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目的:采用CTA探讨脉颈动脉分叉部、颈内动脉虹吸段斑块成分和体积的差异、及其对脑血管事件的预测价值。方法:纳入行颈动脉CTA检查患者100人,其中男性65人,女性35人,平均年龄(55±9)岁。根据CT值的不同区分颈动脉分叉处及虹吸段斑块成分(脂质斑块<60 HU;混合斑块60~130 HU;钙化斑块>130 HU),并测量各成分斑块体积。分别使用独立样本T检验、x~2检验分析颈内动脉虹吸段与颈总动脉分叉部各组分斑块体积及构成比差异,并计算受试者工作特征曲线(ROC曲线)及其曲线下的面积,分析斑块总体积、各成分斑块体积对预测出现脑血管症状的准确性。结果:颈动脉分叉段与虹吸段斑块总体积分别为(752.3±3.4)mm~3,(56.2±5.541)mm~3,差异存在统计学意义(P<0.05)。颈内动脉虹吸段脂质斑块数量构成比为16.8%,钙化斑块数量构成比为49.1%,混合斑块数量构成比为34.1%;颈总动脉脂质斑块、钙化斑块、混合斑块数量构成比分别为33.3%,32.0%,34.6%,两处斑块数量构成比差异存在统计学意义(x~2=26.077,P<0.05)。ROC曲线分析显示颈动脉分叉斑块总体积、脂质斑块体积及混合斑块体积对脑血管症状的发生有较好的预测价值(P<0.001),曲线下面积分别为0.682、0.773及0.653,且颈动脉分叉脂质斑块体积为203.383 mm3时为最佳截割点,敏感度、特异度分别为69.0%、82.2%。结论:颈动脉分叉部和颈内动脉虹吸部不同类型斑块体积和构成比间有显著差异,颈动脉分叉部脂质斑块体积对脑血管事件有较好的预测价值。
OBJECTIVE: To investigate the differences in the composition and volume of plaque in the bifurcation of the carotid artery and the siphon of the internal carotid artery using CTA and its predictive value for cerebrovascular events. Methods: A total of 100 patients underwent carotid artery CTA examination, including 65 males and 35 females, with an average age of (55 ± 9) years. According to the CT value, the carotid bifurcation and siphon segment plaque components (lipid plaque <60 HU; mixed plaque 60 ~ 130 HU; calcified plaque> 130 HU) were distinguished and the plaque volume of each component was measured. The independent sample T-test was used. The difference of the volume and composition ratio of each component between the siphon segment of the internal carotid artery and the common carotid artery was analyzed by x ~ 2 test, and the receiver operating characteristic curve (ROC curve) and its curve Under the area, analysis of the total volume of the plaque, the size of each component of the plaque to predict the accuracy of cerebrovascular symptoms. Results: The total volume of carotid bifurcation and siphon segments were (752.3 ± 3.4) mm ~ 3 and (56.2 ± 5.541) mm ~ 3, respectively, with statistical significance (P <0.05). The compositional ratio of lipid plaque in siphon segment of internal carotid artery was 16.8%, the number of calcified plaque was 49.1% and the number of mixed plaque was 34.1%. The common carotid artery plaque, calcified plaque, mixed plaque The proportions of the two patches were 33.3%, 32.0% and 34.6%, respectively. There was a statistically significant difference in the proportions of the two patches (x ~ 2 = 26.077, P <0.05). ROC curve analysis showed that carotid artery bifurcated plaque volume, lipid plaque volume and mixed plaque volume had a better predictive value for cerebrovascular symptoms (P <0.001). The areas under the curve were 0.682, 0.773 and 0.653, and the carotid artery bifurcation lipid plaque volume of 203.383 mm3, the best cut-off point, the sensitivity and specificity were 69.0%, 82.2%. Conclusion: There are significant differences in the volume and composition ratio of carotid bifurcation and carotid artery sphincter between different types of plaque. The volume of carotid bifurcation lipid plaque has a good predictive value for cerebrovascular events.