剪切波弹性成像联合Lp-PLA2定量评估颈动脉斑块与脑梗死再发关系

Quantitative evaluation of the relationship between carotid plaque and recurrent cerebral infarction by shear wave elastography combined with Lp-PLA2

目的应用超声剪切波弹性成像联合血清脂蛋白相关磷脂酶A2(Lp-PLA2)定量分析颈动脉斑块的稳定性对脑梗死再发的预测价值。方法选择首次诊断为脑梗死并做常规彩超证实有颈动脉斑块的125例患者作为研究对象,记录患者的性别、年龄、体质指数(BMI)、高血压、糖尿病、高脂血症情况,对其Lp-PLA2水平进行检测,并行颈动脉剪切波弹性成像检查,随访1年,建立各有统计学差异指标的受试者工作特征(ROC)曲线,评估各指标及联合指标对颈动脉斑块引发脑梗死再发的预测价值。结果两组间性别、年龄、体质指数(BMI)、高血压、糖尿病、高脂血症情况无明显差异,脑梗死再发组Emean、Emax、Emin均低于脑梗死未再发组(P<0.05),而脑梗死再发组Lp-PLA2水平高于脑梗死未再发组(P<0.05)。以Emean≤19.1 kPa且Lp-PLA2≥226.5 ng/ml为最佳截断值,两者联合预测脑梗再发的AUC为0.909〔95%CI(0.857,0.962)〕,其灵敏度为89.8%,特异度为84.2%。结论超声剪切波弹性成像和Lp-PLA2对脑梗死再发具有一定的预测价值,两者联合应用预测脑梗再发的灵敏度及特异度更高,可作为预测脑梗死再发的定量指标。

Objective To quantitatively analyze the value of carotid plaque stability in predicting the recurrence of cerebral infarction by ultrasonic shear wave elastography combined with serum lipoprotein associated phospholipase A2(Lp-PLA2).Methods A total of 125patients with carotid plaque diagnosed for the first time by color Doppler ultrasound were selected as subjects.The sex,age,body mass index(BMI),hypertension,diabetes mellitus and hyperlipidemia were recorded.The level of Lp-PLA2 was detected and carotid artery shear wave elastography was performed.The subjects were followed up for one year,and the working characteristic(ROC)curves of the subjects with statistical differences were established.We evaluated the predictive value of each index and combined index in the recurrence of cerebral infarction caused by carotid plaque.Results There was no significant difference in sex,age,body mass index(BMI),hypertension,diabetes and hyperlipidemia between the two groups.Emean,Emax and Emin in recurrent cerebral infarction group were lower than those in non-recurrent cerebral infarction group,while the level of Lp-PLA2 in recurrent cerebral infarction group was higher than that in non-recurrent cerebral infarction group.Taking Emean≤19.1 kPa and Lp-PLA2≥226.5 ng/ml as the best cut-off value,the AUC for predicting recurrent cerebral infarction was 0.909〔95%CI(0.857)0.962〕,the sensitivity was 89.8%,and the specificity was 84.2%.Conclusion Ultrasonic shear wave elastography and Lp-PLA2 have a certain predictive value for the recurrence of cerebral infarction,and the combination of the two has higher sensitivity and specificity in predicting the recurrence of cerebral infarction,and can be used as a quantitative index to predict the recurrence of cerebral infarction.