【作者】 相成；

【导师】 温建中； 关晏星；

【作者基本信息】 江西医学院 ， 影像医学与核医学， 2003， 硕士

【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。更多还原

【Abstract】 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.更多还原