三维超声血管斑块定量分析技术评估颈动脉粥样硬化斑块

doi:10.19723/j.issn.1671-167X.2022.05.028

北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (5): 991-999. doi: 10.19723/j.issn.1671-167X.2022.05.028

三维超声血管斑块定量分析技术评估颈动脉粥样硬化斑块

邢海英^1,²,陈玉辉³,许珂^1,²,黄点点^1,²,彭清^1,²,刘冉^1,²,孙葳^1,²,黄一宁^1,^2,*()

1. 北京大学第一医院神经内科, 北京 100034
2. 神经系统小血管病探索北京市重点实验室, 北京 100034
3. 北京医院神经内科, 北京 100730

收稿日期:2022-06-30 出版日期:2022-10-18 发布日期:2022-10-14
通讯作者: 黄一宁 E-mail:ynhuang@bjmu.edu.cn
作者简介:黄一宁，北京大学第一医院神经内科主任。1987年毕业于中国协和医科大学获硕士学位；1984—2002年在北京协和医院神经科工作，2003年调任现职。长期不间断地在临床工作，经验丰富，并且精通于神经系统疾病常用的检测手段，如神经电生理、神经超声、神经影像学等专业技术，擅长于神经系统急症重症疾病和疑难疾病的诊治，特别是在脑血管病诊断和治疗上有很深的造诣。
2001年以来，牵头开展了多个国家重大科研项目，如国家十五攻关项目、国家十五攻关专项、卫生部临床重大专项、国家十一五重大专项，以及国家自然科学基金、首都发展基金、中德合作中心项目等。在国际顶级专业杂志(如the Lancet Neurology、Neurology、Stroke等)发表多篇文章。现任中华神经科分会常委、脑血管病学组副组长、亚洲急性卒中专家组(ASAP)成员。精通英文，熟悉法文，与国际临床神经病学界有广泛联系。曾被德国乌尔姆大学、法兰克福歌德大学、哥廷根大学、萨拉大学，以及中国的香港中文大学等聘为客座教授、访问教授或访问学者

Evaluation of carotid atherosclerotic plaques by vascular plaque quantification (VPQ) technology of three-dimensional ultrasonography

Hai-ying XING^1,²,Yu-hui CHEN³,Ke XU^1,²,Dian-dian HUANG^1,²,Qing PENG^1,²,Ran LIU^1,²,Wei SUN^1,²,Yi-ning HUANG^1,^2,*()

1. Department of Neurology, Peking University First Hospital, Beijing 100034, China
2. Department of Neurology, Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
3. Department of Neurology, Beijing Hospital, Beijing 100730, China

Received:2022-06-30 Online:2022-10-18 Published:2022-10-14
Contact: Yi-ning HUANG E-mail:ynhuang@bjmu.edu.cn

摘要/Abstract

摘要：

目的: 分析应用三维超声血管斑块定量分析技术(vascular plaque quantification, VPQ)评估颈动脉粥样硬化斑块的可行性并观察他汀类药物对颈动脉粥样硬化斑块的影响。方法: 选择2016年1月至2018年9月于北京大学第一医院神经内科治疗的颈动脉粥样硬化患者, 采用三维超声检查患者的双侧颈动脉, 对存在颈动脉粥样硬化斑块的患者采用VPQ测量颈动脉斑块的灰阶中位数(gray scale median, GSM)及其他血管参数。根据斑块的GSM, 分为低GSM组(GSM < 40)和高GSM组(GSM≥40), 比较两组患者的临床特征和斑块特征, 分析斑块的稳定性。根据患者是否服用他汀类药物, 将患者分为他汀组和非他汀组, 比较两组患者在3个月和2年时颈动脉斑块GSM及其他血管参数的变化。结果: 共入组120例患者, 其中男性79例, 女性41例, 平均年龄(65.39±9.11)岁。低GSM组31例, 高GSM组89例。低GSM组管腔的狭窄程度更重(面积狭窄率41.32%±21.37% vs. 29.79%±17.16%, P < 0.05)。低GSM组的标准化管壁指数(normalized wall index, NWI)显著大于高GSM组(0.61±0.14 vs.0.52±0.12, P < 0.01), 观察了77例患者颈动脉粥样硬化斑块的变化, 其中男51例, 女26例, 年龄(64.96±9.58)岁, 根据是否服用他汀类药物分为他汀组(n=56)和非他汀组(n=21)。与基线相比, 3个月随访时两组患者的颈动脉斑块体积、面积、管腔狭窄度、GSM变化差异均无统计学意义(P >0.05); 2年随访时, 他汀组的GSM增加[中位数10.00(2.00, 28.00)], 而非他汀组的GSM减低[中位数－7.00 (－11.00, 5.50)], 组间差异有统计学意义(P < 0.01)。他汀组的颈动脉斑块体积无明显增加, 而非他汀组的斑块体积略增加, 但两组的变化值差异无统计学意义[他汀组斑块体积增加[中位数0.00 (－30.00, 40.00) mm³, 非他汀组为30.00 (10.00, 70.00) mm³, P>0.05]。结论: 三维超声(three dimensional ultrasound, 3DUS)的VPQ可测量颈动脉斑块的GSM, 低GSM(GSM < 40)组患者的血管狭窄程度更重, 标准化管壁指数更高。VPQ观察到颈动脉粥样硬化斑块的患者服用中强度他汀类药物治疗2年后斑块的灰阶中位数增加, 提示3DUS的VPQ技术可用来观察他汀类药物治疗颈动脉动脉粥样硬化斑块的效果。

关键词: 三维超声, 血管斑块定量分析, 颈动脉斑块, 灰阶中位数, 他汀

Abstract:

Objective: To analyze the feasibility of using vascular plaque quantification (VPQ) to evaluate carotid atherosclerotic plaques and to observe the effect of statins on carotid atherosclerotic plaques. Methods: Patients with carotid plaques from January 2016 to September 2018 in Peking University First Hospital Neurology Department were recruited and underwent three-dimonsional ultrasound (3DUS). Their gray scale median (GSM) and other parameters of carotid plaques were measured with VPQ. The patients were divided into low GSM group (GSM < 40) and high GSM group (GSM≥40). The clinical characteristics and plaque characteristics of the patients in the two groups were compared to analyze the stability of plaques. According to whether taking statins or not, the patients were further divided into statin group and non-statin group, plaque GSM and other parameters of their carotid plaques were measured and the changes of carotid plaques at the end of 3 months and 2 years were observed. Results: A total of 120 patients were enrolled, including 79 males and 41 females, with an average age of (65.39±9.11) years. The patients were divided into low GSM group (31 cases) (GSM < 40) and high GSM group (89 cases) (GSM≥40). The stenosis of the lumen in the low GSM group was more severe (the area stenosis rate was 41.32%±21.37% vs. 29.79%±17.16%, P < 0.05). The nor-malized wall index (NWI) of plaque in low GSM group was significantly higher than that in high GSM group (0.61 ±0.14 vs. 0.52±0.12, P < 0.01). A total of 77 patients, including 51 males and 26 females, aged (64.96±9.58) years, were enrolled to observe the statin effects on carotid plaque. They were divided into statin group (n=56) and non-statin group (n=21) according to whether taking statins or not. At the baseline and 3-month follow-up, there were no significant differences in carotid plaque volume, area, degree of luminal stenosis and GSM between the two groups (P>0.05). At the end of the 2-year follow-up, GSM increased in the statin group [median 10.00 (2.00, 28.00)] but decreased in the non-statin group [median －7.00 (－11.00, 5.50)], with a statistically significant difference between the two groups (P < 0.01). There was no significant increase in carotid plaque volume in the statin group, while there was a slight increase in the non-statin group, but there was no significant difference between the two groups [median increase in plaque volume was 0.00 (－30.00, 40.00) mm³ in the statin group and 30.00 (10.00, 70.00) mm³ in the non-statin group, P>0.05]. Conclusion: The VPQ technology of 3DUS can be used to evaluate carotid atherosclerotic plaques. Patients with low GSM (GSM < 40) have more severe vascular stenosis and higher normalized wall index. VPQ technology can also be used to observe the effect of statins on carotid plaque, the GSM of plaques increase in patients who are taking moderate-intensity statin treatment for two years.

Key words: Three-dimensional ultrasonography, Vascular plaque quantification, Carotid plaque, Gray scale median, Statin

中图分类号:

R543.4

邢海英,陈玉辉,许珂,黄点点,彭清,刘冉,孙葳,黄一宁. 三维超声血管斑块定量分析技术评估颈动脉粥样硬化斑块[J]. 北京大学学报（医学版）, 2022, 54(5): 991-999.

Hai-ying XING,Yu-hui CHEN,Ke XU,Dian-dian HUANG,Qing PENG,Ran LIU,Wei SUN,Yi-ning HUANG. Evaluation of carotid atherosclerotic plaques by vascular plaque quantification (VPQ) technology of three-dimensional ultrasonography[J]. Journal of Peking University (Health Sciences), 2022, 54(5): 991-999.

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参考文献 23

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Items	Total(n=120)	Low GSM group(n=31)	High GSM group(n=89)	P
Age/years, $\bar x \pm s$	65.39±9.11	66.1±9.29	65.15±9.09	0.62
Male, n (%)	79 (65.83)	18 (58.06)	61 (68.53)	0.44
Smoking，n (%)	50 (42.37)	10 (32.25)	40 (44.94)	0.25
Hypertension, n (%)	80 (67.80)	18 (58.06)	62 (69.66)	0.29
Diabetes mellitus, n (%)	42 (35.59)	13 (41.94)	29 (32.58)	0.31
ASCVD, n (%)	68 (61.82)	15 (48.38)	53 (62.92)	0.44
Stroke, n (%)	61 (51.70)	14 (45.16)	47 (52.81)	0.52
BMI/(kg/m²), $\bar x \pm s$	24.64 ±3.31	24.76 ±3.05	24.59 ±3.41	0.80
SBP /mmHg, $\bar x \pm s$	137.26 ±17.03	139.72 ±16.66	136.45 ±17.16	0.37
DBP /mmHg, $\bar x \pm s$	74.06 ±12.74	72.45 ±13.47	74.59 ±12.52	0.45
Glucose/(mmol/L), $\bar x \pm s$	6.13 ±1.73	6.00 ±1.20	6.16 ±1.86	0.61
TG/(mmol/L), $\bar x \pm s$	1.38 ±0.73	1.41±0.69	1.37 ±0.75	0.79
LDL-C/(mmol/L), $\bar x \pm s$	1.98 ±0.86	1.86 ±1.05	2.02±0.80	0.45
Antiplatelet, n (%)	99 (83.90)	25 (80.64)	74 (83.14)	0.92
Lipid lowering, n (%)	87 (72.50)	21 (67.74)	66 (74.16)	0.49

Items	Total(n=120)	Low GSM group(n=31)	High GSM group(n=89)	P
Plaque volume /mm³, M (P₂₅, P₇₅)	170.0 (100.0, 267.5)	180.0 (120.0, 270.0)	160.0 (95.0, 260.0)	0.29
Plaque area/mm², $\bar x \pm s$	15.97 ±11.37	18.02 ±13.13	15.26 ±10.69	0.30
Stenosis ratio/%, $\bar x \pm s$	32.77 ±18.93	41.32 ±21.37	29.79 ±17.16	0.01
NWI, $\bar x \pm s$	0.54 ±0.13	0.61 ±0.14	0.52 ±0.12	< 0.01

Items	Total(n=77)	Statin group(n=56)	Non-statin group (n=21)	P^*
Plaque volume /mm³, M (P₂₅, P₇₅)
Baseline	170.00 (100.00, 230.00)	170.00 (107.50, 235.00)	140.00 (80.00, 245.00)	0.28
3-month	160.00 (100.00, 260.00)	160.00 (100.00, 230.00)	160.00 (85.00, 275.00)	0.76
Change	0.00 (－20.00, 20.00)	0.00 (－20.00, 12.50)	0.00 (－25.00, 40.00)	0.47
P^#	0.65	0.46	0.38
Plaque area/mm²
Baseline, $\bar x \pm s$	15.12±10.39	16.20±10.85	12.21±8.61	0.13
3-month, $\bar x \pm s$	14.35±10.57	14.44±9.93	14.10±12.37	0.90
Change, M (P₂₅, P₇₅)	－0.31 (－3.02, 2.89)	－0.83 (－3.35, 1.81)	0.48 (－1.47, 4.10)	0.07
P^#	0.33	0.09	0.32
Stenosis ratio/%
Baseline, $\bar x \pm s$	31.69±18.75	33.63±18.52	26.52±18.81	0.14
3-month, $\bar x \pm s$	31.30±17.82	31.66±16.52	30.33±21.32	0.77
Change, M (P₂₅, P₇₅)	0 (－3.50, 5.50)	0.00 (－7.00, 5.00)	2.00 (－1.00, 10.00)	0.10
P^#	0.79	0.52	0.09
NWI
Baseline, $\bar x \pm s$	0.54±0.14	0.55±0.14	0.51±0.13	0.25
3-month, $\bar x \pm s$	0.54±0.13	0.54±0.13	0.52±0.15	0.61
Change, M (P₂₅, P₇₅)	0.00 (－0.04, 0.03)	0.00 (－0.05, 0.03)	0.00 (－0.03, 0.04)	0.53
P^#	0.68	0.93	0.31

Items	Total(n=77)	Statin group(n=56)	Non-statin group(n=21)	P^*
Baseline, $\bar x \pm s$	54.20±19.16	55.57±21.03	49.07±7.91	0.06
3-month, $\bar x \pm s$	55.63±18.38	57.88±18.98	47.20±13.35	0.02
Change, M (P₂₅, P₇₅)	0.00 (－8.00, 11.00)	0.50 (－7.00, 13.00)	－3.00 (－9.00, 6.00)	0.23
P^#	0.51	0.33	0.52

Items	Total(n=62)	Statin group(n=47)	Non-statin group(n=15)	P^*
Plaque volume /mm³, M (P₂₅, P₇₅)
Baseline	180.00 (97.50, 312.50)	200.00 (90.00, 320.00)	140.00 (100.00, 280.00)	0.74
2 years	185.00 (117.50, 302.50)	200.00 (120.00, 300.00)	160.00 (110.00, 360.00)	0.86
Change	15.00 (－30.00, 50.00)	0.00 (－30.00, 40.00)	30.00 (10.00, 70.00)	0.09
P^#	0.11	0.56	0.02
Plaque area /mm²
Baseline, $\bar x \pm s$	15.97±12.63	15.41±10.19	17.72±8.69	0.65
2 years, $\bar x \pm s$	13.68±8.82	12.88±8.35	16.19±10.05	0.26
Change, M (P₂₅, P₇₅)	－0.44 (－7.10, 2.58)	－0.81 (－8.47, 2.13)	1.46 (－6.17, 5.71)	0.14
P^#	0.13	0.07	0.89
Stenosis ratio/%
Baseline, $\bar x \pm s$	31.76±19.80	31.49±18.96	32.60±22.92	0.10
2 years, $\bar x \pm s$	31.40±17.25	30.79±17.07	33.33±18.29	0.64
Change, M (P₂₅, P₇₅)	－1.00 (－5.25, 8.00)	－1.00 (－4.00, 8.00)	－1.00 (－9.00, 9.00)	0.93
P^#	0.95	0.88	0.95
NWI
Baseline, $\bar x \pm s$	0.53±0.14	0.53±0.14	0.54±0.16	0.94
2 years, $\bar x \pm s$	0.54±0.12	0.53±0.12	0.54±0.13	0.94
Change, M (P₂₅, P₇₅)	－0.01 (－0.05, 0.06)	－0.01 (－0.04, 0.06)	－0.02 (－0.06, 0.07)	0.96
P^#	0.87	0.87	0.93

三维超声血管斑块定量分析技术评估颈动脉粥样硬化斑块

Evaluation of carotid atherosclerotic plaques by vascular plaque quantification (VPQ) technology of three-dimensional ultrasonography

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