颈动脉斑块灰阶中位数、斑块总体积及其比值Q与缺血性脑梗死的相关性研究

Study on the correlation between gray-scale median,total plaque volume,ratio Q in carotid plaque and stroke

目的应用三维超声测量颈动脉斑块的灰阶中位数(GSM)和斑块总体积(TPV),分析GSM、TPV及二者比值(Q)与缺血性脑梗死发生的相关性。方法随机选取颈动脉斑块患者107例,根据其颅脑CT和MRI检查结果,将颈动脉斑块与脑梗死发生部位为同侧者66例判定为脑梗死组(A组),将颈动脉斑块与脑梗死发生部位为异侧者41例判定为非脑梗死组(B组)。两组患者均行三维超声检查,应用QLAB-VPQ软件获取GSM和TPV,并计算其比值Q,分析GSM、TPV及Q值与缺血性脑梗死的相关性。绘制ROC曲线比较GSM、TPV及Q值诊断缺血性脑梗死的曲线下面积和95%可信区间。结果 A、B组GSM、TPV及Q值行Wilcoxon秩和检验,差异均有统计学意义(Z=-1.644、-4.515、-4.857,P=0.032、0.043、0.000)。非条件Logistic回归分析显示,GSM的OR值为1.078(1.024~1.135),TPV的OR值为1.037(1.019~1.056),Q值的OR值为1.015(1.007~1.024)。ROC曲线显示GSM诊断缺血性脑梗死的曲线下面积为0.812,95%可信区间0.729~0.894(P=0.000);TPV诊断缺血性脑梗死的曲线下面积为0.806,95%可信区间0.729~0.891(P=0.000);Q值诊断缺血性脑梗死的曲线下面积为0.821,95%可信区间0.743~0.899(P=0.000)。结论 GSM、TPV及Q值均与缺血性脑梗死的发生具有一定相关性,Q值的诊断价值最高。

Objective To measure the gray-scale median(GSM) and total plaque volume(TPV) in carotid plaque by three-dimensional ultrasonography,and to analyze the correlation between GSM,TPV,the ratio Q and stroke.Methods A total of 107 patients with carotid plaque were randomly selected,based on cranial CT and MRI findings,66 cases of carotid plaque and stroke occurred in the same side were identified as stroke group(group A),and 41 cases of carotid plaque and stroke occurred in the opposite side were identified as non-stroke group(group B). Three-dimensional ultrasonography was performed on both groups,and GSM and TPV were obtained by QLAB-VPQ software,the ratio Q was calculated to analyze their correlation with stroke.ROC curve was drawn to obtain the area under curve and 95%CI by using GSM,TPV and ratio Q in diagnosis of stroke. Results The Wilcoxon rank-sum test of GSM,TPV and ratio Q between group A and group B were performed,there were significant difference(Z=-1.644,-4.515,-4.857,P=0.032,0.043,0.000). Unconditional logistic regression analysis showed that OR of GSM was calculated as 1.078(1.024~1.135), OR of TPV was calculated as 1.037(1.019~1.056),OR of ratio Q was calculated as 1.015(1.007~1.024). ROC curve showed that AUC of GSM in diagnosis of stroke was 0.812, 95%CI 0.729~0.894(P=0.000), AUC of TPV in diagnosis of stroke was 0.806,95%CI 0.729~0.891(P=0.000),AUC of ratio Q in diagnosis of stroke was 0.821, 95%CI 0.743~0.899(P=0.000).Conclusion GSM,TPV and ratio Q has a certain correlation with the occurrence of stoke,ratio Q with the highest diagnostic value.