冠状动脉CTA和DSA对冠心病患者的临床诊断价值比较

目的:比较冠状动脉CT血管成像(CT angiography,CTA)以及数字减影血管造影(digital subtraction angiography,DSA)诊断冠心病的临床价值差异。方法:选择2013年12月至2020年3月安徽医科大学第三附属医院、安徽医科大学第四附属医院收治的60例冠心病患者为研究对象,首先对其实施多排螺旋CT冠状动脉血管造影检测(CTA),而后2 w内再对其实施DSA检测,比较两种检测方式对不同血管狭窄程度、不同性质斑块检出率的差异,最后以DSA检测结果为金标准,评估CTA对冠状动脉狭窄诊断的一致性、灵敏度、特异度、阳性预测值和阴性预测值。结果:(1)CTA检测狭窄血管共计387支,轻度狭窄152支(39.28%),中度狭窄118支(30.49%),重度狭窄105支(27.13%),闭塞12支(3.10%);DSA检测狭窄血管392支,轻度狭窄150支(38.27%),中度狭窄124支(31.63%),重度狭窄112支(28.57%),闭塞6支(1.53%),两组各血管狭窄类型比较差异无统计学意义(P0.05);(2)CTA检测斑块69个,其中钙化斑43个(62.32%),非钙化斑26个(37.68%),DSA检测斑块61个,其中钙化斑33个(54.10%),非钙化斑28个(45.50%),两种检测方式差异无统计学意义(P0.05);(3)以DSA检测为金标准,CTA对重度及以上血管狭窄诊断一致性为99.23%,特异度为98.31%,灵敏度为99.64%,阳性预测值为99.15%,阴性预测值为99.27%。结论:与DSA相比,CTA对冠心病患者血管狭窄的诊断价值相当,且属于无创检测,在冠心病早期筛查中临床应用价值更高。     

三维高分辨率磁共振血管壁成像对脑梗死患者血管狭窄的诊断价值分析

目的：探讨三维高分辨率磁共振血管壁成像（HR-MRI VWI）对脑梗死患者血管狭窄的诊断价值。方法：回顾性收集2022年1月至2022年10月于广州市中西医结合医院治疗的196例脑梗死患者的临床资料,所有患者均行HR-MRI VWI和数字减影血管造影（DSA）检查。记录脑梗死患者HR-MRI VWI成像特征,以DSA为金标准,Kappa检验HR-MRI VWI与DSA检出病变血管部位、血管狭窄程度的一致性。受试者工作特征（ROC）曲线分析HR-MRI VWI诊断脑梗死血管狭窄程度的价值。结果：HR-MRI VWI可检测到脑梗死病变血管区域皮层下梗死以及同侧病变血管内斑块,斑块HR-MRI VWI成像特征为斑块增强、阳性壁重塑、斑块T1高强度和斑块表面不规则,平均斑块负荷（75.09±12.13）%。DSA检出病变血管223支,HR-MRI VWI检出病变血管212支。HR-MRI VWI与DSA检出病变血管部位、血管狭窄程度一致性良好（Kappa值=0.802、0.775,P<0.05）。HR-MRI VWI鉴别诊断脑梗死血管狭窄Ⅲ～Ⅳ级的曲线下面积为0.942,灵敏度为94.9...     

血管内介入治疗颈动脉、椎动脉狭窄的临床疗效和安全性

目的:研究血管内介入治疗颈动脉、椎动脉狭窄的临床疗效和安全性。方法:选择2011年3月~2016年3月在我院进行诊治的210例颈动脉和椎动脉狭窄患者狭窄程度在70%~99%之间,颈、椎动脉直径狭窄率超过70%,所有患者均进行了血管内介入治疗,观察患者的临床表现、DSA和血管超声检查结果和围手术期并发症,并进行随访。结果:经颈部血管听诊发现,有163例(77.62%)患者出现血管杂音,合并高血压103例(49.05%)、高脂血症123例(58.57%)、吸烟76例(36.19%)、糖尿病98例(46.67%)、高同型半胱氨酸血症13例(6.19%);DSA检查发现有126例患者为单纯颅外段颈动脉狭窄,51例患者为单纯椎动脉起始部狭窄,22例患者为颅外段颈动脉合并椎动脉狭窄;术后的颈、椎动脉平均狭窄率为(4.15±7.26)%,明显低于术前的(79.25±6.34)%(P0.05);所有患者均未出现严重神经系统并发症和手术期死亡;术后随访8~36个月,均未出现与支架相关的短暂性脑缺血和新发脑梗死。结论:血管内介入治疗颈动脉、椎动脉狭窄安全有效,具有较高的临床应用价值。     

血管超声与64排螺旋CT血管造影在评价颈动脉狭窄中的对比研究

目的:比较血管超声与64排螺旋CT血管造影(CTA)对颈动脉狭窄的诊断价值。方法:选取2014年12月到2015年12月我院收治的疑似颈动脉狭窄患者70例(278节段),所有患者入院1周内均行血管超声、64排螺旋CTA检查,以数字减影血管造影(DSA)为金标准,比较血管超声与64排螺旋CTA对颈动脉狭窄诊断的符合率、特异度和灵敏度。结果:血管超声和64排螺旋CTA对不同程度颈动脉狭窄诊断的符合率比较,差异均无统计学意义(P0.05);血管超声和64排螺旋CTA对颈动脉狭窄诊断的灵敏度和特异度分别为87.28%、85.71%和85.55%、90.48%,比较差异无统计学意义(P0.05)。结论:血管超声和64排螺旋CTA对颈动脉狭窄均具有较高的诊断价值。     

三维DSA在颅内动脉瘤中的应用

目的探讨三维数字减影血管造影(3D DSA)在颅内动脉瘤中的应用价值。方法使用GE Innova 3100平板血管造影机对40例疑似颅内动脉瘤患者行双侧颈内、外动脉和双侧椎动脉正、侧位2D DSA,进一步对感兴趣血管行3D DSA,通过容积再现(VR)进行颅内血管重建。结果 3D DSA检出39例动脉瘤患者,47枚动脉瘤,2D DSA检出31例动脉瘤患者,35枚动脉瘤,二者检出动脉瘤的长、短径无统计学差异(P>0.05),图像质量有统计学差异(P<0.05)。2D DSA出现假阳性动脉瘤3枚,假阴性动脉瘤15枚,评估颅内动脉瘤的灵敏度为78.9%,特异性为85.2%;3D DSA没有出现假阳性、假阴性动脉瘤,评估颅内动脉瘤的灵敏度为100%,特异性为100%。在动脉瘤形态、瘤颈尺寸及与相邻血管间的关系的显示上,3D DSA明显优于2D DSA。结论 3D DSA作为脑动脉造影中2D DSA的进一步补充,对颅内动脉瘤的诊断与治疗具有重要价值。     

螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值

目的:探讨螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值。方法:选取2014年1月至2016年1月期间来我院就诊的60例急性脑梗死患者作为观察组,另选同期来我院就诊的非急性脑梗死患者60例作为对照组。两组患者均进行螺旋CT头颈部血管成像检查,比较两组患者的颈动脉狭窄程度及各段血管斑块分布情况,并根据检查结果评价螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值。结果:观察组轻度狭窄与中度狭窄检出率均显著高于对照组(P0.05),重度狭窄与闭塞检出率与对照组比较无统计学差异(P0.05),观察组总检出狭窄率高于对照组(P0.05)。观察组与对照组在颈动脉分叉处、颈总动脉、颈内动脉及颈外动脉均有斑块检出,观察组斑块总检出率为69.4%,显著高于对照组的41.2%(P0.05)。结论:临床上应用128层螺旋CT头颈部血管成像技术对急性脑梗死患者颈动脉狭窄情况可进行有效评估,该方法对患者轻、中度狭窄以及双侧颈动脉斑块检出率更高,在临床诊断及预后防治中具有应用推广价值。     

常规心电图与冠脉造影术在冠心病诊断中的效果分析

目的:探讨常规心电图(ECG)与冠脉造影术(CAG)在冠心病诊断中的效果。方法:选取100例冠心病患者,入院后先行CAG,后经ECG检查,通过CAG检查的冠脉狭窄程度、冠脉病变支数与ECG检查结果的对比两种检查方法对冠心病诊断结果,评价ECG与CAG在冠心病诊断中的临床价值。结果:CAG诊断冠心病的阳性诊断率82.0%,ECG诊断冠心病阳性诊断率为79.0%,两组阳性诊断率相比,无统计学差异(P0.05)。ECG对三组冠心病患者的灵敏度分别为65.0%,92.6%,96.9%,冠脉狭窄程度50%-70%时,灵敏度低于其他两组(P0.05)。经CAG诊断为冠脉单支病变、双支病变、三支病变患者,采用ECG诊断时,组间灵敏度相比,差异有统计学意义(P0.05)。结论:ECG多支病变冠心病患者容易出现漏诊、误诊情况,CAG与ECG诊断灵敏度相当,可直观反映冠脉病变情况。     

心电图ST段不同改变与急性心肌梗死患者冠脉造影病变特点及生活质量的相关性研究

目的:探讨心电图ST段不同改变与急性心肌梗死患者冠脉造影病变特点及生活质量的相关性。方法:选取选取2015年6月到2017年6月在本院接受治疗的急性心肌梗死患者208例,根据心电图ST段的改变情况将患者分为ST段抬高组(124例)、ST段压低组(64例)、ST段无偏移组(20例),所有患者进行冠脉造影检查和常规治疗,比较治疗前三组患者的冠脉造影情况和冠脉狭窄程度,比较治疗1个月后三组患者的生活质量评分。结果:在ST段抬高组中,共检测出单支血管闭塞病变99例,占79.84%,两支或两支以上血管病变25例,占20.16%,其中侧支循环开放19例,开放率为15.32%。在ST段压低组中,共检测出单支血管非闭塞病变6例,占9.38%,两支或两支以上血管非闭塞病变56例,占87.50%,单支血管闭塞病变2例,占3.13%,其中侧支循环开放34例,开放率为53.13%。在ST段无偏移组中,单支血管闭塞病变15例,占75.00%,单支或多支血管非闭塞病变5例,占25.00%,其中侧支循环开放7例,开放率为35.00%。ST段抬高组、ST段无偏移组患者的冠脉狭窄程度以重度狭窄为主,ST段压低组患者的冠脉狭窄程度以中度狭窄为主,三组患者的轻度狭窄、中度狭窄、重度狭窄整体比较存在统计学差异(P0.05)。三组患者的疼痛评分、躯体受限评分、精神及活动评分整体比较具有统计学差异(P0.05),ST段压低组的上述评分均显著高于ST段抬高组和ST段无偏移组(P0.05)。结论:心电图ST段不同改变与急性心肌梗死患者冠脉造影病变密切相关,且ST段压低患者的预后通常较好。     

B超检测颈动脉粥样硬化与脑梗死相关性的研究

目的:探讨颈动脉粥样硬化变化与脑梗死的关系.方法:选择我院2007年4月～2009年脑梗死患者103例作为观察组,同时选择本院同期住院非脑梗死患者51例作为对照组,彩色多普勒超声仪检测显示颈部动脉:经总动脉远端:颈内动脉起始部和颈动脉分叉处,观察血管解剖形态内膜情况有无斑块形成以及斑块的形态大小性质及管腔是否狭窄狭窄程度.结果:①两组患者内膜增厚发生率比较,差异无统计学意义,P＞0.05;两组患者斑块形成发生率相比,差异有统计学意义,P＜0.05;②斑块发生在颈总动脉膨大部,占43.8%;发生在颈总动脉主干,占30.1%;发生在颈内动脉起始部13.6%;发生在颈内动脉主干,占6.8%;发生在椎动脉,占5.4%;③观察组和对照组在轻度狭窄发生率、中度狭窄发生率、重度狭窄发生率比较,差异有统计学意义,P＜0.05.结论:颈动脉粥样硬化在一定程度上能够反映脑动脉粥样硬化的情况,与脑梗死的关系密切,是预测脑梗死风险的重要指标,早期发现颈动脉粥样硬化对预防脑梗死的发生有着重要意义.     

ST段抬高性和非ST 段抬高性急性心肌梗死患者的冠状动脉病变特点比较

目的:比较ST段抬高性和非ST段抬高性急性心肌梗死患者的冠状动脉病变特点。方法:选取100例在我院接受24h动态心电图和冠状动脉造影检查的急性心肌梗死患者,根据心电图结果分为观察组和对照组各50例。对照组为ST段抬高性心肌梗死(STEMI)患者,观察组为非ST段抬高性心肌梗死(NSTEMI)患者,比较两组患者冠状动脉病变的差异。结果:对照组LAD(左前降支)闭塞血管比例(52.00%)显著高于观察组(18.00%),差异具有统计学意义(P0.05)。对照组LCX(回旋支)闭塞血管比例(8.00%)显著低于观察组(50.00%),差异具有统计学意义(P0.05)。对照组RCA(右冠脉主干)闭塞血管比例(40.00%)和观察组(30.00%)比较,差异无统计学意义(P0.05)。对照组单支病变比例(46.00%)明显高于观察组(12.00%),对照组三支病变比例(20.00%)明显低于观察组(48.00%)比较,差异均具有统计学意义(P0.05)。对照组二支及正常血管比例与观察组比较,差异均无统计学意义(P0.05)。对照组罪犯血管狭窄程度在76%-90%、91%-99%及完全闭塞的比例与观察组比较差异均具有统计学意义(P0.05)。罪犯血管狭窄程度在50%及50%-75%时,两组差异无统计学意义(P0.05)。两组并发症发生情况比较,差异无统计学意义(P0.05)。结论:1NSTEMI罪犯血管闭塞以LCX多见,STEMI罪犯血管闭塞以LAD多见;2NSTEMI以三支血管病变较多见,STEMI以单支病变较多见。     

Comparison between carotid stenting and carotid endarterectomy in early outcome

Carotid artery stenting (CAS) is a widely used method in prevention of stroke for carotid artery stenosis as an alternative to surgical treatment. Initial studies reveal higher morbidity and mortality rates for CAS than acceptable standards for carotid endarterectomy (CEA). The aim of this study was to compare results in a series of CAS with concurrent risk-matched group of CEA patients. The study included two groups of 50 patients with internal carotid artery stenosis. We compared early outcome (30 days after procedure) in risk-matched groups of patients that underwent these procedures. Post procedural complications were equally frequent in both groups. There was no significant difference in perioperative complication rates (P = 0.871). Comparison of these two methods shows that CAS and CEA are competitive methods for treatment of carotid artery stenosis. Particularly in symptomatic patients with high risk for surgery CAS is alternative treatment.     

Nitric oxide synthase in the rat carotid body and carotid sinus

The participation of nitric oxide synthase (NOS) in the innervation of the rat carotid body and carotid sinus was investigated by means of NADPH-diaphorase histochemistry and NOS immunohistochemistry using antisera raised against purified neuronal NOS and a synthetic tridecapeptide. NOS was detected in 23% of neurons at the periphery of the carotid bodies. Some negative neurons were surrounded by NOS-positive terminals. NOS-containing varicose nerve fibres innervated the arterial vascular bed and, to a lesser extent, the islands of glomus cells. These fibres persisted after transection of the carotid sinus nerve and are probably derived from intrinsic neurons. Large NOS-positive axonal swellings in the wall of the carotid sinus were absent after transection of the sinus nerve, indicating their sensory origin. The results suggest a neuronal nitrergic control of blood flow, neuronal activity and chemoreception in the carotid body, and an intrinsic role of NO in the process of arterial baroreception.     

Carbonic anhydrase in the carotid body and the carotid sinus nerve

Summary It is well known that carbonic anhydrase plays an important role in the physiological responses of carotidbody chemoreceptors to hypercapnia. Nevertheless the precise location of the enzyme within the carotid body has been a matter of controversy for many years. Using the Hansson method we found histochemical evidence that this enzyme is localized in type I cells. Type II cells and nerve terminals did not show enzymatic activity. These results allow us to define the carotid body as a secondary receptor in the context of the acidic hypothesis of transduction in the carotid body.     

Carbonic anhydrase in the carotid body and the carotid sinus nerve

It is well known that carbonic anhydrase plays an important role in the physiological responses of carotid-body chemoreceptors to hypercapnia. Nevertheless the precise location of the enzyme within the carotid body has been a matter of controversy for many years. Using the Hansson method we found histochemical evidence that this enzyme is localized in type I cells. Type II cells and nerve terminals did not show enzymatic activity. These results allow us to define the carotid body as a secondary receptor in the context of the "acidic hypothesis" of transduction in the carotid body.     

Effect of common carotid artery inlet length on normal carotid bifurcation hemodynamics

Controversy exists regarding the suitability of fully developed versus measured inlet velocity profiles for image-based computational fluid dynamics (CFD) studies of carotid bifurcation hemodynamics. Here, we attempt to resolve this by investigating the impact of the reconstructed common carotid artery (CCA) inlet length on computed metrics of "disturbed" flow. Twelve normal carotid bifurcation geometries were reconstructed from contrast-enhanced angiograms acquired as part of the Vascular Aging--The Link That Bridges Age to Atherosclerosis study (VALIDATE). The right carotid artery lumen geometry was reconstructed from its brachiocephalic origin to well above the bifurcation, and the CCA was truncated objectively at locations one, three, five, and seven diameters proximal to where it flares into the bifurcation. Relative to the simulations carried out using the full CCA, models truncated at one CCA diameter strongly overestimated the amount of disturbed flow. Substantial improvement was offered by using three CCA diameters, with only minor further improvement using five CCA diameters. With seven CCA diameters, the amounts of disturbed flow agreed unambiguously with those predicted by the corresponding full-length models. Based on these findings, we recommend that image-based CFD models of the carotid bifurcation should incorporate at least three diameters of CCA length if fully developed velocity profiles are to be imposed at the inlet. The need for imposing measured inlet velocity profiles would seem to be relevant only for those cases where the CCA is severely truncated.     

Sympathetic innervation of the carotid bifurcation in the rabbit and cat: Blood vessels,carotid body and carotid sinus

Summary Two postganglionic branches of the superior cervical ganglion enter the area of the carotid bifurcation in the rabbit and the cat. The common and external carotid arteries receive a rich adrenergic nerve supply, which can be demonstrated by fluorophores of biogenic amines appearing after formaldehyde treatment. The internal carotid artery is only sparsely innervated; however, it shows a dense sympathetic supply at the site of pressor receptors. Following removal of the superior cervical ganglion, a total loss of fluorescent adrenergic nerves occurs and degeneration of nerve endings possessing dense core vesicles is conspicuous. These nerve terminals are situated mainly subendothelially in the carotid body sinusoids; they only rarely terminate on type I cells.