超声造影参数在评估急性脑梗死患者新生血管分级及颈动脉斑块稳定性中的应用价值

doi:10.3969/j.issn.1006-6233.2024.02.025

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摘要 目的: 探讨超声造影(CEUS)参数在评估急性脑梗死(ACI)患者新生血管分级及颈动脉斑块稳定性中的应用价值。方法: 选取我院2020年5月至2023年5月收治的115例ACI患者。所有患者均进行CEUS检查,对比不同新生血管分级和颈动脉斑块稳定性患者CEUS参数[达峰时间(Tp)、平均渡越时间(MTT)、时间-强度曲线下面积(AUCt)、峰值强度比值(PI)],采用Spearman相关分析CEUS参数与ACI新生血管分级相关性,采用受试者工作特征(ROC)曲线分析CEUS参数在评估颈动脉斑块稳定性中的应用价值。结果: CEUS检出ACI患者新生血管分级0级11例,1级33例,2级71例,占比分别为9.57%、28.70%、61.74%;三组Tp、MTT值比较均为0级>1级>2级(P<0.05),三组AUCt、PI值比较均为0级<1级<2级(P<0.05);Spearman相关分析发现,Tp、MTT与新生血管分级呈负相关(P<0.05),AUCt、PI与新生血管分级呈正相关(P<0.05)。CEUS检出软斑块(不稳定)85例,占比为73.91%,稳定斑块30例,其中硬斑块14例,占比为12.17%,混合斑块16例,占比为13.91%;三组Tp、MTT值比较均为软斑块<混合斑块<硬斑块(P<0.05),三组AUCt、PI值比较均为软斑块>混合斑块>硬斑块(P<0.05);作ROC曲线分析从115例患者中预测软斑块的效能显示,Tp、MTT、AUCt、PI及联合检测(并联诊断)对ACI软斑块均有预测效能(P<0.05),其AUC分别为0.778、0.724、0.830、0.817、0.833,单独检测中AUCt效能最高,但仍低于联合检测效能。结论: ACI患者新生血管分级与Tp、MTT呈负相关,AUCt、PI呈正相关,可通过检测Tp、MTT、AUCt、PI指导患者新生血管分级,且颈动脉不稳定斑块患者的Tp、MTT均较稳定性好患者低,AUCt、PI均较稳定性好患者高,CEUS参数用于评估ACI颈动脉斑块稳定性具有较高的效能。

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关键词 ：急性脑梗死, 超声造影, 新生血管, 颈动脉斑块, 稳定性

Abstract：Objective: To explore the application value of contrast-enhanced ultrasound (CEUS) parameters on evaluating the neovascularization grading and carotid plaque stability in patients with acute cerebral infarction (ACI). Methods: A total of 115 patients with ACI admitted to our hospital from May 2020 to May 2023 were selected. All patients underwent CEUS examination, and the CEUS parameters [time to peak (Tp), mean transit time (MTT), area under the time-intensity curve (AUCt), peak intensity (PI)] were compared among patients with different neovascularization grades and carotid plaque stability, and the correlation between CEUS parameters and ACI neovascularization grading was analyzed by Spearman correlation analysis. The application value of CEUS parameters on evaluating carotid plaque stability was analyzed by receiver operating characteristic (ROC) curve. Results: CEUS detected 11 cases of neovascularization grade 0, 33 cases of grade 1 and 71 cases of grade 2, accounting for 9.57%, 28.70% and 61.74% respectively. The Tp and MTT in the three groups were manifested as grade 0>grade 1>grade 2 (P<0.05), and the AUCt and PI were shown as grade 0<grade 1<grade 2 (P<0.05). Spearman correlation analysis found that Tp and MTT were negatively correlated with neovascularization grading (P<0.05) while AUCt and PI were positively correlated with neovascularization grading (P<0.05). CEUS detected 85 cases of soft plaque (unstable) (73.91%) and 30 cases of stable plaque, including 14 cases of hard plaque (12.17%) and 16 cases of mixed plaque (13.91%). Tp and MTT in the three groups showed soft plaque < mixed plaque < hard plaque (P<0.05) while AUCt and PI were shown as soft plaque> mixed plaque > hard plaque (P<0.05). ROC curve analysis showed that Tp, MTT, AUCt, PI and combined detection (parallel diagnosis) had predictive efficiency on ACI soft plaques (P<0.05), with AUCs of 0.778, 0.724, 0.830, 0.817 and 0.833 respectively, and single detection of AUC had the highest efficiency, but was still lower than the combined detection. Conclusion: The neovascularization grading in patients with ACI is negatively correlated with Tp and MTT, and is positively correlated with AUCt and PI. The detection of Tp, MTT, AUCt and PI can guide the neovascularization grading of patients. In addition, the Tp and MTT of patients with carotid unstable plaque are lower than those in patients with good stability, and the AUCt and PI are higher than those in patients with good stability. CEUS parameters are effective in assessing the ACI carotid plaque stability.

Key words： Acute cerebral infarction Contrast-enhanced ultrasound Neovascularization Carotid plaque Stability

基金资助:2019 年高层次卫生人才“六个一工程”拔尖人才科研项目,(编号:LGY2019073)

通讯作者: 魏梅梅

引用本文:

陈烨, 龚怡, 魏梅梅. 超声造影参数在评估急性脑梗死患者新生血管分级及颈动脉斑块稳定性中的应用价值[J]. 河北医学, 2024, 30(2): 301-306.
CHEN Ye, GONG Yi, WEI Meimei. Application Value of Contrast-Enhanced Ultrasound Parameters on Evaluating Neovascularization Grading and Carotid Plaque Stability in Patients with Acute Cerebral Infarction. HeBei Med, 2024, 30(2): 301-306.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.02.025 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I2/301