广西医学

目的探讨动脉粥样硬化性脑梗死患者的颈动脉斑块二维超声指标、超微血管成像（SMI）特征及其临床意义。方法选取150例动脉粥样硬化性脑梗死且颈动脉斑块阳性患者作为脑梗组，另选取150例颈动脉斑块阳性但无脑梗死病灶体检者作为对照组。比较两组患者的血脂血糖指标(血清总胆固醇、三酰甘油、HDL-C、LDL-C、空腹血糖、HbA1c)、颈动脉斑块的二维超声指标［斑块平均个数、斑块平均厚度、斑块平均长度、斑块灰阶中位值（GSM）、颈动脉收缩期峰值血流速度（PSV）、颈动脉舒张末期血流速度（EDV）］及SMI评分，采用受试者工作特征曲线评价颈动脉二维超声指标及SMI评分预测颈动脉粥样硬化患者发生脑梗死的价值。结果脑梗组的血清总胆固醇、三酰甘油水平及颈动脉斑块GSM、颈动脉斑块SMI评分高于对照组，颈动脉PSV、颈动脉EDV低于对照组（P＜0.05）。颈动脉斑块GSM、颈动脉PSV、颈动脉EDV及颈动脉斑块SMI评分预测颈动脉粥样硬化患者发生脑梗死的曲线下面积分别为0.798、0.672、0.729、0.763（P＜0.05）。结论动脉粥样硬化性脑梗死患者的颈动脉斑块GSM增高，颈动脉PSV和EDV减慢，斑块内新生血管形成较为丰富，二维超声和SMI均能较好地预测动脉粥样硬化性患者发生脑梗死的风险。

ObjectiveTo investigate the features of two-dimensional ultrasonic indices and superb microvascular imaging (SMI) of carotid plaques in patients with atherosclerotic cerebral infarction and their clinical significance. MethodsA total of 150 patients with atherosclerotic cerebral infarction and carotid plaques positive were selected as cerebral infarction group, and another 150 check-up individuals with carotid plaques positive but without cerebral infarction lesions as control group. The blood lipid and blood glucose indices (serum total cholesterol, triglyceride, HDL-C, LDL-C, fasting blood glucose, and HbA1c), two-dimensional ultrasonic indices of carotid plaques (mean number of plaques, mean thickness of plaques, mean length of plaques, gray-scale median ［GSM］ of plaques, peak systolic velocity ［PSV］ of carotid artery, end-diastolic velocity ［EDV］ of carotid artery), and SMI score were compared between patients of the two groups. The value of two-dimensional ultrasonic indices and SMI score of carotid plaques for patients with carotid atherosclerosis suffering from cerebral infarction was evaluated by using the receiver operating characteristic curve. ResultsThe cerebral infarction group exhibited higher levels of serum total cholesterol and triglyceride, and higher carotid plaques GSM and SMI score as compared with the control group, whereas lower carotid artery PSV and EDV as compared with the control group (P＜0.05). Areas under the curve of carotid plaques GSM, carotid artery PSV and EDV, and carotid plaques SMI score for predicting patients with carotid atherosclerosis suffering from cerebral infarction were 0.798, 0.672, 0.729, and 0.763, respectively (P＜0.05). ConclusionIn patients with atherosclerotic cerebral infarction, carotid plaques GSM is increased, carotid artery PSV and EDV are slowed down, and neovascularization in plaques is relatively abundant. Two-dimensional ultrasonography and SMI can preferably predict the occurrence risk of cerebral infarction in patients with carotid atherosclerosis.