短暂性脑缺血发作患者颈动脉狭窄程度与颈动脉斑块易损性关系及对近期缺血性脑卒中的预测价值研究

Relationship between degree of carotid artery stenosis and vulnerability to carotid plaque in patients with transient ischemic attack and its predictive value for recent ischemic stroke

目的:分析短暂性脑缺血发作患者颈动脉狭窄程度与颈动脉斑块易损性的关系及对早期脑卒中的预测价值。方法:选取206例短暂性脑缺血发作患者作为研究对象,均进行颈动脉超声检查,明确颈动脉狭窄程度,分为明显狭窄组(狭窄率≥30%)和非明显狭窄组(狭窄率<30%);所有患者均接受高分辨磁共振斑块成像检查,定量分析责任侧颈动脉粥样硬化斑块病变参数,使用Pearson相关性分析颈动脉狭窄程度与斑块相关特征的关系;随访12个月,观察缺血性脑卒中发生情况,通过受试者工作特征曲线(ROC)下面积(AUC)评价颈动脉狭窄程度对缺血性脑卒中的预测效能。结果:明显狭窄组与非明显狭窄组的责任侧颈动脉粥样硬化斑块病变参数比较,差异有统计学意义(均P<0.05);经Peason相关性分析,短暂性脑缺血发作患者颈动脉狭窄程度与最大管壁厚度(maxWT)和富脂质核(LRNC)%均呈正相关(r=0.642、0.718,均P=0.000);所有患者均获得随访12个月,发生缺血性脑卒中42例,占20.39%。经ROC曲线分析,颈动脉狭窄程度预测短暂性脑缺血发作患者发生缺血性脑卒中的AUC为0.869。结论:短暂性脑缺血发作患者颈动脉狭窄程度与斑块易损性呈正相关,预测近期缺血性脑卒中发生的效能较好,值得临床予以重视应用。

Objective:To analyze the relationship between carotid artery stenosis degree and vulnerability to carotid plaque in patients with transient ischemic attack and its predictive value for recent ischemic stroke.Methods:206 patients with transient ischemic attack were selected as the subjects.All patients underwent carotid artery ultrasound examination to determine the degree of carotid artery stenosis,and were divided into obvious stenosis group(stenosis rate≥30%)and non-obvious stenosis group(stenosis rate<30%).All patients received high resolution magnetic resonance plaque imaging,and the lesion parameters of carotid atherosclerotic plaque on the responsible side were quantitatively analyzed.Pearson correlation analysis was used to analyze the relationship between the degree of carotid artery stenosis and plaque related characteristics.After 12 months of follow-up,the incidence of ischemic stroke was observed,and the area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the predictive efficiency of carotid artery stenosis on ischemic stroke.Results:There were statistically significant differences in the lesion parameters of carotid atherosclerotic plaque on the responsible side between the obvious stenosis group and the non-obvious stenosis group(all P<0.05).Through Peason correlation analysis,the degree of carotid stenosis was positively correlated with maxWT and LRNC%(r=0.642,0.718,all P=0.000).All patients were followed up for 12 months,and 42 patients(20.39%)had ischemic stroke.According to ROC curve analysis,the AUC of degree of carotid stenosis in predicting ischemic stroke in patients with transient ischemic attack was 0.869.Conclusion:The degree of carotid stenosis in patients with transient ischemic attack is positively correlated with plaque vulnerability,which is effective in predicting the occurrence of recent ischemic stroke and deserves clinical attention.