超声弹性成像联合血清胱抑素C、D-二聚体对颈动脉斑块稳定性的评估价值

Value of ultrasound elastography combined with serum cystatin C and D-dimer on evaluating the stability of carotid plaque

目的探讨超声弹性成像联合血清胱抑素C(CysC)、D-二聚体(D-dimer)对脑梗死病人颈动脉斑块稳定性的评估价值。方法选取2019年1月至2020年5月郑州大学附属郑州中心医院收治的98例脑梗死病人为研究对象(脑梗死组),同期选取82例健康体检者作为对照组。根据内-中膜厚度(IMT),将脑梗死病人分为12例IMT正常组、19例内膜增厚组、67例斑块形成组;根据斑块回声特点,将斑块形成组病人分为35例规则形均质回声斑块组和32例不规则形不均质回声斑块组。采用超声诊断仪检测病人颈动脉感兴趣区斑块(A)、颈动脉管壁应变值(B),计算B/A比值;采用酶联免疫吸附(ELISA)法检测血清CysC、D-dimer水平;分析不规则形不均质回声斑块组脑梗死病人超声弹性成像参数B/A比值与血清CysC、D-dimer的相关性;分析超声弹性成像参数B/A比值、血清CysC、D-dimer对颈动脉不规则形不均质回声斑块的评估价值;分析影响颈动脉斑块稳定性的因素。结果脑梗死组病人血清CysC、D-dimer水平高于对照组(P<0.05);斑块形成组病人血清CysC、D-dimer水平高于内膜增厚组和IMT正常组(P<0.05);不规则形不均质回声斑块组B/A比值低于规则形均质回声斑块组,血清CysC、D-dimer水平高于规则形均质回声斑块组(P<0.05);B/A比值与血清CysC、D-dimer水平均呈负相关(r=−0.56、−0.58;均P<0.05);B/A比值、血清CysC、D-dimer评估颈动脉不规则形不均质回声斑块的曲线下面积(AUC)分别为0.876、0.895、0.804,特异性分别为84.2%、97.5%、60.8%,灵敏度分别为79.6%、76.5%、88.3%;三者联合评估颈动脉不规则形不均质回声斑块的AUC为0.956,特异性为97.4%,灵敏度为82.9%;CysC、D-dimer是影响颈动脉不规则形不均质回声斑块出现的独立危险因素(P<0.05),B/A比值是影响颈动脉不规则形不均质回声斑块出现的保护因素(P<0.05)。结论超声弹性成像、血清CysC、D-dimer对颈动脉斑块稳定性有一定的评估价值,且三者联合后评估效果更明显。

Objective To investigate the value of ultrasound elastography combined with serum cystatin C(Cys C) and D-Dimer(Ddimer) on evaluating the stability of carotid plaque in patients with cerebral infarction.Methods Ninety-eight patients with cerebral infarction in Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2019 to May 2020 were selected as the research objects(cerebral infarction group),at the same time,82 healthy people were selected as the control group.According to the inner-media thickness(IMT),patients with cerebral infarction were assigned into 12 cases of normal IMT group,19 cases of intimal thickening group and 67 cases of plaque formation group;according to the characteristics of plaque echo,the plaque formation group was assigned into 35 stable plaque group and 32 vulnerable plaque group.The carotid plaques in the area of interest(A) and carotid artery wall strain(B) were detected by ultrasonic diagnostic instrument,and the B/A ratio was calculated;the levels of serum Cys C and D-dimer were detected by enzyme-linked immunosorbent assay(ELISA);the correlation between B/A ratio and serum Cys C,D-dimer in patients with cerebral infarction in vulnerable plaque group was analyzed;the values of B/A ratio,serum Cys C and D-dimer in the evaluation of vulnerable carotid plaque were analyzed;and the factors influencing the stability of carotid plaque were analyzed.Results The levels of serum Cys C and D-dimer in cerebral infarction group were higher than those in control group(P<0.05);the levels of serum Cys C and D-dimer in plaque forming group were higher than those in intimal thickening group and normal IMT group(P<0.05);the B/A ratio of vulnerable plaque group was lower than that of stable plaque group,levels of serum Cys C,D-dimer were higher than those in stable plaque group(P<0.05);B/A ratio was negatively correlated with levels of serum Cys C and D-dimer(r=-0.56,-0.58;P<0.05);the area under the curve(AUC) of B/A ratio,serum Cys C and D-dimer in evaluation for vulnerable carotid plaques was 0.876,0.895 and0.804 respectively,the specificity was 84.2%,97.5%,60.8%,and the sensitivity was 79.6%,76.5% and 88.3%,respectively;the AUC of the combined evaluation was 0.956,the specificity was 97.4%,and the sensitivity was 82.9%;Cys C and D-dimer were independent risk factors of vulnerable carotid plaque(P<0.05),and B/A ratio was a protective factor(P<0.05).Conclusion Ultrasound elastography,serum Cys C and D-dimer have certain evaluation value on the stability of carotid plaque,and the combined evaluation effect is more obvious.