多模态超声影像组学联合实验室指标对缺血性脑卒中进展的预测价值  

Value of multimodal ultrasonography combined with clinical indicators in predicting the progression of ischemic stroke

作　　者：邹金秀 李绍东 ZOU Jinxiu;LI Shaodong(Xuzhou Medical University,Jiangsu,Xuzhou 221004,China;不详)

机构地区：[1]徐州医科大学,江苏省徐州市221004 [2]江苏省宿迁市钟吾医院超声科 [3]徐州医科大学附属医院影像科

出　　处：《河北医药》2024年第9期1291-1295,共5页Hebei Medical Journal

摘　　要：目的分析基于彩色多普勒超声(CDUS)、超声造影(CEUS)、剪切波弹性成像技术(SWE)的多模态超声影像组学联合超敏-C反应蛋白/白蛋白比值(hs-CRP/ALB)预测进展性缺血性脑卒中(PIS)的价值。方法选择2019年8月至2023年5月就诊的100例急性脑卒中患者,患者入院时均接受CDUS、CEUS、SWE检查,测定血脂水平与血清hs-CRP、ALB水平。根据发病6~7 d内美国国立卫生研究院卒中量表(NIHSS)增加是否≥2分将患者分为PIS组、非PIS组(NPIS组)。比较2组一般资料、多模态超声影像参数、hs-CRP/ALB,Logistic回归分析影响PIS发生的因素。基于Logistic多因素建立预测PIS发生模型,绘制ROC曲线分析预测模型预测PIS发生的价值。结果2组性别比、年龄、体重指数(BMI)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及合并高血压、糖尿病、冠心病、吸烟、斑块长度、斑块厚度、斑块回声相比,差异均无统计学意义(P>0.05);PIS组斑块表面形态不规则占比高于NPIS组(P<0.05);PIS组峰值强度比值(P)与斑块内新生血管分级Ⅱ型占比高于NPIS组,达峰值时间(tP)、平均渡越时间(MTT)低于NPIS组(P<0.05);PIS组最大杨氏模量值(Max YM)、最小杨氏模量值(Min YM)、平均杨氏模量组(Mean YM)、hs-CRP、hs-CRP/ALB高于NPIS组,ALB低于NPIS组(P<0.05);Logistic回归分析结果显示,斑块表面形态不规则、P、Max YM、Min YM、Mean YM、hs-CRP、hs-CRP/ALB是PIS发生的危险因素(OR=9.569、1.297、1.082、1.299、1.142、3.797、4.231,P<0.05),tP、MTT、ALB是保护因素(OR=0.733、0.871、0.667,P<0.05),带入回归方程可得:Logit(P)=-6.169+9.569X1+1.297X3+0.733X4+0.871X5+1.082X6+1.299X7+1.142X8+3.797X9+0.667X10+4.231X11;绘制ROC曲线结果显示,基于Logistic回归模型的预测概率预测PIS发生的AUC为0.988(95%CI:0.972~1.000)。结论基于CDUS、CEUS、SWE的多模态超声影像组学联合血清hs-CRP、ALB、hs-CRP/ALB可有效预测PIS发生,可Objective To analyze the value of multimodal ultrasound imaging based on color Doppler ultrasound(CDUS),contrast-enhanced ultrasound(CEUS)and shear wave elastography(SWE)combined with clinical indicator measurement of high-sensitivity C-reactive protein/albumin ratio(hs-CRP/ALB)in predicting progressive ischemic stroke(PIS).Methods A total of 100 patients with acute stroke admitted to our hospital from August 2019 to May 2023 were selected.All patients received multimodal ultrasound examinations of CDUS,CEUS and SWE on admission,and measurements of blood lipid levels,serum hs-CRP and ALB.Patients were divided into PIS group(NIHSS score increase≥2 points)and non-PIS group(NIHSS score increase<2 points)according to the increase in the National Institutes of Health Stroke Scale(NIHSS)score within 6 hours to 7 days of onset.General data,multimodal ultrasound parameters and hs-CRP/ALB were compared between the two groups.Risk factors for PIS were analyzed by Logistic regression,and then a prediction model was created and validated by plotting the receiver operating characteristic(ROC)curves.Results There were no significant differences in gender,age,body mass index(BMI),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),hypertension,diabetes,coronary heart disease,smoking,plaque length,plaque thickness and plaque echo between PIS and NPIS groups(P>0.05).The proportion of irregular patch surface in PIS group was higher than that of NPIS group(P<0.05).The proportion of P and typeⅡneovascularization in plaques of PIS group was significantly higher than that of NPIS group,and tP and mean transit time(MTT)were lower than that in NPIS group(P<0.05).Max YM,Min YM,Mean YM,hs-CRP and hs-CRP/ALB in PIS group were significantly higher than those of NPIS group,but ALB was significantly lower(P<0.05).Logistic regression analysis showed that irregular patch surface,P,Max YM,Min YM,Mean YM,hs-CRP and hs-CRP/ALB were risk factors for the occurrence of PIS(OR=9.569,1.297,1.082,1

关 键 词：进展性缺血性脑卒中 彩色多普勒超声 超声造影 剪切波弹性成像技术 超敏C-反应蛋白 白蛋白 

分 类 号：R742[医药卫生—神经病学与精神病学]