| Research purpose:① Through the semi quantitative analysis of contrast-enhanced ultrasound combined with quantitative analysis,the characteristics of carotid atherosclerosis under ultrasound and the distribution of TCM syndrome elements were explored,and their similarities and differences were summarized.② To explore the correlation between carotid atherosclerosis "hyperactivity of collaterals" and clinical laboratory tests,plaque properties and other indicators.Research methods:From 2021 to 2022,31 patients with carotid atherosclerotic hypoechoic plaques who were admitted to the Department of Encephalopathy,Beijing University of Traditional Chinese Medicine were collected.Collect patients’ general data,TCM four diagnostic information,clinical symptoms and signs,and calculate syndrome element scores according to the symptom measurement values in Syndrome Element Differentiation,to analyze the distribution of TCM syndrome elements in carotid atherosclerosis patients.Then,comprehensive ultrasonic evaluation(including conventional ultrasonic evaluation and contrast-enhanced ultrasound evaluation)was carried out for the enrolled patients,and semi quantitative grading and quantitative analysis of the neovascularization in the plaque were carried out according to the ultrasonic results,further laboratory examination was completed,and finally the above data were statistically analyzed to explore the correlation between the TCM syndromes of carotid atherosclerosis patients and the plaque properties under ultrasound,clinical laboratory examination and other indicators.Research results:1.Comparison of overall general information of enrolled patients:A total of 31 CAS plaque patients were included in this study,with the oldest being 81 years old and the youngest being 35 years old.The average age was 59.65 ± 11.64 years old.There are 24 male patients and 7 female patients,with significantly more male patients than female patients.Among them,19 cases(61.29%)had a history of hypertension;Diabetes 12 cases(38.71%);12 cases(38.71%)had a history of cerebrovascular disease events;7 cases(22.58%)of coronary heart disease;7 cases(22.58%)had a history of smoking;Family history of cardio cerebrovascular disease was 7 cases(22.58%);6 cases of hyperlipidemia(19.35%);There were 5 cases(16.13%)of sleep apnea syndrome.2.The overall distribution characteristics of TCM syndrome elements of enrolled patients:the most common syndrome elements of patients with carotid atherosclerosis plaque are qi deficiency(96.77%),followed by yin deficiency(93.55%),blood deficiency(87.10%),yang deficiency(77.42%),qi stagnation(67.74%),and phlegm(61.29%).It is suggested that "deficiency" is an important initiating link and promoting factor in the progression of atherosclerosis.3.Comparison between the group with and without neovascularization:① There was no statistically significant difference in general data such as age and gender between the two groups(P>0.05)There was statistical significance between the neovascularization group and the non neovascularization group in the incidence of diabetes and hypertension(P<0.05),and there was no statistical significance in the history of hyperlipidemia,coronary heart disease,sleep apnea syndrome,cerebrovascular disease,family history,and smoking(P>0.05).③ The syndrome elements and symptoms of the two groups of patients are different,with the neovascularization group ranking as follows:kidney,liver,heart and mind,spleen,and lung.Ranking of disease location and syndrome elements in the group without neovascularization:liver,kidney,heart and mind,spleen,and lung.Ranking of pathogenic syndrome elements in the neovascularization group:Qi deficiency,Yin deficiency,blood deficiency,Yang deficiency,and phlegm.Ranking of disease related syndrome elements in the group without neovascularization:Yang deficiency,Qi deficiency,Yin deficiency,blood deficiency,and Qi stagnation The high-frequency symptoms of the neovascularization group include dizziness,forgetfulness,poor sleep,tinnitus,insomnia,shortness of breath,bitter mouth,palpitations,fatigue,restlessness,irritability,prolonged illness,fatigue,emotional agitation,pale complexion,severe physical activity or fatigue,weak or prone to sweating,numbness of body skin,soreness of the waist and knees,dry and astringent eyes,loose teeth,headache,sparse and thick phlegm,white phlegm,poor joint and limb movement,and night sweating.The high-frequency symptoms in the group without neovascularization include insomnia,palpitations,dizziness,poor sleep,blurred vision,long-term frequent urination,frequent nocturia,dry throat,restlessness,impatience,irritability,fatigue,frequent fear of cold,dreaminess,forgetfulness,numbness of body skin,bloating and pain,shortness of breath,thirst,frequent constipation,and the condition is related to emotions The two groups of patients showed statistical significance in the laboratory examination indicators of neutrophil count to lymphocyte count ratio(NLR)(P<0.01)and homocysteine(HCY)(P<0.05).⑤ There was no significant difference between the two groups in cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C)(P>0.05).4.Characteristics analysis of plaque neovascularization under ultrasound:①Enhancement of neovascularization mainly occurs in the shoulder of the plaque;② There is a correlation between plaque thickness and semi quantitative grading of neovascularization(P<0.05),and a significant difference between plaque thickness and quantitative analysis parameters EI,ratio,and AUC(P<0.01);③ The semi quantitative grading of plaque neovascularization is correlated with plaque morphology(P<0.05),and the neovascularization grading of irregular and ulcerative plaques is higher;④The quantitative analysis parameter ratio value of contrast-enhanced ultrasound is correlated with the ratio of neutrophil count to lymphocyte count(NLR)(P<0.05),indicating a close correlation between neovascularization and inflammation progression;⑤ The semi quantitative grading of plaque neovascularization is correlated with the quantitative analysis parameters EI,AUC,and ratio(P<0.05),demonstrating good consistency between the quantitative and semi quantitative analysis methods of contrast-enhanced ultrasound for evaluating neovascularization.5.Analysis of plaque characteristics and traditional Chinese medicine syndrome elements:① There is a correlation between plaque morphology and the grading of qi deficiency and phlegm syndrome elements(P<0.05);② The semi quantitative grading of neovascularization is correlated with the grading of qi deficiency,yang deficiency,blood deficiency,qi depression,essence deficiency,cold and dampness syndrome elements,and the difference is statistically significant(P<0.05)There were statistical differences(P<0.05)in the quantitative analysis parameters Area,ratio,and degree of qi deficiency using contrast-enhanced ultrasound.Conclusion:The pathogenesis of atherosclerosis is related to the syndrome elements of qi deficiency,yin deficiency,blood deficiency,yang deficiency,qi stagnation,and phlegm.The degree of neovascularization is positively related to the degree of qi deficiency,suggesting that the loss of qi deficiency of syndrome elements may be its basic pathogenesis.The treatment of atherosclerosis can be based on the differentiation of syndromes by supplementing qi.The quantitative and semi quantitative analysis of contrast-enhanced ultrasound showed that the pathological nourishment of atherosclerotic plaque angiogenesis was correlated with hypertension,diabetes,plaque morphology,plaque thickness,NLR,and HCY,which could be used as a predictor for clinical screening of atherosclerotic plaque neovascularization. |
PDF Full Text Request