脑梗死患者颈动脉粥样硬化斑块性质和颈动脉狭窄程度变化及意义  

Changes and significances of carotid atherosclerotic plaque natures and degrees of carotid stenosis in patients with cerebral infarction

作　　者：付瑶[1] 张媛媛 聂颖[3] 孔令伟[4] 刘红军[3] 聂曦明 FU Yao;ZHANG Yuan-yuan;NIE Ying;KONG Ling-wei;LIU Hong-jun;NIE Xi-ming(Department of Ultrasound,Beijing Jiaotong University Hospital,Beijing 100044,China;Department of Radiology,Beijing Yangfangdian Hospital,Beijing 100038,China;Department of Cardiology,Beijing Jiaotong University Hospital,Beijing 100044,China;Department of General Surgery,Beijing Jiaotong University Hospital,Beijing 100044,China;Neurology Center,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China)

机构地区：[1]北京交通大学医院超声科,北京100044 [2]北京市羊坊店医院放射科,北京100038 [3]北京交通大学医院心内科,北京100044 [4]北京交通大学医院普外科,北京100044 [5]首都医科大学附属北京天坛医院神经病学中心,北京100070

出　　处：《中华实用诊断与治疗杂志》2022年第9期951-954,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(82001920)。

摘　　要：目的 观察脑梗死患者颈动脉粥样硬化斑块性质及颈动脉狭窄程度变化,探讨其临床意义。方法 74例脑梗死患者为观察组,同期体检者72例为对照组。2组均行颈动脉超声及超声造影检查,记录颈动脉内-中膜厚度增厚、粥样硬化斑块检出率、斑块性质及颈动脉狭窄程度;绘制ROC曲线,评估软斑块、混合回声斑块及内-中膜厚度单独及联合检测预测脑梗死的效能。结果 观察组颈动脉内-中膜厚度[(0.95±0.24)mm]大于对照组[(0.79±0.21)mm](t=4.282,P<0.001),颈动脉内-中膜增厚(32.43%)、斑块(90.54%)、软斑块(25.68%)、混合回声斑块(17.57%)检出率均高于对照组(16.67%、59.72%、11.11%、5.56%)(P<0.05);2组强回声斑块、等回声斑块检出率比较差异均无统计学意义(P>0.05)。观察组轻(32.43%)、中(17.57%)、重度狭窄(9.46%)及血管闭塞(5.41%)发生率均高于对照组(18.06%、8.33%、1.39%、0)(P<0.05)。颈动脉内-中膜厚度以0.92 mm为最佳截断值,预测脑梗死发生的AUC为0.835(95%CI:0.746~0.870,P<0.001),灵敏度为91.89%,特异度为91.67%;有软斑块、混合回声斑块预测脑梗死发生的AUC分别为0.776(95%CI:0.745~0.841,P<0.001)、0.792(95%CI:0.726~0.853,P<0.001),灵敏度分别为74.72%、91.67%,特异度分别为74.32%、82.43%;三者联合检测预测脑梗死发生的AUC为0.879(95%CI:0.795~0.953,P<0.001)。结论 脑梗死患者颈动脉内-中膜厚度增厚,软斑块、混合回声斑块检出率高,三者联合检测预测脑梗死发生有较高价值。Objective To observe the changes of carotid atherosclerotic plaque natures and carotid stenosis degree in patients with cerebral infarction,and to investigate the clinical significances.Methods Seventy-four patients with cerebral infarction(observation group)and 72healthy volunteers(control group)received carotid artery ultrasound and angiography to record the carotid intima-media thickness(CIMT),detection rate of atherosclerotic plaque,nature of the plaque and degree of carotid stenosis.ROC curve was drawn to assess the efficiency of joint and single detection of soft plaque,mixed echo plaque and CIMT on predicting the occurrence of cerebral infarction.Results The CIMT was greater in observation group[(0.95±0.24)mm]than that in control group[(0.79±0.21)mm](t=4.282,P<0.001),and the detection rates of CIMT,plaque,soft plaque and mixed echo plaque were higher in observation group (32.43%,90.54%,25.68%,17.57%)than those in control group (16.67%,59.72%,11.11%,5.56%)(P<0.05).There were no significant differences in the detection rates of hyperechoic plaque and isoechoic plaque between two groups(P>0.05).The percentages of patients with mild,moderate and severe stenosis as well as vascular occlusion were higher in observation group(32.43%,17.57%,9.46%,5.41%)than those in control group(18.06%,8.33%,1.39%,0)(P<0.05).When the optimal cut-off value of CIMT was 0.92 mm,the AUCfor predicting cerebral infarction was0.835(95%CI:0.746-0.870,P<0.001),the sensitivity was 91.89%,and the specificity was 91.67%.The AUCs of soft plaque and mixed echo plaque for predicting cerebral infarction were 0.776(95%CI:0.745-0.841,P<0.001)and0.792(95%CI:0.726-0.853,P<0.001),the sensitivities were 74.72%and 91.67%,and the specificities were74.32%and 82.43%,respectively.The AUCof joint detection of them three for predicting cerebral infarction was 0.879(95%CI:0.795-0.953,P<0.001).Conclusion Patients with cerebral infarction have high detection rates of thickened CIMT,soft plaque and mixed echo plaque,and the joint detection of them three has a

关 键 词：脑梗死 颈动脉超声 超声造影 颈动脉斑块性质 狭窄程度 

分 类 号：R743.33[医药卫生—神经病学与精神病学]