result:①The intimal-medial thickness of carotid thickenedin the position of trunk and its tributaries thickened in patients with hemispheric infarction as compared with those in the controls.Atherosclerotic plaques of carotid arteries occurred in 32 cases(32/41, 78.0%).②The prevalence of plaqueincreased from the lowest to the highest quintile of IMT(linear trend:P＜0.01)and the mean IMT was lower in subject without plaque than in subjects with plaques (0.64±0.12mm vs 0.83±0.16, P＜0.01）. ③Compared with controls, the plaque of common carotid artery and arteriae carotis interna widened significantly, and the end-diastolic velocity(EDV) and the time average velocity(Vmean) were evidently decreased and the resistive index(RI) as well as pulsatilityindex(PI) increased in carotid and vertedral arteries.Carotid arteriosclerosis was inversely correlated with apolipoprotein(apoAI).Conclusion: The atherosclerosis of carotid and vertedral arteries was related to the incidence of hemispheric infarction and the soft plaque in carotid arteries might be one of the potential cause for hemispheric infarction; Increasured in the CCA are clearly related to atherosclerotic plaque in the ICA; In carotid arteriosclerosis,apoAI result a more significant reduction than it does normally.Besides the two non-injury test techniques,it has clinicad value in prediction and treatment of cerebrovascular disease.
引文
[1] 谭新洪, 黄震东主编. 现代内科治疗学 . 广州: 广东科技出版社， 1997 . 910～919
[2] 王新房, 李治安 . 彩色多普勒论断学 . 北京 : 人民卫生出版社 , 1991 . 217～233
[3] 周俊，陆国平. 动脉粥样硬化斑块的临床检测 .中国动脉硬化杂志，2002,Vol 10, No 2.178～181
[4] Pignoli P, Tremoli E, Poli A, et al . Intimal plus medial thickness of the arterial wall:a direct measurement with ultrasound imaging [J].Circulation ,1986 ,74:1399～1406
[5] Burke GL, Evans GW, Riley WA,et al. Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. Stroke, 1995, 6:386～394
[6] .Chambless LE, Folsom AR, Clegg LX,et al. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities(ARIC) study. Am J Epidemiol, 2000,151(5):478-487.
[7] .Hennerici M, Meairs S. Imaging arterial wall disease. Cerebrovasc Dis, 2000, 10 (Suppl 5):9-20.
[8] Palak J, Shemanski L,O Leary DH,et al. Relationship between incident stroke and the severity of internal carotid stenosis [J]. Circulation, 1994, 90(part Ⅱ):1399～1404
[9] Sacco RL, Ellenberg JH, Mohr JP, et al. Infarcts of undetermined cause: the NINCDS. Stroke Data Bank. Ann Neurol, 1989, 25:382
[10] 梁玉宏，张小林. 超声检查对颈动脉疾病的诊断价值[J].国外医学脑血管疾病分册，1997，5（3）：154～157
[11] Marie-Louis M. Ultrasound and Lipoproteins as Predictors of Lipid-Rich, Rupture-Prone Plaques in the Carotid Artery. Arteriosclerosis, Thrombosis and Vascular Biology, 1999,19:2～13
[12] Barnett HJM, Mohr JP, Stein BM, et al. Pathophysiology, Diagnosis, and Management. 2nd ed. New York: Churchill Livingstone.Stroke, 1992. 241～268
[13] Ackerman RH, Candia MR. Identifying clinically relevant carotid disease. Stroke, 1994.25:1～3
[14] Steinke W,Meairs S, Ries S, et al. Sonographic assessment of
carotid artery stenosis. Stroke,1996.27:91～94
[15] Briewing B, Morgenstern C, Driesner F, et al. Cerebrovasculascular diease color-flow and power Doppler ultrasonography. Stroke, 1996.27:95～100
[16] Zhu CZ, Norris JW. Role of carotid stenosis in ischemic stoke[J]. Stroke, 1990, 21:1131
[17] Khoury Z , Schwartz R, Gottliet S, et al. Relation of coronary artery diease to atherosclerotic in the aorta, and femoral arteries evaluated by ultrasound[J]. Am J Cardiol,1997,80:1429
[18] Salonen JT, Rlonen R. Ultrasound B-mode imaging in observational study of atherosclerotic progression [J]. Circulation,1993,87:1156
[19] Executibe Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA,1995, 273(18):1421
[20] 王拥军. 应加强颈动脉粥样硬化的基础和临床研究. 中华神经科杂志. 2001,Vol 34,No.5 : 257
[21] Nordestgard BG, Wootton R, Lenis B. Selective retention of VLDL,IDL,and LDL in the arterial intima of size as a determinant of fractional loss from the intima-intermedia. Arterioscler Thromb Vasc Biol,1995,15:534～542
[22] Crouse JR, Byington RP, Bond MG, et al. Pravastatin, lipids, and atherosclerosis in the carotid artery(PLAC-Ⅱ). Am J Cardiol, 1995,75:455
[23] Salonen R, Nyyssonen K, Porkkala E, et al. Kupio Atherosclerosis Prevention Study(KAPS): a population-based primary preventive trial of the effect of LDL lowering on atherosclerotic progression in carotid and femoral arteries. Circulation, 1995, 92:1785
[24] Shephard J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemin. N Engl J Med, 1995,333:1301～1307
[25] Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation, 1995,92:657～671
[26] 徐智章，何银凤，王文平等. 脑梗死患者颈动脉超声检测. 中国医学影像技术，1996，12（5）：321
[27] Wikstrand J, Wiklund O. Frontiers in cardiovascular science,
quantitative measurements of atherosclerotic manifeststions in humans. Arterioscler Thromb,1992,12:114
[28] 韩力群，张化成，夏冰，等。 高频超声对高脂血症患者颈动脉硬化内膜–中膜厚度及斑块形成检测的意义 . 临床超声医学杂志 ，2001 ， 3（4）：237-239
[29] Toubou PJ, Elbaz A, Koller C, et al. Common carotid artery intimamedia thickness and brain infarction: the Etude du Profil Genetiquede Infarctus Cerebral(GENIC) case-control study. The Genic Investigators Circulation, 2000, 102(3): 313-318.
[30] Hennerici M, Meairs S. Imaging arterial wall disease. Cerebrovasc Dis, 2000, 10 (Suppl 5):9-20.
[31] Gnasso A, Motti C, Irace C, et al . Genetic variation in human stromelysin gene promoter and common carotid geometry in healthy male subjects.Arterioscler Thromb Vasc Biol, 2000, 20(6):1600-1605.
[32] Vojutilainen S, Alfthan G, Nyyssonen K, et al. Association between elevated plasma total homocysteine and increased common carotid artery wall thickness.Ann Med, 1998,30(3):300-306.
[33] Mannami T, Konishi M, Baba S,et al. Prevalence of asymptomatic carotid atherosclerotic lesions detected by high-resolution ultrasonography and its relation to cardiovascular risk factors in the general population of a Japanese city: the Suita Study. Stroke. 1997, 28: 518-591.
[34] Yamasaki Y, Kawamori R, Matsushima H, et al. Asymptomatic hyperglycaemia is associated with increased intimal plus medial thickness of the carotid artery. Diabetologia, 1995 ,38 :585-591.
[35] Rongling LI, Bruce B, Patricia A, et al. B-mode-detected carotid artery plaque in a general population. Stroke, 1994, 25: 2377-2383 .
[36] Wong M, Edelstein J, Wollman J,et al. Ultrasonic pathological comparison of human arterial wall: Verification of intima-media thickness[J]. Arterioscler Thromb, 1993,13:482～486
[37] Gnasso A, Irace C, Pujia PLM. Carotid intima-media thickness and coronary heart risk fact[J]. Atherosclerosis, 1996,119:7～15
[38] Skoglund C, Tang R, Bond MG, et al. LDL particle size distribution is associated with carotid intima-media thickness in healthy 50-year-old men[J]. Arterioscler Thromb Vasc Biol, 1999,19:2422
[39] Tonstand S, Joakimsen O, Stensland-Bugge E, et al Riskfacts
related to carotid intima-media thickness asnd plaque in children with familiar hypercholesterolemia and control subjects[J]. Arterioscler Thromb, 1996,16:984
[40] Pauciullo P, Iannuzzi A, Sartorio R, et al. Increased intima-media thicknes of common carotid artery in hypercholesterolemic children[J]. Arterioscler Thromb, 1994,14:1075
[41] O'leary DH, Polak JF, Kronmal RA, et al. Carotid artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults[J]. N Engl J Med, 1999,340:14
[42] Raitakari OT, Adams MR, Celermajer DS. Effect of lipoprotein(a) on the early functional and structural changes of atherosclerosis[J]. Arterioscler Thromb Vasc Biol, 1999,19:990～995
[43] Zureik M, Touboul PJ, Bonithon-Kopp C, et al. Differential association of common carotid intima-media thickness and carotid atherosclerotic plaques with parental history of premature death from coronary heart disease[J]. Arterioscler Thromb Vasc Biol, 1999,19:366
[44] Wendelhag I, Wiklund O, Wkstand J. On quantifying plaque size and intima media thidkness in carotid and femoral arteries:Comments on result from a prospective ultrasound study in patients with familiard hypercholesterolemia[J]. Arterioscler Thromb,1996,16:84
[45] Rosfors S, Stem SH, Rerstin JU, et al. Relationship between intimamedia thickness in the common carotid artery and atherosclerosis in the carotid bifurcation. Stroke, 1998, 29(7):1378-1382.
[46] Fourcelot L, Tranquart F, Bray JM, et al. Ultrasound characterization and quantification of xarotid atherosclerosis lesions. Minerva Cardioangiol, 1999,47(1): 15-24.
[47] Lee DJ, Sigel B, Swami UK, et al. Determination of carotid plaque risk by ultrasonic tissue characterization . Ultrasound Med Biol , 1998, 24(9): 1291-1299.
[48] Joakimsen O ,Bonaa KH, Stensland-Bugge E. Reproducibility of ultrasound assessment of carotid plaque occurrence, thickness ,and morphology :the Tromso Study . Stroke , 1997 ,28 :2201-2207.
[49]Aburahma AF , Kyer PD 3rd, Robinson PA , et al . The correlation of ultrasonic carotid plaque morphology and carotid plaque hemorrhage : clinical Implications . Surgery ,1998, 124(4): 721-728.
[50] Gronhddt MI, Ultrasound and lipoproteins as predictors of lipid-rich, rupture-prone plaques in the carotid artery . Arteroscler Thromb Vasc Biol , 1999, 19: 2-13.
[51] Carr S , Farb A, Pearce WH, et al. Atherosclerotic plaque rupture in symptomatic carotid artery stenosis .J Vasc Surg, 1996, 23: 755-766.
[52] 蔡海江. 脂蛋白与动脉粥样硬化研究进展. 心肺血管病杂志, 1999. 18 (1):1
[2] 王新房, 李治安 . 彩色多普勒论断学 . 北京 : 人民卫生出版社 , 1991 . 217～233
[3] 周俊，陆国平. 动脉粥样硬化斑块的临床检测 .中国动脉硬化杂志，2002,Vol 10, No 2.178～181
[4] Pignoli P, Tremoli E, Poli A, et al . Intimal plus medial thickness of the arterial wall:a direct measurement with ultrasound imaging [J].Circulation ,1986 ,74:1399～1406
[5] Burke GL, Evans GW, Riley WA,et al. Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. Stroke, 1995, 6:386～394
[6] .Chambless LE, Folsom AR, Clegg LX,et al. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities(ARIC) study. Am J Epidemiol, 2000,151(5):478-487.
[7] .Hennerici M, Meairs S. Imaging arterial wall disease. Cerebrovasc Dis, 2000, 10 (Suppl 5):9-20.
[8] Palak J, Shemanski L,O Leary DH,et al. Relationship between incident stroke and the severity of internal carotid stenosis [J]. Circulation, 1994, 90(part Ⅱ):1399～1404
[9] Sacco RL, Ellenberg JH, Mohr JP, et al. Infarcts of undetermined cause: the NINCDS. Stroke Data Bank. Ann Neurol, 1989, 25:382
[10] 梁玉宏，张小林. 超声检查对颈动脉疾病的诊断价值[J].国外医学脑血管疾病分册，1997，5（3）：154～157
[11] Marie-Louis M. Ultrasound and Lipoproteins as Predictors of Lipid-Rich, Rupture-Prone Plaques in the Carotid Artery. Arteriosclerosis, Thrombosis and Vascular Biology, 1999,19:2～13
[12] Barnett HJM, Mohr JP, Stein BM, et al. Pathophysiology, Diagnosis, and Management. 2nd ed. New York: Churchill Livingstone.Stroke, 1992. 241～268
[13] Ackerman RH, Candia MR. Identifying clinically relevant carotid disease. Stroke, 1994.25:1～3
[14] Steinke W,Meairs S, Ries S, et al. Sonographic assessment of
carotid artery stenosis. Stroke,1996.27:91～94
[15] Briewing B, Morgenstern C, Driesner F, et al. Cerebrovasculascular diease color-flow and power Doppler ultrasonography. Stroke, 1996.27:95～100
[16] Zhu CZ, Norris JW. Role of carotid stenosis in ischemic stoke[J]. Stroke, 1990, 21:1131
[17] Khoury Z , Schwartz R, Gottliet S, et al. Relation of coronary artery diease to atherosclerotic in the aorta, and femoral arteries evaluated by ultrasound[J]. Am J Cardiol,1997,80:1429
[18] Salonen JT, Rlonen R. Ultrasound B-mode imaging in observational study of atherosclerotic progression [J]. Circulation,1993,87:1156
[19] Executibe Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA,1995, 273(18):1421
[20] 王拥军. 应加强颈动脉粥样硬化的基础和临床研究. 中华神经科杂志. 2001,Vol 34,No.5 : 257
[21] Nordestgard BG, Wootton R, Lenis B. Selective retention of VLDL,IDL,and LDL in the arterial intima of size as a determinant of fractional loss from the intima-intermedia. Arterioscler Thromb Vasc Biol,1995,15:534～542
[22] Crouse JR, Byington RP, Bond MG, et al. Pravastatin, lipids, and atherosclerosis in the carotid artery(PLAC-Ⅱ). Am J Cardiol, 1995,75:455
[23] Salonen R, Nyyssonen K, Porkkala E, et al. Kupio Atherosclerosis Prevention Study(KAPS): a population-based primary preventive trial of the effect of LDL lowering on atherosclerotic progression in carotid and femoral arteries. Circulation, 1995, 92:1785
[24] Shephard J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemin. N Engl J Med, 1995,333:1301～1307
[25] Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation, 1995,92:657～671
[26] 徐智章，何银凤，王文平等. 脑梗死患者颈动脉超声检测. 中国医学影像技术，1996，12（5）：321
[27] Wikstrand J, Wiklund O. Frontiers in cardiovascular science,
quantitative measurements of atherosclerotic manifeststions in humans. Arterioscler Thromb,1992,12:114
[28] 韩力群，张化成，夏冰，等。 高频超声对高脂血症患者颈动脉硬化内膜–中膜厚度及斑块形成检测的意义 . 临床超声医学杂志 ，2001 ， 3（4）：237-239
[29] Toubou PJ, Elbaz A, Koller C, et al. Common carotid artery intimamedia thickness and brain infarction: the Etude du Profil Genetiquede Infarctus Cerebral(GENIC) case-control study. The Genic Investigators Circulation, 2000, 102(3): 313-318.
[30] Hennerici M, Meairs S. Imaging arterial wall disease. Cerebrovasc Dis, 2000, 10 (Suppl 5):9-20.
[31] Gnasso A, Motti C, Irace C, et al . Genetic variation in human stromelysin gene promoter and common carotid geometry in healthy male subjects.Arterioscler Thromb Vasc Biol, 2000, 20(6):1600-1605.
[32] Vojutilainen S, Alfthan G, Nyyssonen K, et al. Association between elevated plasma total homocysteine and increased common carotid artery wall thickness.Ann Med, 1998,30(3):300-306.
[33] Mannami T, Konishi M, Baba S,et al. Prevalence of asymptomatic carotid atherosclerotic lesions detected by high-resolution ultrasonography and its relation to cardiovascular risk factors in the general population of a Japanese city: the Suita Study. Stroke. 1997, 28: 518-591.
[34] Yamasaki Y, Kawamori R, Matsushima H, et al. Asymptomatic hyperglycaemia is associated with increased intimal plus medial thickness of the carotid artery. Diabetologia, 1995 ,38 :585-591.
[35] Rongling LI, Bruce B, Patricia A, et al. B-mode-detected carotid artery plaque in a general population. Stroke, 1994, 25: 2377-2383 .
[36] Wong M, Edelstein J, Wollman J,et al. Ultrasonic pathological comparison of human arterial wall: Verification of intima-media thickness[J]. Arterioscler Thromb, 1993,13:482～486
[37] Gnasso A, Irace C, Pujia PLM. Carotid intima-media thickness and coronary heart risk fact[J]. Atherosclerosis, 1996,119:7～15
[38] Skoglund C, Tang R, Bond MG, et al. LDL particle size distribution is associated with carotid intima-media thickness in healthy 50-year-old men[J]. Arterioscler Thromb Vasc Biol, 1999,19:2422
[39] Tonstand S, Joakimsen O, Stensland-Bugge E, et al Riskfacts
related to carotid intima-media thickness asnd plaque in children with familiar hypercholesterolemia and control subjects[J]. Arterioscler Thromb, 1996,16:984
[40] Pauciullo P, Iannuzzi A, Sartorio R, et al. Increased intima-media thicknes of common carotid artery in hypercholesterolemic children[J]. Arterioscler Thromb, 1994,14:1075
[41] O'leary DH, Polak JF, Kronmal RA, et al. Carotid artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults[J]. N Engl J Med, 1999,340:14
[42] Raitakari OT, Adams MR, Celermajer DS. Effect of lipoprotein(a) on the early functional and structural changes of atherosclerosis[J]. Arterioscler Thromb Vasc Biol, 1999,19:990～995
[43] Zureik M, Touboul PJ, Bonithon-Kopp C, et al. Differential association of common carotid intima-media thickness and carotid atherosclerotic plaques with parental history of premature death from coronary heart disease[J]. Arterioscler Thromb Vasc Biol, 1999,19:366
[44] Wendelhag I, Wiklund O, Wkstand J. On quantifying plaque size and intima media thidkness in carotid and femoral arteries:Comments on result from a prospective ultrasound study in patients with familiard hypercholesterolemia[J]. Arterioscler Thromb,1996,16:84
[45] Rosfors S, Stem SH, Rerstin JU, et al. Relationship between intimamedia thickness in the common carotid artery and atherosclerosis in the carotid bifurcation. Stroke, 1998, 29(7):1378-1382.
[46] Fourcelot L, Tranquart F, Bray JM, et al. Ultrasound characterization and quantification of xarotid atherosclerosis lesions. Minerva Cardioangiol, 1999,47(1): 15-24.
[47] Lee DJ, Sigel B, Swami UK, et al. Determination of carotid plaque risk by ultrasonic tissue characterization . Ultrasound Med Biol , 1998, 24(9): 1291-1299.
[48] Joakimsen O ,Bonaa KH, Stensland-Bugge E. Reproducibility of ultrasound assessment of carotid plaque occurrence, thickness ,and morphology :the Tromso Study . Stroke , 1997 ,28 :2201-2207.
[49]Aburahma AF , Kyer PD 3rd, Robinson PA , et al . The correlation of ultrasonic carotid plaque morphology and carotid plaque hemorrhage : clinical Implications . Surgery ,1998, 124(4): 721-728.
[50] Gronhddt MI, Ultrasound and lipoproteins as predictors of lipid-rich, rupture-prone plaques in the carotid artery . Arteroscler Thromb Vasc Biol , 1999, 19: 2-13.
[51] Carr S , Farb A, Pearce WH, et al. Atherosclerotic plaque rupture in symptomatic carotid artery stenosis .J Vasc Surg, 1996, 23: 755-766.
[52] 蔡海江. 脂蛋白与动脉粥样硬化研究进展. 心肺血管病杂志, 1999. 18 (1):1