颈动脉超声评估颈动脉硬化程度及斑块情况对急性冠脉综合征发生风险的预测价值  

Value of degree of carotid atherosclerosis and plaque status evaluated by carotid artery ultrasound in predicting the risk of acute coronary syndrome

作　　者：李林 尚晓斌[2] 梁金文 LI Lin;SHANG Xiao-bin;LIANG Jin-wen(Department of Ultrasound,Henan Veterans Hospital,Xinxiang 453000,Henan,CHINA;Department of Ultrasound,the Second Affiliated Hospital of Xinxiang Medical College,Xinxiang 453000,Henan,CHINA)

机构地区：[1]河南省荣军医院超声科,河南新乡453000 [2]新乡医学院第二附属医院超声科,河南新乡453000

出　　处：《海南医学》2025年第4期534-538,共5页Hainan Medical Journal

基　　金：2021年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20211811)。

摘　　要：目的探讨颈动脉超声(CAU)评估颈动脉硬化(CAS)程度及斑块情况对急性冠脉综合征(ACS)发生风险的预测价值。方法前瞻性选取2020年6月至2023年6月河南省荣军医院收治的98例稳定型冠心病(SCAD)患者作为研究对象,所有患者均行CAU检查,统计颈动脉内-中膜厚度(CIMT)、颈动脉斑块数量、斑块性质、斑块面积及颈动脉斑块总积分(Crouse积分),随访6个月,共失访2例,成功完成随访96例,根据是否发生ACS分为稳定组65例和ACS组31例。比较两组患者的基线资料、CAU参数[CIMT、颈动脉斑块、斑块面积、斑块数量、Crouse积分],采用Pearson法分析CAU参数与冠脉Gensini积分的相关性,采用Logistic回归分析CAU参数对发生ACS的影响,采用受试者工作特征(ROC)曲线分析CAU参数预测发生ACS的价值。结果ACS组患者的高血压、高脂血症比例及冠脉Gensini积分、CIMT、颈动脉斑块数量、斑块面积、Crouse积分分别为51.61%、58.06%、(62.25±10.96)分、(1.65±0.24)mm、(1.86±0.57)个、(33.64±10.03)mm^(2)、(2.58±0.62)分,明显高(大)于稳定组患者的23.08%、30.77%、(48.19±8.23)分、(1.42±0.17)mm、(1.28±0.31)个、(18.95±6.14)mm^(2)、(1.76±0.46)分,差异均有统计学意义(P<0.05);Pearson法分析结果显示,CIMT、颈动脉斑块数量、斑块面积、Crouse积分与冠脉Gensini积分呈正相关(r=0.528、0.506、0.515、0.543,P<0.05);Logistic回归分析结果显示,将高血压、高脂血症、冠脉Gensini积分校正后,CIMT(OR=1.478,95%CI:1.022~2.137)、颈动脉斑块数量(OR=1.459,95%CI:1.135~1.875)、斑块面积(OR=1.436,95%CI:1.074~1.920)、Crouse积分(OR=1.452,95%CI:1.041~2.026)仍是SCAD患者发生ACS的独立危险因素(P<0.05);ROC分析结果显示,CIMT、颈动脉斑块数量、斑块面积、Crouse积分联合预测ACS发生的曲线下面积(AUC)为0.914,优于各参数单一预测效能(P<0.05)。结论CAU参数CIMT、颈动脉斑块数量、斑块面积、Crouse积分均是SCAD患者发生ACS�Objective To investigate the value of the degree of carotid atherosclerosis(CAS)and plaque status evaluated by carotid artery ultrasound(CAU)for predicting the risk of acute coronary syndrome(ACS).Methods A total of 98 patients with stable coronary heart disease(SCAD)admitted to Henan Veterans Hospital from June 2020 to June 2023 were prospectively enrolled.All patients underwent CAU examination.Carotid intima-media thickness(CIMT),number of carotid plaques,plaque properties,plaque area,and total carotid plaque score(Crouse score)were measured.The patients were followed up for 6 months,and 2 patients were lost and 96 patients successfully completed the fol-low-up.Based on whether ACS occurred,the patients were divided into a stable group(65 cases)and an ACS group(31 cases).The baseline data and CAU parameters(CIMT,carotid plaque,plaque area,plaque number,Crouse score)were compared between the two groups of patients.The correlation between CAU parameters and coronary Gensini score was analyzed using the Pearson method.The impact of CAU parameters on the occurrence of ACS was analyzed using logistic regression.The predictive value of CAU parameters for the occurrence of ACS was analyzed using receiver operating characteristic(ROC)curve.Results The proportions of hypertension and hyperlipidemia,as well as the coronary Gensini score,CIMT,number of carotid plaques,plaque area,and Crouse score in the ACS group were 51.61%,58.06%,(62.25±10.96)points,(1.65±0.24)mm,1.86±0.57,(33.64±10.03)mm^(2),and(2.58±0.62)points,respectively,which were significantly higher(larger)than 23.08%,30.77%,(48.19±8.23)points,(1.42±0.17)mm,1.28±0.31,(18.95±6.14)mm^(2),and(1.76±0.46)points in the stable group(P<0.05).Pearson correlation analysis showed that CIMT,number of carotid plaques,plaque area,and Crouse score were positively correlated with the coronary Gensini score(r=0.528,0.506,0.515,0.543,respectively;P<0.05).Logistic regression analysis showed that after adjusting for hypertension,hyperlipid-emia,and coronary Gensini scores

关 键 词：颈动脉超声 定量参数 颈动脉硬化 斑块 急性冠脉综合征 预测 

分 类 号：R541.4[医药卫生—心血管疾病]