超声造影联合血脂检测评价颈动脉易损斑块对缺血性脑卒中患者的预测价值  

Predictive value of contrast-enhanced ultrasound parameters combined with blood lipids for vulnerable carotid plaques in IS patients

作　　者：李令枝 魏贺基 李雁萍 胡敏如 Li Lingzhi;Wei Heji;Li Yanping;Hu Minru(Department of Physical Function,Nanhai District Fourth People's Hospital,Foshan 528211,Guangdong Province,China)

机构地区：[1]佛山市南海区第四人民医院功能科,528211 [2]佛山市南海区第四人民医院神经内科,528211

出　　处：《中华老年心脑血管病杂志》2025年第3期348-353,共6页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：佛山市科技局自筹经费类科技创新项目(2220001005155)。

摘　　要：目的探讨超声造影联合血脂检测评价颈动脉易损斑块对缺血性脑卒中患者的预测价值。方法本研究为前瞻性研究,选择2023年1月至2024年5月佛山市南海区第四人民医院确诊的颈动脉易损斑块患者120例,其中缺血性脑卒中患者60例为研究组,无缺血性脑卒中患者60例为对照组。分别对2组进行常规超声、超声造影及血脂检查,分析研究组与对照组、研究组不同血流分级患者不稳定斑块积分比、斑块最大长度、斑块最大厚度、溃疡斑、面积狭窄、狭窄处峰值流速、阻力指数及血脂水平的差异。采用ROC曲线分析,并计算曲线下面积(the area under curve,AUC)。结果研究组与对照组不稳定斑块积分比、斑块最大长度、斑块最大厚度、溃疡斑、面积狭窄、狭窄处峰值流速、阻力指数、血流特征比较,差异有统计学意义(P<0.01)。研究组三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、低密度胆固醇(low density lipoprotein,LDL)、水平明显高于对照组,高密度胆固醇(high density lipoprotein,HDL)水平明显低于对照组(P<0.01)。研究组不同血流分级患者不稳定斑块积分比、斑块最大长度、斑块最大厚度、溃疡斑、面积狭窄、狭窄处峰值流速、阻力指数比较,差异有统计学意义(P<0.05,P<0.01)。研究组不同血流分级患者TC、TG、LDL、HDL水平比较,差异有统计学意义(P<0.01)。研究组血流分级Ⅲ级、Ⅱ级、Ⅰ级患者TC、TG、LDL依次降低,HDL依次升高(P<0.01)。Pearman相关性分析显示,血流分级与TC、TG、LDL水平呈正相关(r=0.456,r=0.652,r=0.362,P=0.000),与HDL水平呈负相关(r=-0.256,P=0.000)。ROC曲线分析显示,超声造影血流分级与血脂水平联合检测对颈动脉易损斑块缺血性脑卒中患者诊断的AUC明显高于单独检测,通过截断值分析,颈动脉易损斑块缺血性脑卒中患者超声造影血流分级为Ⅱ级以上,TC为5.22 mmol/L,TG为2.33 mmol/L,LDL为2.Objective To explore the predictive value of contrast-enhanced ultrasound(CEUS)parameters combined with blood lipids in evaluating vulnerable carotid plaques in patients with ischemic stroke.Methods A prospective trial was conducted on 120 patients diagnosed with vulnerable carotid plaques in our hospital from January 2023 to May 2024.According to having ischemic stroke or not,60 of them were assigned into ischemic stroke(study group),and the other 60 into control group.Routine ultrasound,CEUS and blood lipid examinations were performed respectively in the two groups.The unstable plaque integral ratio,maximum plaque length,maximum plaque thickness,ulceration plaque,area stenosis,peak velocity at stenosis,resistance index and blood lipid levels between the study group and the control group and in the study group with different blood flow grades were analyzed.ROC curve analysis was used to calculate the AUC value.Results There were statistical differences between the study group and the control group in terms of unstable plaque integral ratio,maximum plaque length,maximum plaque thickness,ulcerationplaque,area stenosis,peak velocity at stenosis,resistance index and blood flow characteristics(P<0.01).The study group had significantly higher TC,TG and LDL levels and lower HDL levelthan the control group(P<o.01).Obvious differences were observed in unstable plaque integralratio,maximum plaque length,maximum plaque thickness,ulceration plaque,area stenosis,peakvelocity at stenosis and resistance index among the patients from the study group with differentblood flow grades(P<0.05,P<0.01),so were their TC,TG,LDL and TG levels in them(P<O.O1).For above these patients,the TC,TG and LDL levels were gradually decreased,while thatof HDL was increased in turn in the patients with blood flow grades II,II to I(P<o.01).Theblood flow grade was positively correlated with TC,TG and LDL levels(r=0.456,r=0.652,r=0.362,P=0.000),while negatively with HDL level(r=-0.256,P=0.000).ROC curve analysisshowed that the AUC value of the combinat

关 键 词：超声检查 甘油三酯类 脂蛋白类 颈动脉狭窄 ROC曲线 

分 类 号：R743.3[医药卫生—神经病学与精神病学]