目的 运用对比超声增强技术(contrast-enhanced ultrasound,CEUS)评估颈动脉低回声斑块新生血管强化分级与急性前循环责任病灶侧脑梗死的关系.方法 对60例急性前循环脑梗死患者双侧颈动脉低回声斑块行CEUS,根据斑块造影增强程度分为Ⅰ ～Ⅳ级,并检测所有斑块的厚度.结果 与非责任病灶侧相比,前循环责任病灶侧脑梗死检出低回声斑块53例(88.3％),经CEUS检测,责任病灶侧低回声斑块Ⅲ级增强患者比率明显高于Ⅰ级和Ⅱ级(χ2分别为5.588,3.565,P<0.05),但与Ⅳ级比较差异无统计学意义(χ2=0.005,P=0.944),责任病灶侧Ⅲ级与Ⅳ级发生率明显高于非责任病灶侧(χ2=8.394,P=0.004).颈动脉低回声斑块厚度与斑块内新生血管强化程度之间存在正相关关系(r=0.599,P<0.001).结论 前循环脑梗死的发生与病灶侧颈动脉低回声斑块新生血管强化程度有关,Ⅲ、Ⅳ级增强者斑块更易损,并随着斑块厚度的增加,斑块强化程度增加.颈动脉低回声斑块新生血管强化程度对急性前循环脑梗死发生预测有一定意义.

In recent years,research on carotid atherosclerosis has turned to the aspect of neovascularization in vulnerable plaques.The evaluation of neovascularization in plaques using contrast-enhanced ultrasonography has become one of the novel technologies to determine the plaque stability.This article reviews the principles of contrast-enhanced ultrasonography and its application in the evaluation of neovascularization in carotid atherosclerotic plaques and vulnerable plaques.

Objective To examine the relationship between carotid atherosclerosis in acute ischemic stroke and risk stratification of the recurrent ischemic stroke.Methods The risk factors were evaluated by ESRS in 82 patients with the acute ischemic stroke and divided into ESRS≥3 group(n=40)and ESRS 0-2 group(n=42).Carotid artery were assessed by color Doppler ultrasound in both groups,the difference of the characteristics of carotid atherosclerosis between the both groups were compared.Results Compared with ESRS 0-2 group,the proportions of older patients,arterial hypertension,diabetes mellitus and previous TIA or ischemic stroke in addition to qualifying event in the ESRS≥3 group were significantly higher(P0.05).The carotid intima-media thickness(IMT),the ratios of the carotid lipid and calcified plaques,moderate and severe carotid atherosclerosis in the ESRS≥3 group were significantly higher than that of ESRS 0-2 group(P0.05).The logistic regression analysis showed common carotid artery IMT thicker than 1.0 mm,lipid plaques and calcific plaques,the severity of carotid atherosclerosis were positively related to high risk recurrent ischemic stroke.Conclusion Common carotid artery IMT and the severity carotid atherosclerosis may be a risk predictor in high risk patients recurrent ischemic stroke.

颈动脉粥样硬化斑块是缺血性卒中(ischemic stroke,IS)的重要病因.尸体解剖研究证实,在颈动脉粥样硬化的基础上,易损斑块不可预测地突然破损、血小板激活、血栓形成是IS重要的发病机制[1].因此,关于颈动脉斑块稳定性相关因素及其作用机制的研究对降低卒中发生率具有重要意义.我们将近年来对颈动脉易损斑块与IS关系的研究综述如下.

临床资料患者男,27岁,系头痛2个月伴双下肢无力1个月余于2011年12月19日入院.患者于2010年11月突发右下肢肿痛在浙江某医院行B超检查,显示下肢静脉血栓形成,病因不明.2011年3月患者出现左下肢肿痛,在某市立医院行下肢静脉造影,结果显示左下肢深静脉血栓形成,予以华法林口服.2011年11月患者自觉头痛不适,双侧颞部呈持续性胀痛伴有视物模糊,12月患者晨起突发恶心呕吐,呕吐物为胃内容物,伴有四肢无力、活动受限,同时出现生殖器溃疡,自行停用华法林.追问病史,患者已有反复口腔溃疡2～3年,每年发作3～5次,背部反复出现皮疹数月.体检:意识清楚,生命体征平稳,双眼球外展稍受限,余活动正常,颈抵抗,克布征(+),双手握力差,双上肢末梢型感觉障碍,下肢肌力V-,四肢腱反射迟钝～消失,背部可见毛囊炎样丘疹,腹部针刺反应阳性,阴囊可见溃疡瘢痕.