超声造影对高危缺血性脑卒中患者颈动脉斑块稳定性的临床价值及影响因素分析  

Clinical value and influencing factors of contrast-enhanced ultrasonography in carotid plaque stability of patients with high-risk ischemic stroke

作　　者：栾云[1] 李宏波[1] 高慧[1] 朱正球[1] 王银萍 黄辉[1] Luan Yun;Li Hongbo;Gao Hui;Zhu Zhengqiu;Wang Yinping;Huang Hui(Department of Ultrasound,Jiangsu Province Hospital of Chinese Medicine/Affiliated Hospital of Nanjing University ofChinese Medicine,Nanjing 210029,Jiangsu,China)

机构地区：[1]江苏省中医院/南京中医药大学附属医院超声医学科,江苏南京210029

出　　处：《血管与腔内血管外科杂志》2022年第5期537-541,576,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨超声造影对高危缺血性脑卒中患者颈动脉斑块稳定性的临床价值及影响因素分析。方法收集2017年1月至2019年8月江苏省中医院/南京中医药大学附属医院收治的187例高危缺血性脑卒中患者的临床资料。根据临床病史及头颅计算机断层扫描和/或磁共振检查情况将其分为脑卒中病史组(n=120)和无脑卒中病史组(n=67)。采用Kruskale Wallis检验及Logistic回归模型分析两组患者颈动脉斑块情况,采用受试者工作特征(ROC)曲线分析各单独参数及参数联合的曲线下面积(AUC)、最佳截断值、灵敏度和特异度。结果重度造影剂充填方式、斑块表面不光整、峰值强度越强是高危缺血性脑卒中患者颈动脉斑块不稳定性的独立危险因素;曲线下面积越大是高危缺血性脑卒中患者颈动脉斑块不稳定性的保护因素(P<0.05)。参数联合诊断AUC为0.798(95%CI:0.732~0.864),高于造影剂充填方式的0.707(95%CI:0.629~0.786)、斑块表面情况的0.643(95%CI:0.560~0.727)、峰值强度的0.689(95%CI:0.613~0.765)、曲线下面积的0.598(95%CI:0.515~0.682)。结论二维超声和超声造影技术联合检测能够对高危缺血性脑卒中患者颈动脉斑块进行定量分析,有助于斑块稳定性的鉴别。Objective To explore the clinical value and influencing factors of contrast-enhanced ultrasonography in the stability of carotid plaque of patients with high-risk ischemic stroke.Method The clinical data of 187 patients with high risk of ischemic stroke were collected from January 2017 to August 2019 in Jiangsu Province Hospital of Chinese Medicine/Affiliated Hospital of Nanjing University of Chinese Medicine.According to the clinical history,computer tomography and/or magnetic resonance imaging examination,all patients were divided into ischemic stroke history group(n=120)and non-ischemic stroke history group(n=67).The carotid plaque was analyzed and compared between the two groups using the Kruskale Wallis test and the Logistic regression analysis.Receiver operator characteristic(ROC)curve was employed to evaluate area under the curve(AUC),the best cut-off value,sensitivity and specificity of single or combined parameters.Result Heavy contrast agent filling,unsmooth plaque surface,high peak intensity were independent risk factors for instability of carotid plaque in high-risk ischemic stroke;larger area under curve was protective factors(P<0.05).The AUC of combined parameters was 0.798(95%CI:0.732-0.864),which was higher than 0.707(95%CI:0.629-0.786)of contrast agent filling types,0.643(95%CI:0.560-0.727)of plaque surface,0.689(95%CI:0.613-0.765)of peak intensity,0.598(95%CI:0.515-0.682)of area under curve.Conclusion The carotid plaque could be quantitatively analyzed by the two-dimensional ultrasound combined with contrast-enhanced ultrasonography,which is a useful technique to access the stability of the plaque.

关 键 词：超声造影 缺血性脑卒中 颈动脉斑块 定量分析 

分 类 号：R543[医药卫生—心血管疾病]