系统性炎症评分与颈动脉狭窄患者斑块稳定性的相关性及其预测价值分析  

Correlation and predictive value analysis of systemic inflammation grade and plaque stability in patients with carotid artery stenosis

作　　者：王庆贺 唐晨 蔡晶 王宜梅 郑磊 赵飙 范丽桢 倪茜 梁子舜 乔彤[1] Wang Qinghe;Tang Chen;Cai Jing;Wang Yimei;Zheng Lei;Zhao Biao;Fan Lizhen;Ni Qian;Liang Zishun;Qiao Tong(Department of Vascular Surgery,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China;Department of Vascular Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Traditional Chinese Medicine,Chinacal College of Nanjing University of Traditional Chinese Medicine,Nanjing 210008,China;Department of Geriatrics,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院血管外科,南京210008 [2]南京中医药大学鼓楼临床医学院血管外科,南京210008 [3]南京大学医学院附属鼓楼医院老年科,南京210008

出　　处：《中华医学杂志》2025年第7期537-543,共7页National Medical Journal of China

基　　金：国家自然科学基金(81870348、82200543、82101425);江苏省卫生健康委医学科研项目(ZD2021056);南京鼓楼医院临床研究青年培育项目(2022‑LCYJ‑PY‑12)。

摘　　要：目的分析系统性炎症评分(SIG)与颈动脉狭窄患者斑块稳定性的相关性,并评估其预测价值。方法回顾性分析2019年1月至2023年10月于南京大学医学院附属鼓楼医院住院治疗的149例颈动脉狭窄患者的临床资料,年龄(68.2±8.9)岁,男124例,女25例。根据颈动脉内膜剥脱术后标本病理结果将患者分为斑块稳定组(n=70)和斑块易损组(n=79)。收集患者术前血液实验室指标,计算中性粒细胞与淋巴细胞比值和改良格拉斯哥预后评分(mGPS),并将二者联合计算出SIG。采用多因素logistic回归模型分析影响颈动脉狭窄患者斑块稳定性的相关因素,采用受试者工作特征(ROC)曲线分析SIG对颈动脉狭窄患者斑块稳定性的预测价值。结果斑块易损组糖尿病史患者占比[36.7%(29/79)比20.0%(14/70)]及IL‑6[0.43(0.31,0.64)比0.34(0.17,0.44)ng/L]均高于斑块稳定组(均P<0.05)。斑块易损组mGPS评分及SIG评分均高于斑块稳定组(均P<0.05)。多因素logistic回归模型结果显示,糖尿病病史(OR=2.82,95%CI:1.23~6.48)、IL‑6水平高(OR=1.16,95%CI:1.01~1.33)和SIG评分高[以SIG=0为参照,OR(SIG=1)=1.76,95%CI:1.21~2.41;OR(SIG=2)=2.21,95%CI:1.51~3.01;OR(SIG=3)=4.47,95%CI:2.42~6.52;OR(SIG=4)=3.19,95%CI:2.01~4.36]是颈动脉狭窄患者斑块稳定性的危险因素。ROC曲线分析结果显示,SIG cut‑off值为1.5分时,预测颈动脉狭窄患者斑块稳定性的灵敏度为70.0%,特异度为74.3%,曲线下面积为0.745(95%CI:0.666~0.825,P<0.001)。结论SIG评分高是颈动脉狭窄患者斑块稳定性的危险因素,且具有良好的预测效能。Objective To analyze the correlation between the systemic inflammation score(SIG)and plaque stability in patients with carotid artery stenosis,and to evaluate the predictive value.Methods The clinical data of 149 patients with carotid artery stenosis who were hospitalized in Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2019 to October 2023 were retrospectively analyzed,including 124 males and 25 females,aged(68.2±8.9)years.According to the results of pathological analysis of specimens after carotid endarterectomy,the patients were divided into plaque stable group(n=70)and plaque vulnerable group(n=79).After preoperative blood biochemical indexes were collected and neutrophil‑lymphocyte ratio and modified glasgow prognostic score(mGPS)were calculated,the SIG was calculated together.The multivariate logistic regression model was used to analyze the correlative factors of plaque stability in patients with carotid artery stenosis,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of SIG for plaque stability in patients with carotid artery stenosis.Results The proportion of patients with a history of diabetes in the plaque vulnerable group[36.7%(29/79)vs 20.0%(14/70)]and IL‑6[0.43(0.31,0.64)vs 0.34(0.17,0.44)ng/L]were higher than those in the plaque stabilization group(both P<0.05).The mGPS score and SIG score of the plaque vulnerable group were higher than those of the plaque stabilization group(both P<0.05).The results of the multivariate logistic regression model showed that diabetes history(OR=2.82,95%CI:1.23-6.48),high interleukin‑6(IL‑6)level(OR=1.16,95%CI:1.01-1.33),and high SIG scores[with SIG=0 as the reference,OR(SIG=1)=1.76,95%CI:1.21-2.41;OR(SIG=2)=2.21,95%CI:1.51-3.01;OR(SIG=3)=4.47,95%CI:2.42-6.52;OR(SIG=4)=3.19,95%CI:2.01-4.36]were risk factors for plaque instability in patients with carotid artery stenosis.The results of ROC curve analysis showed that when the SIG cut‑off value was 1.5 points,the sensi

关 键 词：颈动脉狭窄 动脉粥样硬化 系统性炎症评分 斑块稳定性 

分 类 号：R543.4[医药卫生—心血管疾病]