摘要：

目的 探讨颈动脉内膜切除术前颈动脉超声造影评价动脉粥样硬化斑块内新生血管水平的临床意义。方法 纳入 2017 年 9 月至 2018 年 10 月经数字减影血管造影术证实为中至重度颈动脉狭窄并行颈动脉内膜切除术病例，术前行颈动脉超声造影检查、术后行病理检查。结果 与术后病理结果比较，24 例患者中 22 例术前经颈动脉超声造影明确诊断、2 例漏诊，术前诊断准确率约为 91.67%（22/24）；其中颈动脉斑块Ⅰ级 6 例（25%）、Ⅱ级 6 例（25%）、Ⅲ级 6 例（25%）、Ⅳ级 6 例（25%）。经 Pearson 相关分析，颈动脉斑块分级与 CD34 呈阳性的新生血管数目呈正相关（r = 0.871，P = 0.000）；曲线下面积为0.927（95%CI：0.848 ~ 1.006，P = 0.000）。结论 颈动脉斑块分级与 CD34 呈阳性的新生血管数目呈正相关，颈动脉超声造影对预测斑块易损性和缺血性卒中风险、判断手术时机具有重要临床价值。

关键词: 颈动脉狭窄, 动脉粥样硬化, 新生血管化, 病理性, 超声检查

Abstract:

Objective To investigate the value of predicting the vulnerability of atherosclerotic plaques in assessment of intraplaque neovascularization using carotid contrast-enhanced ultrasound. Methods A total of 24 cases diagnosed as moderate to severe carotid stenosis by digital subtraction angiography (DSA) underwent carotid endarterectomy (CEA) from September 2017 to October 2018. Preoperative carotid contrast-enhanced ultrasound and postoperative pathological examination were performed in the patients. Results Compared with postoperative pathological results, 22 cases were clearly diagnosed by preoperative carotid contrast-enhanced ultrasound, and 2 cases were missed. The precision rate of preoperative diagnosis was 91.67% (22/24). Meanwhile carotid plaques were divided into four grades (Grade Ⅰ-Ⅳ) according to the degree of enhancing extent of contrast-enhanced ultrasound. Each grade included 6 cases (25%). Pearson correlation analysis showed there was an evidently positive correlation between preoperative grade of carotid plaques and number of intraplaque CD34-positive neovessels (r = 0.871, P = 0.000). The value of area under the curve (AUC) was 0.927 (95% CI: 0.848-1.006, P = 0.000). Conclusions The grade of carotid plaques was positively related to intraplaque CD34-positive neovessels. Hence, carotid contrast-enhanced ultrasound plays an important role in predicting the vulnerability of atherosclerotic plaques and risk of ischemic stroke and judging optimal surgical time.

Key words: Carotid stenosis, Atherosclerosis, Neovascularization, pathologic, Ultrasonography