首页|多项超声技术联合探查颈动脉斑块预测缺血性脑卒中复发的价值

多项超声技术联合探查颈动脉斑块预测缺血性脑卒中复发的价值

Value of combined exploration of carotid plaque by multiple ultrasound techniques to predict recurrence of ischemic stroke

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目的 探讨二维和三维超声、超声造影(CEUS)和剪切波弹性成像(SWE)联合探查颈动脉斑块并分析其预测缺血性脑卒中(IS)复发的价值.方法 筛选新疆医科大学第二附属医院2021年10月-2023年1月收治的首发IS合并颈动脉粥样硬化斑块患者95例,根据是否复发分为复发组和未复发组.采用logistic回归分析研究影响IS患者复发的危险因素.采用ROC曲线分析多项超声技术联合预测IS复发的价值.结果 失访5例,有37例患者复发,复发率为41.11%,复发组高血压占比高于未复发组,药物依从性好占比则低于未复发组(P<0.05).复发组CEUS-血流Ⅲ~Ⅳ级占比及二维-动脉内中膜厚度(IMT)、三维-颈动脉斑块总面积(TPA)值高于未复发组,杨氏模量平均值则低于未复发组(P<0.05).多因素logistic回归分析显示,CEUS-血流Ⅲ~Ⅳ级、二维-IMT高和三维-TPA大及杨氏模量平均值低是影响IS患者复发的危险因素,药物依从性好则是其保护因素(P<0.05)o ROC曲线分析显示,二维-IMT、三维-TPA、杨氏模量平均值及CEUS-血流Ⅲ~Ⅳ级单项预测IS患者复发的AUC分别为0.674、0.717、0.729、0.746,联合预测AUC为0.908,高于单项检测(P<0.05).结论 二维、三维及SWE、CEUS超声技术通过评估颈动脉斑块不稳定性,在预测IS复发方面具有一定的临床价值,四者联合价值更高.
Objective To investigate the value of combined 2D and 3D ultrasound,contrast-enhanced ultrasonography(CEUS)and shear-wave elastography(SWE)for the detection of carotid plaques,and to analyze their value in predic-ting recurrence of ischaemic stroke(IS).Methods A total of 95 patients with first-ever IS and carotid atherosclerotic plaque from October,2021 to January,2023 in the Second Affiliated Hospital of Xinjiang Medical University were select-ed,and divided into a recurrence group and a non-recurrence group according to whether they had recurred or not.Risk factors for relapse in patients with IS were analyzed using logistic regression.Receiver operating characteristic(ROC)curves were used to analyze the value of different ultrasound techniques in predicting the recurrence of IS.Results Five cases were lost to follow-up.The recurrence rate was 41.11%,and there were no deaths after treatment.The proportion of hypertension in the recurrent group was higher than that in the non-recurrent group,and the proportion of good medica-tion compliance was lower than that in the non-recurrent group(P<0.05).The ratio of CEUS blood flow grade Ⅲ to Ⅳ,2-D intima-media thickness(IMT)and 3-D-TPA in the recurrent group were higher than those in the non-recurrent,while the mean Young's modulus was lower than that in the non-recurrent group(P<0.05).Multivariate logistic regres-sion analysis showed that CEUS blood flow level Ⅲ to Ⅳ,high 2-IMT,large 3-3D total carotid plaque area(TPA)and low mean Young's modulus were risk factors for recurrence in IS patients,and good medication compliance was a protec-tive factor(P<0.05).ROC curve analysis showed that the AUC of 2-D IMT,3-D TPA,mean Young's modulus and CEUS blood flow Ⅲ to Ⅳ in predicting recurrence of in IS patients were 0.674,0.717,0.729 and 0.746,respectively.The combined predictive AUC of 0.908 was higher than that of single detection(P<0.05).Conclusion 2D,3D and SWE and CEUS ultrasound techniques have some clinical value in predicting the recurrence of IS by evaluating carotid plaque instability,and the combined value of the four is higher.

Ischemic strokeCarotid artery plaqueThree-dimensional ultrasoundContrast-enhanced ultrasoundShear-wave elastography

张茜、勉丽、王霞

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省部共建中亚高发病成因与防治国家重点实验室,新疆医科大学第二附属医院超声诊断科,新疆乌鲁木齐 830063

缺血性脑卒中 颈动脉斑块 三维超声 超声造影 剪切波弹性成像技术

省部共建中亚高发病成因与防治国家重点实验室开放课题项目

SKL-HIDCA-2022-NKX8

2024

中华全科医学
中华预防医学会,安徽省全科医学会

中华全科医学

CSTPCD
影响因子:1.688
ISSN:1674-4152
年,卷(期):2024.22(7)