2020 年第 9 期 第 15 卷

超声造影检测颈动脉斑块内新生血管预测心脑血管事件发生的单中心2年随访研究

Neovascularization in carotid plaque detected by contrast-enhanced ultrasound and cardio-cerebrovascular events: a single-center study with 2-year follow-up

作者：张辉1钟钧琳1张奥华1黄卓山2赵云跃2张艳玲1

英文作者：Zhang Hui1 Zhong Junlin1 Zhang Aohua1 Huang Zhuoshan2 Zhao Yunyue2 Zhang Yanling1 

单位：1中山大学附属第三医院超声科，广州510630；2中山大学附属第三医院心血管内科，广州510630

英文单位：1Department of Ultrasound the Third Affiliated Hospital Sun Yat-sen University Guangzhou 510630 China; 2Department of Cardiovascular Medicine the Third Affiliated Hospital Sun Yat-sen University Guangzhou 510630 China 

关键词：颈动脉粥样硬化；超声造影；斑块；新生血管；心脑血管事件

英文关键词：Carotidatherosclerosis;Contrast-enhancedultrasound;Plaque;Neovascularization;Cardio-cerebrovascularevents

• 摘要：

• 目的 探讨超声造影检测颈动脉斑块内新生血管对患者发生心脑血管事件的预警作用。方法 选取2016年6月至2018年6月在中山大学附属第三医院就诊的颈动脉斑块患者38例。通过颈动脉超声检查斑块的位置、回声特性、厚度。所有患者均进行颈动脉超声造影检查斑块新生血管。记录2年随访过程中心脑血管事件的发生情况，以及患者使用他汀类药物治疗的剂量和时间。结果 本组38例患者中，共检出46个斑块，24个斑块位于颈总动脉，20个斑块位于颈总动脉分叉处，2个斑块位于颈内动脉。低回声斑块35个，混合回声斑块11个。颈动脉内膜中层厚度(0.79±0.25)mm、斑块厚度(2.5±0.6)mm、斑块长度(15.4±5.3)mm。38例患者随访18~24个月，其中16例发生心脑血管事件患者超声造影可见斑块内新生血管，1例发生心脑血管事件患者超声造影未见斑块内新生血管，7例患者超声造影发现斑块内新生血管但是未出现心脑血管事件。超声造影检测颈动脉斑块内新生血管评估心脑血管事件发生的敏感度为94.1%，特异度为66.7%，准确度为78.9%，阳性预测值为69.5%，阴性预测值为93.3%。规律使用他汀类药物治疗6个月以上者31例，超声造影检查发现颈动脉斑块内新生血管1例；未规律服用他汀类药物的7例患者中，超声造影检查发现颈动脉斑块内新生血管6例；二者新生血管比例差异有统计学意义(P＜0.001)。结论 超声造影对于预测可能出现的心脑血管事件具有较高的敏感度。规律服用他汀类药物治疗＞6个月能够降低颈动脉斑块的易损性。

• Objective To investigate the early warning effect of carotid plaque neovascularization detected by contrast-enhanced ultrasound(CEUS) on cardiovascular and cerebrovascular events. Methods Thirty-eight patients with carotid plaques were enrolled from June 2016 to June 2018 in the Third Affiliated Hospital, Sun Yat-sen University. Position, echo characteristics and thickness of plaques were measured by carotid ultrasound. Neovascularization in plaques was detected by CEUS. Occurrences of cardiovascular and cerebrovascular events were followed up for 2 years. The dose of statins and the duration of usage were recorded. Results A total of 46 plaques detected in 38 patients; 24 plaques located at common carotid artery; 20 plaques located at the bifurcation of carotid artery; 2 plaques located at internal carotid artery. Thirty-five plaques were hypoechoic and 11 were mixed echo. Carotid intima-media thickness was (0.79±0.25)mm; plaque thickness was(2.5±0.6)mm; plaque length was (15.4±5.3)mm. During 24-month follow-up, plaque neovascularization was found in 16 patients with cardio-cerebrovascular events; 1 patient with cardio-cerebrovascular events showed no neovascularization; 7 patients who had neovascularization did not suffer from cardio-cerebrovascular events. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of plaque neovascularization in predicting cardio-cerebrovascular events were 94.1%, 66.7%, 78.9%, 69.5% and 93.3%, respectively. Among 31 patients treated with statins regularly for more than 6 months, plaque neovascularization was noticed in 1 patient; 6 in 7 patients without regular statins treatment had plaque neovascularization(P＜0.001). Conclusions CEUS is sensitive in predicting cardiovascular and cerebrovascular events in patients with carotid plaques. Regular treatment with statins for more than 6 months can reduce the vulnerability of plaques.