目的 分析颈动脉粥样斑块易损性与缺血性卒中的相关性,探讨准确评估易损斑块的临床意义.方法 选取2014年10月至2016年2月在苏州大学附属第一医院行颈动脉内膜剥脱术(CEA)患者64例,术前、术后均行基于颈部血管超声(CDU)的多模式影像学检查,根据术前6个月内是否首发缺血性卒中,分为缺血组(44例)与非缺血组(20例);根据术前CDU检查、术后斑块大体形态及HE染色特征评估斑块的性质,采用x2检验对患者进行卒中高危因素分析及斑块性质与缺血性卒中的统计学分析,采用Kappa检验对术前CDU结果与术后相应层面病理学结果行一致性分析.结果 缺血组与非缺血组的斑块性质:缺血组44例,其中,CDU评估易损斑块81.8％ (36/44),稳定斑块18.2％ (8/44);病理学评估易损斑块86.4％ (38/44),稳定斑块13.6％ (6/44);非缺血组20例,其中CDU评估易损斑块35％ (7/20),稳定斑块65％ (13/20);病理学评估易损斑块40％ (8/20),稳定斑块60％ (12/20).斑块易损性与缺血性卒中比较:CDU与病理学评估缺血组易损斑块均明显高于非缺血组,差异均有统计学意义(x2=13.67、14.62,P均＜0.001).CDU与病理学评估斑块易损性的一致性:两者有较好的一致性(Kappa=0.669,P＜ 0.01).结论 颈动脉易损斑块与缺血性卒中密切相关,CDU能准确评估斑块易损性,对于及早发现并精准治疗易损斑块、防止缺血性脑卒中有重要的临床意义.%Objective To analysis the correlation between the vulnerability of carotid plaque and ischemic stroke and to explore the clinical significance of assessing vulnerable plaques accurately.Methods A total of 64 patients,who underwent carotid endarterectomy (CEA) in First Affiliated Hospital of Soochow University from October 2014 to February 2016,were classified into ischemic and non-ischemic stroke group according to whether ischemic stroke symptoms occurred during the last 6 months before surgery.To judge the stable and vulnerable plaques,the patients underwent carotid doppler ultrasonography (CDU) before surgery,and the carotid plaques were evaluated with HE staining after CEA.We also analyzed the risk factors of plaque formation and the relevance between the plaque characteristic and ischemic stroke with chi-square test.Kappa test were used to analyze the consistency of CDU and pathology.Results Of the 44 cases in ischemic stroke group,CDU identified 81.8％ (36/44) vulnerable plaques and 18.2％ (8/44) stable plaques,while pathology confirmed 86.4％ (38/44) vulnerable plaques and 13.6％ (6/44) stable plaques.Of the 20 cases in non-ischemic stroke group,CDU identified 35％ (7/20) vulnerable plaques and 65％ (13/20) stable plaques,while pathology confirmed 40％ (8/20) vulnerable plaques and 60％ (12/20) stable plaques.In both CDU and pathology,vulnerable plaques in ischemic stroke group were obviously higher than that in non-ischemia group (x2=13.67,P ＜ 0.001;x2=14.62,P ＜ 0.001).The results of CDU agreed well to that of pathology results (Kappa=0.669,P ＜ 0.01).Conclusions The vulnerability of plaques were closely related to the ischemic stroke.CDU is a reliable examination method to identify vulnerable plaques.The accurate assessment of vulnerability of plaques has a great significance in preventing ischemic stroke.
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