缺血性脑血管病患者颈动脉内-中膜厚度及斑块分级对颅内外大动脉狭窄的预测价值

Predictive value of carotid intima media thickness and carotid plaque scores on extracranial or intracerebral artery stenosis in patients with ischemic cerebrovascular disease

目的探讨缺血性脑血管病（ICVD）患者颈动脉内-中膜厚度（IMT）和斑块分级对颅内外大动脉狭窄的预测价值。方法对459例ICVD患者进行颈动脉IMT及斑块检测。采用数字减影血管造影（DSA）对患者颅内外大动脉进行检查。根据有无颅内外大动脉狭窄及狭窄部位将患者分为无动脉狭窄组、颅外动脉狭窄组、颅内动脉狭窄组和颅内外动脉狭窄组;根据狭窄程度又将各狭窄组分轻、中、重度狭窄亚组。比较各组间颈动脉IMT及斑块分级,分析其对颅内外大动脉狭窄的预测价值。结果本组中399例ICVD患者（86.9%）伴颅内外大动脉狭窄。各狭窄组间对应亚组的颈动脉IMT及斑块分级比较,差异均无统计学意义。各狭窄组中,中、重度狭窄亚组颈动脉IMT≥1.07 mm,斑块分级为3,均较无动脉狭窄组及轻度狭窄亚组显著增高（P〈0.05~0.01）。ROC分析结果显示,颈动脉IMT增厚及斑块分级增加可预测中、重度颅内外大动脉狭窄（均P〈0.01）。将颈动脉IMT≥1.07 mm及斑块分级为3作为预测中、重度颅内外大动脉狭窄的截断值,其敏感度均≥49.17%,特异度均≥81.67%,准确度均≥62.78%。结论颈动脉IMT≥1.07 mm及斑块分级为3对ICVD患者发生中、重度颅内外大动脉狭窄有一定的预测价值。

Objective To explore the predictive value of carotid intima media thickness（IMT） and carotid plaque scores on extracranial or intracerebral artery stenosis in patients with ischemic cerebrovascular disease（ICVD）.Methods The carotid IMT and plaques of 459 ICVD patients were detected.The digital subtraction angiography（DSA） was used to detect the extracranial and intracerebral artery.According to the existing and the position of extracranial or intracerebral artery stenosis,they were divided into no stenosis group,extracranial artery stenosis group,intracerebral artery stenosis group and extracranial-intracerebral artery stenosis group.And according to the severity of stenosis,each stenosis group was divided into slight,midrange and severe sub-groups,separately.The carotid IMT and plaques score of these groups were compared with each other,and the predictive value of which on extracranial or intracerebral artery stenosis was analyzed.Results There were 399 ICVD patients（86.9%） with extracranial or intracerebral artery stenosis in this group.And there were no significant difference of carotid IMT and carotid plaques score among the stenosis groups.In each stenosis group,the carotid IMT in midrange and severe stenosis sub-groups were ≥1.07 mm,and the carotid plaques score in midrange and severe stenosis sub-groups were 3,which were all significantly higher than in the no stenosis group and slight stenosis sub-groups（P0.01-0.05）.ROC analysis showed that the increases of carotid IMT and plague score can predict midrange to severe extracranial or intracerebral artery stenosis.To predict midrange to severe extracranial or intracerebral artery stenosis,when the cut-off value of carotid IMT≥1.07 mm and plague score was 3,the sensitivity was ≥49.17%,the specificity was ≥81.67% and the accuracy rate was ≥62.78%.Conclusion The carotid IMT≥1.07 mm and plague score is 3 may be valuable to predict midrange to severe extracranial or intracerebral artery stenosis in ICVD patients.