基于颈动脉弹性成像联合颈动脉斑块超声造影分析缺血性脑血管病进展的独立风险因素  

Independent risk factors for the progression of ischemic cerebrovascular disease based on carotid artery elastography combined with carotid plaque ultrasonography

作　　者：洪敏[1] 李云亭[1] 武柏伶 侯春杰[3] 杜佩[3] HONG Min;LI Yunting;WU Bailing;HOU Chunjie;DU Pei(Department of Ultrasonography,Pan’an County People’s Hospital,Jinhua 322300,China;The Second School of Clinical Medicine,Hangzhou Normal University,Hangzhou 310036,China;Department of Ultrasound,Zhejiang Provincial People’s Hospital,Hangzhou 310014,China)

机构地区：[1]磐安县人民医院超声科,浙江金华322300 [2]杭州师范大学第二临床医学院,浙江杭州310036 [3]浙江省人民医院超声科,浙江杭州310014

出　　处：《温州医科大学学报》2025年第2期121-127,共7页Journal of Wenzhou Medical University

基　　金：浙江省医药卫生科技计划项目(2023XY215);浙江省教育厅一般科研项目(Y202249268)。

摘　　要：目的:采用超声造影联合颈动脉弹性成像检测探究影响缺血性脑血管病(ICVD)进展的独立风险因素。方法:将132例缺血性脑血管病患者依据是否出现ICVD症状分为无症状组和症状组,分析这两组患者的颈动脉责任斑块二维、超声造影及颈动脉弹性评估指标[扩张系数、顺应性系数、α系数、β系数以及脉搏波传导速度(PWV)等]的差异性,明确ICVD进展的独立风险因素,应用ROC曲线评估独立风险因素预测ICVD症状发生的价值。结果:症状组磁共振成像缺血性病灶患者比例、血管重度狭窄比例、斑块造影分级>2级患者比例明显高于无症状组,症状组PWV明显高于无症状组(P<0.01)。多因素Logistic回归分析结果显示,斑块长度长、血管狭窄程度>70%、斑块造影分级>2级与PWV高为ICVD症状发生的独立风险因素(P=0.007、P=0.003、P=0.020、P<0.01)。ROC曲线分析显示以斑块造影分级>2级预测ICVD的灵敏度和特异度分别为69.8%和78.5%,其AUC为0.742(95%CI=0.654~0.830,P<0.01);以PWV预测ICVD的灵敏度和特异度分别为84.1%和85.4%,其AUC为0.927(95%CI=0.880~0.973,P<0.01);联合两种技术的灵敏度和特异度分别为88.9%和89.2%,其AUC为0.947(95%CI=0.911~0.982,P<0.01)。联合四项独立风险因素,其灵敏度和特异度则达到95.0%和93.1%,其AUC为0.973(95%CI=0.951~0.995,P<0.01)。结论:颈动脉斑块新生血管的超声造影分级>2级与颈动脉PWV高均为ICVD的独立风险因素。将这两者结合进行检查,能在一定程度上提升预测的准确性。Objective:To explore the independent risk factors for the progression of ischemic cerebrovascular disease by using contrast-enhanced ultrasound combined with carotid artery elasticity imaging.Methods:A total of 132 patients with ischemic cerebrovascular disease were divided as asymptomatic group and symptomatic group according to whether they had symptoms of ischemic cerebrovascular disease.The differences between the two groups in carotid artery plaque two-dimensional,contrast-enhanced ultrasound and carotid artery elasticity evaluation indexes(dilation coefficient,compliance coefficient,αcoefficient,βcoefficient,and pulse wave velocity PWV)were analyzed.The independent risk factors for the progression of ischemic cerebrovascular disease were identified,and the value of independent risk factors in predicting the occurrence of ischemic cerebrovascular disease symptoms was evaluated using receiver operating characteristic curve.Results:The proportion of patients with MRI ischemic lesions,the proportion of patients with severe vessel stenosis,and the proportion of patients with plaque angiographic classification>gradeⅡwere significantly higher in the symptomatic group than in the asymptomatic group,and the PWV was all significantly higher in the symptomatic group than in the asymptomatic group(P<0.01).The results of multifactorial Logistic regression analysis showed that long plaque length,degree of stenosis>70%,plaque angiographic classification>grade 2 and high PWV were independent risk factors for the development of symptoms of ischemic cerebrovascular disease(P=0.007,P=0.003,P=0.02,P<0.01),respectively.Receiver operating characteristic curve analysis showed that plaque length,degree of stenosis,plaque angiographic classification>Ⅱpredicted the occurrence of symptoms of ischemic cerebrovascular disease.The sensitivity and specificity of predicting ischemic cerebrovascular disease by contrast grading>gradeⅡwere 69.8%and 78.5%,respectively,with AUCs of 0.742(95%CI=0.654-0.830,P<0.01);the sensityivity and s

关 键 词：颈动脉斑块 缺血性脑血管病 超声造影 弹性成像 

分 类 号：R445.1[医药卫生—影像医学与核医学]