经颅多普勒超声微栓子监测评估PAS治疗颈动脉颈段易损斑块疗效的观察

Value of transcranial Doppler microembolus monitoring in evaluating the efficacy of PAS therapy in treatment of vulnerable carotid plaques

摘要:

目的 探讨经颅多普勒超声（TCD）微栓子监测评估PAS（抗氧化、抗血小板、调脂治疗）治疗颈动脉颈段易损斑块的疗效。方法 收集中国人民解放军联勤保障部队第九一〇医院2019年7月至2021年7月收治的采用PAS疗法进行治疗的颈动脉颈段易损斑块患者作为研究组（46例）。选取2015年6月至2019年6月该院收治的仅采用AS疗法（抗血小板、调脂治疗）治疗的颈动脉颈段易损斑块患者作为对照组（38例）。对2组患者治疗前后进行TCD微栓子监测，并评估斑块稳定性。结果 治疗后研究组共检测出微栓子信号（MES）阳性患者1例，对照组共检测出MES阳性患者6例（P<0.05）。治疗后颈动脉内膜中层厚度（IMT）研究组低于对照组（P<0.05）。研究组治疗后IMT明显低于治疗前（P<0.05），对照组治疗前后IMT无明显变化（P>0.05）。随访1年，研究组缺血事件发生率显著低于对照组（P<0.05），且发生急性脑梗死患者的卒中严重程度轻于对照组（P<0.05）。研究组出现3例消化系统不良反应，不影响治疗及预后。结论 PAS治疗颈动脉颈段易损斑块，有助于提高斑块稳定性，可以降低卒中发生风险，减轻卒中严重程度。

Abstract:

Objective To investigate the value of transcranial Doppler （TCD） microembolus monitoring in evaluating the efficacy of PAS （anti-oxidation， anti-platelet， and lipid-regulating） therapy in the treatment of vulnerable carotid plaques.Methods A total of 46 patients with vulnerable carotid plaques who received PAS therapy in The 910th Hospital of Chinese People's Liberation Army from July 2019 to July 2021 were enrolled as the research group， and 38 patients with vulnerable carotid plaques who were treated with AS （anti-platelet and lipid-regulating） therapy alone from June 2015 to June 2019 were enrolled as the control group. TCD microembolus monitoring was performed for both groups before and after treatment， and plaque stability was assessed.Results After treatment， 1 patient in the research group and 6 in the control group were found to have positive microembolic signals （P<0.05）. After treatment， the research group had a significantly lower carotid intima-media thickness （IMT） than the control group （P<0.05）. The research group had a significant reduction in IMT after treatment （P<0.05）， while the control group showed no significant change after treatment （P>0.05）. Both groups were followed up for 1 year， and compared with the control group， the research group had a significantly lower incidence rate of ischemic events and a significantly lower severity of stroke in patients with acute cerebral infarction （P<0.05）. There were three patients with adverse gastrointestinal reactions， which did not affect treatment and prognosis.Conclusions PAS treatment of vulnerable carotid plaques can help to improve plaque stability， reduce the risk of stroke， and alleviate the severity of stroke.