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。

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。

（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）。

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。

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

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.

(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).

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.