颈动脉斑块SMI分级联合血清超敏C-反应蛋白在急性缺血性脑卒中风险评估中的应用价值  

Application value of carotid plaque SMI classification combined with serum hypersensitive C-reactive protein in risk assessment of acute ischemic stroke

作　　者：张力维[1] 李德鑫 王义成[1] 韩潮[1] 马姝颖[1] 王嫒嫒 ZHANG Li-wei;LI De-xin;WANG Yi-cheng;HAN Chao;MA Shu-ying;WANG Ai-ai(Department of Ultrasound,the First Affiliated Hospital of Hebei North University,Hebei Province,Zhangjiakou 075000,China;Department of Ultrasound,Shenzhou Municipal Hospital,Hebei Province,Shenzhou 053800,China)

机构地区：[1]河北北方学院附属第一医院超声医学科,河北张家口075000 [2]河北省深州市医院超声科,河北深州053800

出　　处：《河北医科大学学报》2023年第3期329-333,共5页Journal of Hebei Medical University

基　　金：河北省医学科学研究课题计划(20210404)。

摘　　要：目的 探讨颈动脉斑块超微血流成像(superb micro-vascular imaging, SMI)分级联合血清超敏C反应蛋白(hypersensitive C-reactive protein, hs-CRP)在急性缺血性脑卒中(acute ischemic stroke, AIS)风险评估中的应用价值。方法 纳入就诊于我院神经内科且存在颈动脉斑块的患者156例,依据MRI检查结果及临床诊断分为AIS组(72例)和非急性缺血性脑卒中(non-acute ischemic stroke, NAIS)组(84例)。2组患者均进行颈动脉常规超声检查、SMI检查及血清hs-CRP水平检测。基于Logistic回归模型及受试者工作特征曲线分析斑块内新生血管SMI分级、血清hs-CRP单独及联合诊断预测AIS发生的风险,并确定其截断值。结果 2组间SMI分级比较,差异有统计学意义(P<0.05)。AIS组患者血清hs-CRP水平较NAIS组高,差异有统计学意义(P<0.05)。2组间斑块的厚度和面积狭窄率差异均无统计学意义(P均>0.05)。SMI分级(OR=4.015,95%CI:2.426~6.646,P<0.001)、血清hs-CRP(OR=1.809,95%CI:1.313~2.498,P<0.001)均为影响AIS发生的独立危险因素(P均<0.05)。以SMI分级≥2级作为预测发生AIS的诊断标准,其曲线下面积(area under curve, AUC)为0.787,敏感度、特异度分别为81.97%、66.66%。以血清hs-CRP≥4.7 mg/L作为预测发生AIS的诊断标准,其AUC为0.699,敏感度、特异度分别为66.67%、65.48%。二者联合诊断预测发生AIS的AUC为0.842,敏感度、特异度分别为90.28%、66.67%。结论 颈动脉斑块SMI分级联合血清hs-CRP能够提高预测AIS发生风险的准确性。Objective To investigate the application value of carotid plaque superb micro-vascular imaging(SMI) classification combined with serum hypersensitive C-reactive protein(hs-CRP) in risk assessment of acute ischemic stroke(AIS).Methods A total of 156 patients with carotid plaque in the Department of Neurology of our hospital were included.According to MRI examination results and the clinical diagnosis,they were divided into AIS group(n=72) and non-AIS group(n=84).All the patients underwent routine carotid ultrasonography examination and SMI examination,and serum hs-CRP level was measured.Based on logistic regression model and receiver operating characteristic(ROC) curve,SMI classification of neovascularization in plaque and serum hs-CRP alone or in combination were analyzed to predict the risk of AIS,and its cut-off value was determined.Results There was significant difference in SMI classification between two groups(P<0.05).The level of serum hs-CRP in AIS group was significantly higher than that in NAIS group(P<0.05).There was no significant difference in plaque thickness and area stenosis rate between two groups(both P>0.05).SMI classification(OR=4.015,95%CI:2.426-6.646,P<0.001) and serum hs-CRP(OR=1.809,95%CI:1.313-2.498,P<0.001) were independent risk factors for the occurrence of AIS(both P<0.05).Taking SMI classification≥2 as the diagnostic standard for predicting the occurrence of AIS,the area under ROC curve(AUC) was 0.787,and the sensitivity and specificity were 81.97% and 66.66% respectively.Taking serum hs-CRP ≥ 4.7 mg/L as the diagnostic standard for predicting the occurrence of AIS,the AUC was 0.699,and the sensitivity and specificity were 66.67% and 65.48% respectively.The AUC of the combined diagnosis for predicting the occurrence of AIS was 0.842,and the sensitivity and specificity were 90.28% and 66.67% respectively.Conclusion Carotid plaque SMI classification combined with serum hs-CRP can improve the accuracy of predicting the risk of AIS.

关 键 词：缺血性卒中 颈动脉狭窄 C反应蛋白质 

分 类 号：R743.3[医药卫生—神经病学与精神病学]