剪切波弹性成像联合循环血中性粒细胞对粥样硬化性脑梗死的预测价值

Shear Wave Elastography Combined with Circulating Blood Neutrophils in Prediction of Atherosclerotic Cerebral Infarction

目的探讨剪切波弹性成像杨氏模量值联合循环血中性粒细胞诊断动脉粥样硬化性脑梗死(ACI)与预测斑块稳定性的价值。资料与方法回顾性选取2020年1月—2021年5月陕西省人民医院首发缺血性脑梗死患者54例,另选取同期健康体检者54例作为对照组,均进行颈动脉超声检查和外周血生化指标检测,比较两组外周血生化指标。采用受试者工作特征曲线评价中性粒细胞、杨氏模量值诊断ACI的价值。结果脑梗死组循环血低密度脂蛋白胆固醇及中性粒细胞水平高于对照组,差异有统计学意义(t=2.691、2.941,P<0.05);脑梗死组最大弹性模量值(Emax)及平均值均低于对照组,差异有统计学意义(t=3.28、2.90,均P<0.05);中性粒细胞与Emax联合诊断的曲线下面积为0.707(95%CI 0.607~0.807),优于中性粒细胞、Emax单独诊断(Z=2.75、3.42,P<0.05);中性粒细胞诊断ACI的曲线下面积为0.636(95%CI 0.530~0.742),当血清中性粒细胞>3.89×109/L时,其诊断敏感度为74.0%,特异度为45.0%;斑块Emax诊断ACI的曲线下面积为0.617(95%CI 0.505~0.729),当斑块Emax>79 kPa时,其诊断敏感度为81.5%,特异度为54.0%。结论循环血中性粒细胞水平联合剪切波弹性成像有助于评价颈动脉斑块易损性,进而帮助诊断ACI。

Purpose To investigate the value of Young's modulus values of shear wave elastography combined with circulating blood neutrophils in diagnosing atherosclerotic cerebral infarction(ACI)and predicting plaque stability.Materials and Methods Fifty-four patients with first-ever ischemic cerebral infarction from January 2020 to May 2021 in Shaanxi Provincial People's Hospital were retrospectively selected as the cerebral infarction group,and another 54 patients with healthy physical examination in the same period were selected as the control group.Carotid ultrasonography and peripheral blood biochemical indexes were performed,and peripheral blood biochemical indexes were compared between the two groups.Receiver operating characteristic curves were used to explore the diagnostic efficiency of neutrophil and Young's modulus values in patients with ACI.Results The low density lipoprotein cholesterin level and circulating blood neutrophil were significantly higher in the cerebral infarction group than those in the control group(t=2.691,2.941,P<0.05).The maximum modulus of elasticity(Emax)and mean modulus of elasticity were significantly lower in the cerebral infarction group than those in the control group(t=3.28,2.90,P<0.05).The area under the curve of combination between neutrophil and Emax was 0.707(95%CI 0.607-0.807),which was superior to the diagnostic value of neutrophils or Emax,respectively(Z=2.75,3.42,P<0.05).The area under the curve of neutrophil was 0.636(95%CI 0.530-0.742)in patients with ACI,and when serum neutrophil level was higher than 3.89×109/L,the sensitivity and specificity were 74.0%and 45.0%,respectively.The area under the curve of Emax plaque was 0.617(95%CI 0.505-0.729)in patients with ACI,and when the Emax plaque was higher than 79 kPa,the sensitivity and specificity were 81.5%and 54.0%,respectively.Conclusion Combination with circulating blood neutrophil level and shear wave elastography is helpful to evaluate the vulnerability of carotid artery plaque,and further improve the diagnosis of ACI.