CT联合血清指标评价脑梗死患者颈动脉粥样硬化的临床价值

Clinical value of CT combined with serum index in assessing carotid atherosclerosis in cerebral infarction patients

目的探讨16层螺旋CT联合基质金属蛋白酶9(MMP-9)、金属蛋白酶组织抑制因子1(TIMP-1)用于老年脑梗死患者颈动脉粥样硬化的临床价值。方法选择我院神经内科收治的186例脑梗死患者作为A组,依据超声检查将患者分为不稳定斑块组(A-1组,107例)、稳定斑块组(A-2组,43例)和无斑块组(A-3组,36例);同期收治190例无症状颈动脉粥样硬化患者作为B组,依据超声检查分为不稳定斑块组(B-1组,33例)、稳定斑块组(B-2组,55例)和无斑块组(B-3组,102例),同期体检的90例健康者作为对照组,所有研究对象入院后接受多层螺旋CT血管成像(MSCTA)、多普勒超声检查,并取血测定血清MMP-9、TIMP-1水平。比较各组颈动脉狭窄情况、斑块检出情况,并分析MMP-9、TIMP-1诊断脑梗死患者不稳定斑块的效果。结果 MSCTA颈动脉狭窄检出A组轻度狭窄率显著低于B组(23.1%vs 48.9%,P=0.000),重度狭窄率显著高于B组(48.4%vs 16.8%,P=0.000);MSCTA检出A组、B组的斑块稳定性情况与超声检查一致率分别为81.7%和83.2%;MSCTA检出A组稳定斑块与不稳定斑块[(147±71)HUvs(11±20)HU]、B组稳定斑块与不稳定斑块[(155±81)HUvs(9±21)HU]的CT测量值比较差异有统计学意义(P=0.000);与对照组比较,A-1组、A-2组、B-1组血清MMP-9、TIMP-1水平显著升高,差异有统计学意义(P<0.01)。MMP-9、TIMP-1诊断脑梗死患者不稳定斑块的ROC曲线下面积分别为0.891、0.814。结论 MSCTA能够准确检测老年脑梗死患者颈动脉粥样硬化狭窄,但容易误判斑块性质,血清MMP-9、TIMP-1可有效诊断老年脑梗死患者不稳定斑块,可作为MSCTA的重要补充。

Objective To study the clinical value of 16-slice spiral CT combined with MMP-9 and TIMP-1 in assessing carotid atherosclerosis in elderly cerebral infarction（CI）patients.MethodsOne hundred and eighty-six CI patients served as group A and 190 asymptomatic carotid atherosclerosis patients served as group B with 90 healthy subjects served as a control group in this study.The patients in group A were further divided into unstable plaque（A-1）group,stable plaque（A-2）group and plaque-free（A-3）group while those in group B were further divided into unstable plaque（B-1）group,stable plaque（B-2）group and plaque-free（B-3）group.The patients included in this study underwent multislice spiral CT angiography（MSCTA）and Doppler ultrasonography.Their serum levels of MMP-9 and TIMP-1 were measured.Their carotid artery stenosis and plaques were detected.The efficacy of MMP-9 and TIMP-1 in diagnosis of unstable plaques in CI patients was analyzed.Results The rate of mild stenosis detected by MSCTA was significantly lower while that of severe stenosis detected by MSCTA was significantly higher in group A than in group B（23.1%vs 48.9%,P=0.000;48.4%vs 16.8%,P=0.000）.The rate of unstable plaques detected by MSCTA and ultrasonography was 81.7%and 83.2%respectively in groups A and B.The rate of stable and unstable plaques detected by MSCTA was significantly higher in group A than that detected by CT in group B（147±71 HUvs 11±20 HU,155±81 HU vs 9±21 HU,P=0.000）.The serum levels of MMP-9 and TIMP-1 were significantly higher in A-1 group and A-2 group,B-1 group and B-2 group than in control group（P〈0.01）.The area under the ROC curve for MMP-9 and TIMP-1 in diagnosis of unstable plaques was 0.891 and 0.814 respectively.Conclusion MSCTA can accurately detect carotid atherosclerosis in elderly CI patients.However,it is easy to misjudge the nature of plaques.Serum levels of MMP-9 and TIMP-1 can effectively diagnose unstable plaques and can thus be used as an important supplement to MSCTA.