头颈CTA联合血清HCY、sdLDLC对脑梗死的诊断价值

Diagnostic value of head and neck CTA combined with serum HCY and sdLDLC in cerebral infarction

目的研究头颈CT血管成像(CTA)联合血清同型半胱氨酸(HCY)、小而密低密度脂蛋白(sdLDLC)对脑梗死的诊断价值。方法回顾性选择2022年9月至2022年10月入住苏州市第九人民医院的脑梗死患者56例纳入研究组,选取同期体检且颈动脉及脑血管正常者56名纳入对照组。研究组患者根据颈动脉狭窄分级分为:轻度狭窄患者12例,重度狭窄患者14例,中度狭窄患者25例,闭塞患者5例。以彩色超声检查两组脑血流动力学指标,研究组行头颈CTA诊断,检测血清HCY、sdLDLC水平。观察两组大脑中动脉VM、大脑中动脉PI等脑血流动力学指标;两组血清HCY、sdLDLC水平;研究组颈动脉不同狭窄分级患者血清HCY、sdLDLC水平及脑血流动力学指标情况。分析脑血流动力学指标及血清HCY、sdLDLC与颈动脉狭窄分级的相关性。结果研究组血清HCY、sdLDLC水平为(22.06±2.43)μmol/L、(1.55±0.18)mmol/L,均高于对照组[(16.96±1.84)μmol/L、(0.49±0.07)mmol/L],大脑中动脉VM、大脑中动脉PI为(49.86±5.31)、(0.68±0.07)cm/s,均低于对照组[(56.98±5.93)、(0.82±0.09)cm/s],差异均有统计学意义(P<0.05)。研究组不同颈动脉狭窄分级患者大脑中动脉VM、大脑中动脉PI及血清HCY、sdLDLC水平差异均有统计学意义(P<0.05),颈动脉闭塞、狭窄越严重,患者大脑中动脉VM、大脑中动脉PI水平越低,血清HCY、sdLDLC水平越高。经Pearson相关分析,大脑中动脉VM、大脑中动脉PI及血清HCY、sdLDLC水平与颈动脉狭窄分级正相关(r=0.327、0.336、0.450、0.385,P<0.05)。结论脑梗死患者均存在程度不同的颈动脉狭窄、脑血流动力学改变及血清HCY、sdLDLC水平异常升高,且大脑中动脉VM、大脑中动脉PI及血清HCY、sdLDLC水平与颈动脉狭窄分级正相关,提示头颈CTA联合血清HCY、sdLDLC对脑梗死具有较高的诊断价值。

Objective To investigate the diagnostic value of head and neck CT angiography(CTA)combined with serum homocysteine(HCY)and small dense low-density lipoprotein(sdLDLC)in cerebral infarction.Methods A total of 56 patients with cerebral infarction admitted to the Ninth People’s Hospital in Suzhou from July 2019 to June 2022 were retrospectively selected as the study group,and 56 patients with normal carotid artery and cerebrovascular in the Ninth People’s Hospital in Suzhou during the same period were selected as the control group.The patients in the study group were divided into 12 patients with mild stenosis,25 patients with moderate stenosis,14 patients with severe stenosis,and 5 patients with occlusion according to the classification of carotid stenosis.Color ultrasound was used to examine the cerebral hemodynamic indexes of the two groups.The study group was diagnosed by head and neck CTA,and serum levels of HCY and sdLDLC were detected.The cerebrovascular hemodynamic indexes such as VM and PI of middle cerebral artery were observed in the two groups.Serum levels of HCY and sdLDLC in the two groups.Serum levels of HCY,sdLDLC and cerebrovascular hemodynamics in patients with different grades of carotid artery stenosis in the study group.The correlation between cerebrovascular hemodynamic indexes,serum HCY,sdLDLC and carotid stenosis grade was analyzed.Results The serum levels of HCY and sdLDLC in the study group were(22.06±2.43)μmol/L,(1.55±0.18)mmol/L,which were higher than those in the control group[(16.96±1.84)μmol/L,(0.49±0.07)mmol/L],and the VM and PI of the middle cerebral artery were(49.86±5.31),(0.68±0.07)cm/s,which were lower than those in the control group[(56.98±5.93),(0.82±0.09)cm/s],the differences were statistically significant(P<0.05).There were significant differences in VM,PI and serum HCY and sdLDLC levels in patients with different grades of carotid artery stenosis in the study group,the differences were statistically significant(P<0.05),the more severe the carotid artery occlusion and stenosis,the lower the VM and PI levels of the middle cerebral artery,and the higher the serum HCY and sdLDLC levels.Pearson correlation analysis showed that VM,PI,HCY and sdLDLC levels in the middle cerebral artery were positively correlated with the grade of carotid stenosis(r=0.327,0.336,0.450,0.385,P<0.05).Conclusion All patients with cerebral infarction have different degrees of carotid artery stenosis,cerebral hemodynamic changes and abnormal elevation of serum levels of HCY and sdLDLC,and the levels of VM,PI,HCY and sdLDLC in middle cerebral artery are positively correlated with the grade of carotid artery stenosis.It is suggested that head and neck CTA combined with serum HCY and sdLDLC has high diagnostic value for cerebral infarction.