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目的探讨超声对颈动脉粥样硬化(CAS)斑块性质判定的准确性及临床应用价值。方法 61例CAS斑块患者均行颈动脉超声检查及颈动脉内膜剥脱术(CEA),标本送病理分析。超声评估血管管腔直径狭窄率,斑块性质(低回声斑块、混合回声斑块、强回声斑块),并与相应的颈动脉内膜病理改变进行对照分析。结果 61例患者中,混合回声斑块34例,低回声斑块25例,强回声斑块2例。93.4%(57/61)的斑块病理改变为脂质坏死池形成。混合回声斑块和低回声斑块的病理改变中的慢性炎细胞浸润的比例分别为42.6%(26/61)、37.7%(23/61),混合回声斑块的慢性炎细胞浸润较低回声斑块比例高。不连续性纤维帽的斑块比例(52.5%,32/61)较连续性纤维帽的斑块比例高(37.7%,23/61)。钙化是强回声斑块的主要病理改变。结论超声可直观评价CAS斑块性质。超声评价CAS斑块性质为临床诊断提供了客观依据,具有重要的应用价值。
Objective To investigate the accuracy and clinical value of ultrasound in assessing the plaque quality of carotid atherosclerosis (CAS). Methods Sixty-one patients with CAS plaque underwent carotid ultrasonography and carotid endarterectomy (CEA), and the specimens were sent for pathological analysis. Ultrasonography was used to assess the stenosis rate and plaque quality (hypoechoic plaque, mixed echogenic plaque and hyperechoic plaque) of the vessels, and compared with corresponding carotid artery endometrial pathological changes. Results Among the 61 patients, there were 34 cases of mixed echogenic plaque, 25 cases of hypoechoic plaque and 2 cases of hyperechoic plaque. 93.4% (57/61) of the plaque pathological changes of lipid necrosis pool formation. The rates of chronic inflammatory infiltration in the pathological changes of mixed echogenic and hypoechoic plaques were 42.6% (26/61) and 37.7% (23/61), respectively. The mixed echogenic plaques had lower chronic infiltration of inflammatory cells High plaque ratio. The proportion of plaque in discontinuous fibrous cap (52.5%, 32/61) was higher than that in continuous fibrous cap (37.7%, 23/61). Calcification is a major pathological change in hyperechoic plaques. Conclusion Ultrasound can directly evaluate the nature of CAS plaque. Ultrasound evaluation of CAS plaque properties provide an objective basis for clinical diagnosis, has important application value.