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多发性大动脉炎颈动脉受累的超声表现及活动性评估

王亚红 李建初 刘赫 王蕾 齐振红 孔晶 蔡胜 戴晴

王亚红, 李建初, 刘赫, 王蕾, 齐振红, 孔晶, 蔡胜, 戴晴. 多发性大动脉炎颈动脉受累的超声表现及活动性评估[J]. 协和医学杂志, 2014, 5(1): 81-87. doi: 10.3969/j.issn.1674-9081.2014.01.018
引用本文: 王亚红, 李建初, 刘赫, 王蕾, 齐振红, 孔晶, 蔡胜, 戴晴. 多发性大动脉炎颈动脉受累的超声表现及活动性评估[J]. 协和医学杂志, 2014, 5(1): 81-87. doi: 10.3969/j.issn.1674-9081.2014.01.018
Ya-hong WANG, Jian-chu LI, He LIU, Lei WANG, Zhen-hong QI, Jing KONG, Sheng CAI, Qing DAI. Ultrasound Features in the Diagnosis of Takayasu's Arteritis with Carotid Artery Involvement and Evaluation of Disease Activity[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(1): 81-87. doi: 10.3969/j.issn.1674-9081.2014.01.018
Citation: Ya-hong WANG, Jian-chu LI, He LIU, Lei WANG, Zhen-hong QI, Jing KONG, Sheng CAI, Qing DAI. Ultrasound Features in the Diagnosis of Takayasu's Arteritis with Carotid Artery Involvement and Evaluation of Disease Activity[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(1): 81-87. doi: 10.3969/j.issn.1674-9081.2014.01.018

多发性大动脉炎颈动脉受累的超声表现及活动性评估

doi: 10.3969/j.issn.1674-9081.2014.01.018
详细信息
    通讯作者:

    李建初 电话:010-69155785, E-mail:jianchu.li@163.com

  • 中图分类号: R445.1

Ultrasound Features in the Diagnosis of Takayasu's Arteritis with Carotid Artery Involvement and Evaluation of Disease Activity

More Information
  • 摘要:   目的  总结多发性大动脉炎(Takayasu's arteritis, TA)颈动脉受累的声像图特点并评价超声在TA诊断及活动性评估中的作用。  方法  对58例TA患者的颈动脉进行常规超声检查, 测量受累颈总动脉管壁厚度。将TA患者分为活动期和非活动期两组, 以58名正常人作为对照, 比较各组间颈动脉管壁厚度的差异, 并使用受试者工作特征曲线分析管壁厚度对TA活动性的评估效果。  结果  58例TA患者共106条颈动脉受累, 其中76条(71.7%)管壁超声表现为弥漫性、均匀性增厚, 增厚管壁呈中等或中低回声。35条(33.0%)管壁呈通心粉征, 67条(63.2%)呈靶环征。TA活动期组管壁厚度大于非活动期组, 且均大于对照组(P均 < 0.05)。以管壁厚度来判断TA活动状态, 最佳诊断阈值为2.25 mm, 敏感性为71.4%, 特异性66.0%。按照有无管腔狭窄进一步分组, 分别确立诊断阈值后, 非狭窄组中特异性提高为81.5%, 狭窄组中敏感性提高为90.0%。  结论  靶环征是TA受累颈动脉除通心粉征外的另一超声新征象, 有助于TA的超声诊断。管壁厚度对于评估TA活动性有一定帮助。
  • 图  1  多发性大动脉炎受累颈动脉超声表现为“通心粉征”

    A.纵切面管壁呈弥漫性、均匀性增厚;B.横切面呈环状增厚;管壁呈均匀中等回声,与甲状腺实质回声相似或略低IJV:颈内静脉;CCA:颈总动脉;THY:甲状腺

    图  2  多发性大动脉炎受累颈动脉超声表现为“靶环征”

    A.纵切面管壁呈弥漫性、分层状增厚;B.横切面呈靶环状增厚IJV、CCA、THY:同图 1

    图  3  多发性大动脉炎受累颈总动脉声像图

    A.横切面示管壁外侧低回声带为侧方声影区;B.纵切面示管壁外侧无相应低回声带与之对应,说明该低回声带由伪像造成

    图  4  多发性大动脉炎受累颈总动脉声像图

    管壁外层高回声带无明显增厚,甚至变薄(箭头),提示该高回声带并非病理中所见的增厚外膜,而是外膜周围结缔组织

    图  5  多发性大动脉炎受累颈总动脉声像图

    白色箭头示病变边缘处尚未受到累及的内中膜复合物,其回声无明显改变,与外侧增厚的中低回声带分界清晰,两者间可见高回声反射界面;黑色箭头示正常段内中膜复合物

    图  6  管壁厚度判断多发性大动脉炎活动状态的受试者工作特征曲线

    表  1  多发性大动脉炎受累颈总动脉管壁厚度的比较(x±s)

    组别 受累颈动脉
    (n=102)
      有狭窄
    (n=46)
      无狭窄
    (n=56)
    n 管壁厚度
    (mm)
      n 管壁厚度
    (mm)
      n 管壁厚度
    (mm)
    活动期组 49 2.78±1.13   20 3.07±0.74   29 2.58±1.32
    非活动期组 53 2.14±0.79   26 2.48±0.82   27 1.82±0.63
    t   3.241     2.543     2.754
    P   0.002     0.015     0.007
    管腔狭窄指内径减少≥50%;n为动脉条数
    下载: 导出CSV
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出版历程
  • 收稿日期:  2013-10-31
  • 刊出日期:  2014-01-30

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