【作者】 张文芳；

【导师】 王志刚；

【作者基本信息】 重庆医科大学 ， 影像医学与核医学， 2008， 硕士

【摘要】 目的超声图像上的颈动脉粥样硬化斑块回声强度是反映斑块组成与稳定性的重要内容。本文拟通过比较单纯高血压和高血压合并糖尿病两种类型患者颈动脉内膜中层厚度、粥样硬化斑块声像图平均回声强度及相关因素,分析两组患者间颈动脉斑块声像图回声强度的差异及原因,探讨部分影响因素及血液生化指标与斑块声像图回声强度的相关性。方法以灰阶GS值为单位,使用我们研制的国产“DFY型超声图像定量分析诊断仪”定量测定117例颈动脉粥样硬化斑块形成患者(其中单纯高血压73例,高血压合并糖尿病44例)的颈动脉斑块声像图平均回声强度,另测量其颈动脉内膜中层厚度、收缩压最高值和餐后2小时血糖、血脂、血浆纤维蛋白原及血小板等生化指标,比较两组患者间的差异,并分析117例患者性别、吸烟及上述指标与颈动脉粥样硬化斑块声像图平均回声强度的相关性。结果颈动脉内膜中层厚度在单纯高血压与高血压合并糖尿病两组患者间无统计学差异(P >0.05)。高血压合并糖尿病患者组颈动脉粥样硬化斑块声像图平均回声强度显著低于单纯高血压组(P <0.01),其餐后2小时血糖水平升高及高密度脂蛋白降低,较单纯高血压组患者有统计学差异。在所有观察的影响因素中,吸烟、餐后2小时血糖水平、载脂蛋白A1及血浆纤维蛋白原与斑块声像图平均回声强度明显相关。结论高血压合并糖尿病患者的颈动脉粥样硬化斑块声像图平均回声强度较单纯高血压患者低,其斑块可能更不稳定,易破裂脱落,引起脑卒中等危险事件的发生。引起这两者间差异的原因可能主要是餐后血糖水平的升高和高密度脂蛋白的降低。总的说来,颈动脉粥样硬化斑块声像图平均回声强度可能与吸烟、餐后高血糖、血浆纤维蛋白原、载脂蛋白A1及高密度脂蛋白有关。更多还原

【Abstract】 Object The echogenicity of atherosclerotic carotid plaque in ultrasound image is an important reflection to its component and stability. In this paper, we want to compare the carotid artery intima-media thickness (IMT), mean plaque echogenicity in ultrasound image and some related factors in patients with hypertension and hypertension complicated with DM, then to analyze the difference of carotid artery plaque stability between these two groups of patients. The association of the mean carotid plaque echogenicity in ultrasound image with some risk factors and biochemical indicators is explored in the study.Methods The mean atherosclerotic carotid plaque echogenicity in ultrasound image in 117 patients, (44 with hypertension and 73 with hypertension and DM), was measured by DFY Software, using gray scale as the unit. Their IMT, maximum systolic blood pressure, 2h postprandial blood glucose, lipid, plasma fibrinogen and platelet were also recorded and compared. The association of the mean carotid plaque echogenicity in ultrasound image with gender、smoking and the indicators above is evaluated.Results IMT in the two groups was not significantly different(P >0.05). The mean echogenicity of carotid atherosclerotic plaques in ultrasound image in hypertension and DM group was obviously lower than that in hypertension group (P <0.01), and in this group, 2h postprandial blood glucose was obviously higher, HDL was lower. In all the observed indicators, the mean echogenicity in ultrasound image was correlated with smoking, 2h postprandial blood glucose,apoA1 and plasma fibrinogen. Conclusion Patients with hypertension and DM have moreecholucent carotid plaques in ultrasound image than those with only hypertesion. This plaque may be more unstable and easily to rupture, and cause stroke or other dangerous incidents. The main reason may be the increased postprandial blood glucose and the lower HDL. Overall, the mean plaque echogenicity in ultrasound image is probably due to smoking, 2h postprandial blood glucose, plasma fibrinogen, apoA1 and HDL.更多还原