超声造影评估颈动脉斑块易损性与脑梗死复发的观察

Relationship between vulnerability of carotid artery plaques evaluated by contrast-enhanced ultrasonography and the prognosis of cerebral infarction

对2017年5-10月嘉兴市第二医院收治的72例初发脑梗死患者的临床资料进行回顾性分析,72例患者均行常规超声和超声造影检查评估颈动脉斑块二维回声分级和新生血管分级.72例脑梗死患者颈动脉斑块共113块,1年后复发者27例(复发组,斑块数共44块),45例未复发(未复发组,斑块数共99块).常规超声检查:复发组评估斑块回声分级以Ⅰ级和Ⅱ级为主,Ⅰ~Ⅲ级斑块数分别为23、18、3块,未复发组斑块回声分级以Ⅲ级居多,Ⅰ~Ⅲ级斑块数分别为36、23、40块,两组颈动脉斑块回声分级比较差异有统计学意义(P<0.05);超声造影评估:复发组颈动脉新生血管分级主要为Ⅲ和Ⅳ级,Ⅰ~Ⅳ级斑块数分别为2、5、27、10块,未复发组以Ⅰ和Ⅱ级为主,Ⅰ~Ⅳ级斑块数分别为24、52、14、9块,两组颈动脉新生血管分级比较差异有统计学意义(P<0.05);以回声分级<Ⅱ级、<Ⅲ级以及新生血管分级>Ⅰ级、>Ⅱ级、>Ⅲ级为标准预测脑梗死复发的受试者工作特征曲线下面积(AUC)分别为0.553、0.641、0.587、0.793、0.557,新生血管分级>Ⅱ级预测脑梗死复发的AUC值明显大于其他4个评估指标标准(P<0.01);不同新生血管分级的颈动脉斑块的复发曲线比较,差异有统计学意义(χ^2=49.18,P<0.01).提示超声造影评估颈动脉斑块易损性与脑梗死患者预后关系密切.

Seventy two patients with initial cerebral infarction admitted in the Second Hospital of Jiaxing from March 2017 to October 2017 were enrolled.Patients underwent conventional ultrasonography and contrast-enhanced ultrasonography for two-dimensional echo grading and neovascularization grading of carotid artery plaques respectively.There were 113 carotid plaques in 72 patients with cerebral infarction,27 cases recurred after 1 years with 44 patches.The echo grading of recurrence group was mainly grade Ⅰ and grade Ⅱ,the number of Ⅰ,Ⅱ,and Ⅲ plaques was 23,18,and 3,respectively.The echo grading of non-recurrence group was mainly grade Ⅲ,the number of Ⅰ,Ⅱ,and Ⅲ plaques was 36,23,and 40,respectively.The echo grading of carotid artery plaque between the two groups was significantly different(P<0.05).The grade of carotid neovascularization in recurrence group was mainly grade Ⅲ and grade Ⅳ,the number of Ⅰ,Ⅱ,Ⅲ and Ⅳ plaques was 2,5,27 and 10,respectively.The echo grading of non-recurrence group was mainly grade Ⅰ and grade Ⅱ,the number of Ⅰ,Ⅱ,Ⅲ and Ⅳ plaques was 24,52,14 and 9,respectively.There was significant difference in the grade of carotid neovascularization between the two groups(P<0.05).The area under curve(AUC)of echo grade<Ⅱ,echo grade<Ⅲ,neovascularization grade>Ⅰ,neovascularization grade>Ⅱand neovascularization grade>Ⅲin predicting the recurrence of cerebral infarction were 0.553,0.641,0.587,0.793 and 0.557,respectively,the AUC of neovascularization grade>Ⅱwas significantly higher than the other four criteria(P<0.01).The recurrence curves of carotid plaques with different neovascularization grades were significantly different(χ^2=49.18,P<0.01).Carotid plaque vulnerability evaluated by contrast-enhanced ultrasonography is an effective indicator for predicting recurrence of cerebral infarction.