颈动脉体影像学分析及其意义——颈动脉体体积与心血管疾病相关性研究

Imagology Analysis of Carotid Body and Its Significance—Correlation Study between Carotid Body Volume and Cardiovascular Disease

摘要: 颈动脉体(CB)是主要的外周化学感受器，感受机体中的低氧分压、高二氧化碳分压、血液酸性和低灌注刺激。在应对低氧血症、高碳酸血症和酸中毒时，颈动脉化学感觉放电可引起反射性呼吸、自主神经和心血管系统调节。CB过度活化已被认为在交感神经介导的疾病的维持和进展中发挥作用，如高血压、心力衰竭、睡眠呼吸暂停、慢性阻塞性肺疾病和代谢综合征，故而CB可作为治疗上述疾病的潜在靶点。但在某些病理条件下，CB细胞受到刺激，导致大小或重量增加。一些临床研究已经证实CB体积与一些交感神经相关疾病或危险因素有关。CB增大可能是一种新的交感神经相关心血管事件的预测因子，独立于传统的心血管危险因素。CB体积与其他心血管危险因素联合评价的应用可能有利于临床心血管事件的风险评估。目前国际上对于如何直观评估CB大小仍处于探索阶段，现临床较多运用颈动脉超声及CTA评估CB体积，基于核磁(MR)评估CB体积也有一定探索。本文将总结现有的影像学评估CB体积的成果相比较，将具体探讨和验证各方法的准确性，进一步推进将CB无创性评估作为交感神经相关疾病患者的颈动脉体调节治疗的一个有前途的筛查和评估预测指标。

Abstract: The carotid body (CB) is the main peripheral chemoreceptor, sensing hypoxia, hypercapnia, acidosis and hypoperfusion in the body. In response to hypoxemia, hypercapnia and acidosis, carotid chemosensory discharge can cause reflexive regulation of the respiratory, autonomic and cardiovascular systems. Excessive activation of the CB has been implicated in the maintenance and progression of sympathetic-mediated diseases, such as hypertension, heart failure, sleep apnea, chronic obstructive pulmonary disease and metabolic syndrome, thus making the CB a potential therapeutic target for these conditions. However, under certain pathological conditions, CB cells are stimulated, leading to an increase in size or weight. Some clinical studies have confirmed that CB volume is associated with some sympathetic-related diseases or risk factors. Enlarged CB may be a new predictor of sympathetic-related cardiovascular events, independent of traditional cardiovascular risk factors. The combined evaluation of CB volume with other cardiovascular risk factors may be beneficial for the risk assessment of clinical cardiovascular events. Currently, the international community is still in the exploratory stage for how to visually assess the size of the CB. Currently, carotid ultrasound and CTA are commonly used in clinical practice to evaluate CB volume, and there are also certain explorations based on MR for the assessment of CB volume. This article will summarize the existing imaging assessment results of CB volume, specifically discuss and verify the accuracy of each method, and further promote the non-invasive assessment of the CB as a promising screening and predictive indicator for the treatment of carotid body regulation in patients with sympathetic-related diseases.