三维超声联合Lp-PLA2与Resistin评估脑梗死患者颈动脉斑块稳定性  

The Value of RT-3DU VPQ Combined with Lp-PLA2 and Resistin in Evaluating the Stability of Carotid Atherosclerotic Plaques in Cerebral Infarction Patients

作　　者：廖晶威 许佳恒 何毅 林元相 张元隆[1] 杨金金[5] Liao Jingwei;Xu Jiaheng;He Yi;Lin Yuanxiang;Zhang Yuanlong;Yang Jinjin(Department of Neurosurgery,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350000,China;Binhai National Regional Medical Center of the First Affiliated Hospital of Fujian Medical University,Fuzhou 350000,China;Fujian Institute of Neurology,Fuzhou 350000,China;Fujian Clinical Research Center for Neurological Diseases,Fuzhou 350000,China;Department of Ultrasound,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350000,China)

机构地区：[1]福建医科大学附属第一医院神经外科,福州市350000 [2]福建医科大学附属第一医院滨海院区国家区域医疗中心,福州市350000 [3]福建省神经病学研究所,福州市350000 [4]福建省神经系统疾病临床医学研究中心,福州市350000 [5]福建医科大学附属第一医院超声科,福州市350000

出　　处：《中国超声医学杂志》2025年第1期8-12,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨实时三维超声血管斑块定量分析(RT-3DU VPQ)联合血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、人抵抗素(Resistin)评估脑梗死颈动脉斑块稳定性的临床价值。方法收集确诊的脑梗死伴颈动脉斑块的110例患者,均接受RT-3DU VPQ检查。将患者分为稳定性斑块组(GSM≥40)和易损斑块组[灰阶中位数(GSM)<40]。比较两组的临床特征、斑块特性、血浆Lp-PLA2及Resistin水平。采用Logistic回归分析影响斑块稳定性的因素。绘制受试者工作特征(ROC)曲线评估诊断脑梗死颈动脉斑块稳定性的效能。结果110例中65例稳定性斑块、45例易损斑块。RT-3DU VPQ诊断63例稳定性斑块、47例易损斑块,灵敏度、特异度、准确度均≥86.67%,误诊、漏诊均≤12.31%。GSM、Lp-PLA2、Resistin是影响脑梗死颈动脉粥样硬化斑块稳定性的因素(P<0.05)。GSM、Lp-PLA2、Resistin的曲线下面积(AUC)均≥0.760,灵敏度均≥80.00%,特异度均≥58.46%,联合检测的AUC、灵敏度均较高。结论RT-3DU VPQ联合血浆Lp-PLA2与Resistin对脑梗死颈动脉斑块的稳定性具有较高诊断价值,值得临床应用。Objective To investigate the clinical value of real-time three-dimensional ultrasound vascular plaque quantification(RT-3DU VPQ)combined with plasma lipoprotein-associated phospholipase A2(Lp-PLA2)and Resistin in assessing the stability of carotid plaque in patients with cerebral infarction.Methods A total of 110 diagnosed with cerebral infarction and carotid plaque underwent RT-3DU VPQ were selected.The related parameters of carotid artery and plaque were analyzed.All patients were divided into stable plaque group[gray scale median(GSM)≥40]and vulnerable plaque group(GSM<40).The clinical features and plaque characteristics of two groups were compared.The Logistic regression analysis was used to identify factors affecting the stability of carotid plaques in patients with cerebral infarction.The receiver operating characteristic(ROC)curve was plotted and evaluated the efficacy of the relevant indicators in diagnosing the stability of carotid plaques in patients with cerebral infarction.Results Among 110 patients with cerebral infarction and carotid plaques,65 had stable plaques and 45 had vulnerable plaques.The RT-3DU VPQ diagnosed 63 stable plaques and 47 vulnerable plaques,with the sensitivity,specificity,accuracy all≥86.67%,misdiagnosis rate and missed diagnosis rate≤12.31%.The GSM,Lp-PLA2 and Resistin as factors affecting the stability of carotid atherosclerotic plaques in patients with cerebral infarction(P<0.05).GSM,Lp-PLA2,Resistin and RT-3DU VPQ combined with plasma Lp-PLA2 and Resistin for ROC analysis showed that the area under the curve(AUC)was≥0.760,sensitivity≥80.00%and specificity≥58.46%,with the combination were higher than GSM,Lp-PLA2 and Resistin alone.Conclusions RT-3DU VPQ combined with plasma Lp-PLA2 and Resistin has a high diagnostic value for the stability of carotid plaques in patients with cerebral infarction and is worth applying in clinical practice.

关 键 词：实时三维超声血管斑块定量分析 脑梗死 颈动脉斑块 脂蛋白相关磷脂酶A2 人抵抗素 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]