摘要目的：研究颈内静脉自发显影（Internal jugular vein spontaneous echo contrast，IJVSEC）与缺血性脑卒中的相关性。方法：选取缺血性脑卒中患者100例作为病例组，选取50例无脑卒中病史的正常人作为对照组。所有受检者均行常规超声检查及卒中危险因素分析，采用美国公立卫生院卒中评分（National Institute of Health Stroke Scale，NIHSS）对病例组脑卒中严重程度进行评价。根据急性卒中抗凝治疗实验（Trial of org 10 172 in acute stroke treatment，TOAST）将卒中患者按病因分为5个亚型，分析不同病因分型与相关危险因素、实验室指标及超声检测指标的关系，对所有数据进行统计学分析。结果：病例组患者的纤维蛋白原、血红蛋白、D2聚体、内中膜厚度（IMT）、NIHSS评分、斑块积分、自发显影（Spontaneous echo contrast，SEC）评分明显高于对照组，两组间比较差异均具有统计学意义（P<0.001），而双侧颈内静脉平均流速（Mean velocity，MV）两组间比较差异无统计学意义（P>0.05）。斑块积分、IMT在不同亚型的卒中患者中不同，SEC评分与双侧颈内静脉MV在大动脉粥样硬化型卒中组中与在其他亚型卒中组中相比差异无统计学意义（P>0.05）。SEC评分与纤维蛋白原、血红蛋白、D2聚体、NIHSS评分呈正相关（r=0.274，P<0.001；r=0.330，P<0.001；r=0.421，P<0.001；r=0.731，P<0.001），与斑块积分、IMT不相关（r=0.049，P=0.547；r=0.025，P=0.759）；SEC评分与颈内静脉瓣反流（Jugular venous reflux，JVR）呈正相关（r=0.409，P<0.001）。结论：缺血性脑卒中患者更易发生IJVSEC，两者之间关联密切，且IJVSEC严重程度与脑卒中严重程度具有一定相关性；脑卒中患者的IJVSEC现象很可能通过动脉粥样硬化形成机制以外的其他机制形成，IJVSEC是否可作为脑卒中的标志物或治疗指标尚需进一步研究。
Abstract：Objective: To investigate the correlation between internal jugular vein spontaneous echo contrast(IJVSEC) and stroke. Methods: One hundred patients with ischemic stroke were selected as stroke group and 50 normal persons without stroke history were selected as control group. All subjects underwent routine ultrasound examination and stroke risk factor analysis. Then, the severity of stroke was evaluated by National Institute of Health Stroke Scale(NIHSS). According to the trial of org 10 172 in acute stroke treatment(TOAST), stroke patients were divided into five subtypes. The relationship between different etiological types and related risk factors, laboratory indicators and ultrasound detection indicators was analyzed, and all data were analyzed statistically. Results: The fibrinogen, hemoglobin, D2 polymers, intimal-medial thickness(IMT), NIHSS score, plaque integral and spontaneous echo contrast(SEC) score in stroke group were significantly higher than those in control group(P<0.001), but there was no significant difference between the two groups in MV of bilateral internal jugular vein(P>0.05). Plaque integral and IMT were different in different subtypes of stroke patients. There was no significant difference in SEC score and MV of bilateral internal jugular vein between atherosclerotic stroke group and other stroke types group(P>0.05). SEC score was positively correlated with fibrinogen, hemoglobin, D2 polymers, NIHSS score(r=0.274, P<0.001; r=0.330, P<0.001; r=0.421, P<0.001; r=0.731, P<0.001), not correlated with plaque integral and IMT(r=0.049, P=0.547; r=0.025, P=0.759), and SEC score was positively correlated with jugular venous reflux(JVR)(r=0.409, P＜0.001). Conclusions: IJVSEC is more likely to occur in patients with ischemic stroke, and there is a close correlation between the two, and the severity of IJVSEC is correlated with the severity of stroke. IJVSEC phenomena in stroke patients may be formed through other mechanisms besides atherosclerosis, and whether IJVSEC can be used as a marker or therapeutic index of stroke needs further study.
陈伟男，张春梅，张 娟. 颈内静脉自发显影与缺血性卒中关系研究[J]. 中国临床医学影像杂志, 2019, 30(4): 229-233.
CHEN Wei-nan, ZHANG Chun-mei, ZHANG Juan. Study on the relationship between spontaneous echo contrast in the internal jugular vein and stroke. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(4): 229-233.
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