摘要： 研究背景 近年关于颈部动脉粥样硬化的研究更多关注颈总动脉分叉部粥样硬化性病变所带来的不良影响，鲜有文献报道应用彩色多普勒超声筛查右锁骨下动脉起始部粥样硬化性病变，本研究旨在探讨右锁骨下动脉粥样硬化作为颈部动脉粥样硬化性病变早期诊断标志的临床价值。方法 选择455 例符合入选条件的受试者并根据年龄分组，应用彩色多普勒超声逐一筛查双侧颈动脉颅外段及右锁骨下动脉起始部，统计有无危险因素、不同性别、不同年龄阶段颈动脉任意部位粥样硬化性病变的总检出率，以及右锁骨下动脉起始部和颈总动脉分叉部粥样硬化性病变检出率。结果 随着年龄的增长，动脉粥样硬化性病变总检出率呈现递增趋势（χ² = 165.994，P = 0.000）。右锁骨下动脉起始部及颈总动脉分叉部粥样硬化性病变检出率比较，各年龄组之间差异具有统计学意义（均P = 0.000），其中40~49岁和50~ 59岁组患者右锁骨下动脉起始部和颈总动脉分叉部检出率均低于其他年龄组（P < 0.05 ）。除60~ 69岁与≥70岁组之间，其他各年龄组右锁骨下动脉起始部粥样硬化性病变检出率均高于颈总动脉分叉部，且差异有统计学意义（均P < 0.05 ）。根据性别和危险因素筛查，男性及有危险因素组颈总动脉分叉部与右锁骨下动脉起始部粥样硬化性病变检出率分别高于女性（P = 0.029，0.008）和无危险因素组（P = 0.000，0.001）；无危险因素人群中，右锁骨下动脉起始部粥样硬化性病变检出率高于颈总动脉分叉部（P < 0.05 ）。 结论 右锁骨下动脉起始部应作为颈部血管超声筛查的常规部位，以提高男性青壮年人群颈部动脉粥样硬化性病变早期检出率，对预防脑血管病具有重要意义。

关键词: 超声检查, 多普勒, 彩色, 锁骨下动脉, 颈总动脉, 动脉硬化

Abstract: Background  There are many reports regarding the harmful effect of arteriosclerosis at the bifurcation of common carotid artery, but few researches involving the application of color Doppler sonography scanning for the diagnosis of arteriosclerosis at the initial part of right subclavian artery. This study aims to explore the clinical value of early diagnosis for carotid arteriosclerosis. Methods  In this study almost 455 subjects were enrolled and underwent ultrasound examination for large cervical arteries. The subjects were divided into groups by gender and age. Color Doppler sonography was used to scan extracranial part of bilateral carotid artery and the initial part of right subclavian artery. The detectable rates of arteriosclerosis at carotid artery, initial part of right subclavian artery and bifurcate part of common carotid artery were calculated by different ages and genders. Results  Detectable rate of arteriosclerosis was increased by age (χ² = 165.994, P = 0.000). The detectable rate of arteriosclerosis at initial part of right subclavian artery and bifurcate part of common carotid artery in different age groups was significant different ( P = 0.000, for all). In addition, detectable rates of arteriosclerosis at initial part of right subclavian artery and bifurcate part of common carotid artery in group of age 40-49 and 50-59 were lower than other groups ( P < 0.05). The detectable rate of arteriosclerosis at initial part of right subclavian artery was higher than that at bifureate part of common carotid artery for all groups, but the difference was only statistically significant in group of age 40-49 and 50-59 (P = 0.019 in age 40-49 group, P = 0.006 in age 50-59 group). There was no significant difference in group of age 60-69 (P = 0.388) and ≥70 ( P = 0.167). According to the research with gender and risk factors, detectable rate of arteriosclerosis at bifurcate part of common carotid artery and initial part of right subclavian artery in male group and risk factors group was higher than female group ( P = 0.029, 0.008) and without risk factors group (P = 0.000, 0.001) respectively. In the group without risk factors, the detectable rate of arteriosclerosis at initial part of right subclavian artery was higher than bifurcate part of common carotid artery (P < 0.05). Conclusion  The initial part of right subclavian artery should be commonly scanned by color Doppler sonography to early detect arteriosclerosis in middle-aged people. It is important in avoiding cerebrovascular diseases.

Key words: Ultrasonography, Doppler, color, Subclavian artery, Carotid artery, common, Arteriosclerosis