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中华医学超声杂志(电子版) ›› 2016, Vol. 13 ›› Issue (04) : 266 -270. doi: 10.3877/cma.j.jssn.2095-5820.2016.04.007

所属专题: 文献

头颈部超声影像学

超声造影评级联合血同型半胱氨酸对动脉硬化型缺血性脑卒中发生的相关研究
贲志飞1, 陈韵雯1, 俞虎2, 管琼峰2, 范振毅2, 王铮铮3, 陈赛君1,()   
  1. 1. 315000 宁波市第二医院超声科
    2. 315000 宁波市第二医院神经内科
    3. 315000 宁波市第二医院检验科
  • 收稿日期:2015-01-06 出版日期:2016-04-01
  • 通信作者: 陈赛君
  • 基金资助:
    宁波市社发攻关项目(2014C50062)

The value of contrast-enhanced ultrasound grading of carotid plaques combined with blood homocysteine level in predicting the occurrence of arteriosclerotic ischemic stroke

Zhifei Ben1, Yunwen Chen1, Hu Yu2, Qiongfeng Guan2, Zhenyi Fan2, Zhengzheng Wang3, Saijun Chen1,()   

  1. 1. Department of Ultrasound, Ningbo NO.2 Hospital, Ningbo 31500, China
    2. Department of Internal Medicine, Ningbo NO.2 Hospital, Ningbo 31500, China
    3. Department of Clinical Laboratory, Ningbo NO.2 Hospital, Ningbo 31500, China
  • Received:2015-01-06 Published:2016-04-01
  • Corresponding author: Saijun Chen
  • About author:
    Corresponding author: Chen Saijun, Email:
引用本文:

贲志飞, 陈韵雯, 俞虎, 管琼峰, 范振毅, 王铮铮, 陈赛君. 超声造影评级联合血同型半胱氨酸对动脉硬化型缺血性脑卒中发生的相关研究[J/OL]. 中华医学超声杂志(电子版), 2016, 13(04): 266-270.

Zhifei Ben, Yunwen Chen, Hu Yu, Qiongfeng Guan, Zhenyi Fan, Zhengzheng Wang, Saijun Chen. The value of contrast-enhanced ultrasound grading of carotid plaques combined with blood homocysteine level in predicting the occurrence of arteriosclerotic ischemic stroke[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(04): 266-270.

目的

探讨颈动脉斑块超声造影评级和血同型半胱氨酸(Hcy)与动脉硬化型缺血性脑卒中的相关性。

方法

选择2013年10月至2014年7月宁波市第二医院神经内科患者159例,根据中国缺血性脑卒中诊断标准及改良TOAST分型,选择其中动脉硬化型缺血性脑卒中及非缺血性脑卒中患者,分别进入A组和B组,其中A组72例,B组76例。所有患者均进行颈动脉斑块超声造影评级和血Hcy检测,分别采用Spearman相关性检验和Pearson相关性检验分析颈动脉斑块超声造影评级、血Hcy水平与动脉硬化型缺血性脑卒中发生的相关性。

结果

(1)A、B组斑块厚度和斑块类型之间比较,差异无统计学意义(F=0.865、0.827,P值均>0.05),超声造影评级之间比较,差异具有统计学意义(Z=192.350,P<0.01),以超声造影评级≥3级作为预测发生动脉硬化型缺血性脑卒中的诊断标准,则其敏感度和特异度分别为94.44%、94.74%;(2)A、B组患者间血Hcy水平比较,差异具有统计学意义(t=152.383,P<0.01),ROC曲线下面积为0.978,以血Hcy≥13.50 μmol/L作为诊断标准,预测动脉硬化型缺血性脑卒中发生的敏感度、特异度分别为97.21%、90.80%;(3)以颈动脉斑块超声造影评级≥3级或血Hcy≥13.50 μmol/L作为诊断标准预测颈动脉粥样硬化性缺血性脑卒中发生的敏感度、特异度分别为98.71%、96.45%;(4)颈动脉斑块超声造影评级、血Hcy水平与颈动脉粥样硬化性缺血性脑卒中之间存在高度线性正相关(r=0.865、0.827,P值均<0.01)。

结论

颈动脉斑块超声造影评级和血同型半胱氨酸可作为动脉硬化型缺血性脑卒中的重要检查手段,为临床二级预防提供重要信息。

Objective

To discuss the correlation between contrast-enhanced ultrasound grading of carotid plaque combined with blood homocysteine (Hcy) and arteriosclerotic ischemic stroke.

Methods

From October 2013 to July 2014, 159 patients at the department of neurology in Ningbo No.2 Hospital, according to the clinical guideline (Chinese ischemic stroke diagnostic criteria and improved TOAST classification), were respectively distributed into two groups: group A with 72 subjects of atherosclerotic ischemic stroke and group B with 76 subjects of non-ischemic stroke. All patients underwent contrast-enhanced ultrasound of carotid plaque and blood Hcy level. Spearman and Pearson correlation analysis were used respectively to test the correlation between arteriosclerotic ischemic stroke and carotid plaques contrast-enhanced ultrasound grade as well as blood Hcy level.

Results

(1) The difference of the atherosclerotic plaque thickness and the plaque type in conventional ultrasound wasn′t significant statistical between group A and B (F=0.865, 0.827, all P>0.05). But there was a significant difference in the contrast-enhanced ultrasound grade (Z=192.350, P<0.01). With the contrast-enhanced ultrasound grade ≥3 as the diagnostic criteria to predict the occurrence of arteriosclerotic ischemic stroke, its sensitivity and specificity were 94.44% and 94.74%, respectively. (2) The difference between two groups in blood Hcy level was statistically significant (t=152.383, P<0.01). The area under the ROC curve was 0.978. With blood Hcy ≥13.50 μmol/L as diagnostic criteria to predict the occurrence of arteriosclerotic ischemic stroke, its sensitivity and specificity were 97.21% and 90.80%, respectively. (3) With the contrast-enhanced ultrasound grade ≥3 or blood Hcy ≥13.50 μmol/L as diagnostic criteria to predict the occurrence of arteriosclerotic ischemic stroke, its sensitivity and specificity were 98.71%, and 96.45%, respectively. (4) There were high linear correlations between arteriosclerotic ischemic stroke and contrast-enhanced ultrasound grade as well as blood Hcy level (r=0.865, 0.827, all P<0.01).

Conclusions

Contrast-enhanced ultrasound grading of carotid plaque and blood Hcy level could be used as an important predictive indicator of arteriosclerotic ischemic stroke, and provided important information for clinical secondary prevention.

图2 左侧颈总动脉后壁斑块超声造影声像图,斑块内出现弥漫增强,超声造影评级为4级
表1 动脉硬化型缺血性脑卒中组与非缺血性脑卒中组间颈动脉斑块超声检查情况(例)
图3 血Hcy水平预测动脉硬化型缺血性脑卒中的ROC曲线
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