颈动脉斑块高分辨MRI、血清ApoB/ApoA1及FT3/FT4与缺血性脑卒中短期预后的关系

Relationship between carotid plaque high-resolution MRI,serum ApoB/ApoA1 and FT3/FT4 and short-term prognosis of ischemic stroke

目的研究高分辨磁共振成像(MRI)评估颈动脉斑块负荷指标、血清载脂蛋白(Apo)B/Apo A1、游离三碘甲状腺原氨酸(FT3)/游离甲状腺素(FT4)评估缺血性脑卒中患者短期预后的价值。方法回顾性分析2019年12月至2023年1月沧州市人民医院收治的98例缺血性脑卒中患者的临床资料,所有患者均接受阿替普酶静脉溶栓治疗,出院后随访3个月,以改良Rankin量表(mRS)分为预后良好组(n=73)、预后不良组(n=25)。采用MRI测量两组颈动脉斑块负荷指标[血管总面积(TVA)、管壁面积(WA)、管腔面积(LA)、管壁标准化指数(NWI)],检测血清Apo B、Apo A1、FT3、FT4水平,并计算其比值Apo B/Apo A1及FT3/FT4;采用受试者操作特征(ROC)曲线分析颈动脉管壁参数联合Apo B/Apo A1及FT3/FT4评估缺血性脑卒中短期预后不良的价值。结果预后不良组TVA、WA、NWI均高于预后良好组,LA低于预后良好组,差异均有统计学意义(P<0.05)。预后不良组血清Apo B水平及Apo B/Apo A1均高于预后良好组,FT3水平及FT3/FT4均低于预后良好组,差异均有统计学意义(P<0.05);两组Apo A1、FT4水平比较,差异均无统计学意义(P>0.05)。TVA、WA、LA、NWI、Apo B/Apo A1、FT3/FT4评估缺血性脑卒中短期预后不良的曲线下面积(AUC)分别为0.725(95%CI:0.601~0.849)、0.746(95%CI:0.640~0.852)、0.905(95%CI:0.842~0.968)、0.893(95%CI:0.823~0.963)、0.957(95%CI:0.918~0.996)、0.868(95%CI:0.790~0.946),颈动脉管壁参数联合Apo B/Apo A1及FT3/FT4检测的AUC为0.964(95%CI:0.930~0.998),均高于单独检测。结论TVA、WA、LA、NWI等颈动脉斑块负荷指标及Apo B/Apo A1、FT3/FT4比值在不同预后的缺血性脑卒中患者中均有明显差异,可用于评估其短期预后,且各指标联合检测时可进一步提高预测价值。

Objective To investigate the value of high-resolution magnetic resonance imaging(MRI)in evaluating carotid plaque load,serum apolipoprotein(Apo)/Apo A1,and free triiodothyronine(FT3)/free thyroxine(FT4)in evaluating the short-term prognosis of patients with ischemic stroke.Methods The clinical data of 98 patients with ischemic stroke admitted to Cangzhou People's Hospital from December 2019 to January 2023 were retrospectively analyzed.Patients were all received intravenous thrombolytic therapy with alteplase and were followed up for 3 months after discharge.The patients were divided into the good prognosis group(n=73)and the poor prognosis group(n=25)according to the modified Rankin scale(mRS).Carotid plaque load indexes[total vessel area(TVA),tube wall area(WA),lumen area(LA),and wall standardization index(NWI)]of the two groups were measured by MRI,serum levels of Apo B,Apo A1,FT3,FT4 were detected,and their ratios of Apo B/Apo A1 and FT3/FT4 were calculated.The value of carotid wall parameters combined with Apo B/Apo A1 and FT3/FT4 in evaluating the short term poor prognosis of ischemic stroke were analyzed using receiver operating characteristic(ROC).Results The TVA,WA,and NWI of the poor prognosis group were higher than those of the good prognosis group,while LA was lower than that of the good prognosis group,and the differences were statistically significant(P<0.05).The serum Apo B levels and Apo B/Apo A1 in the poor prognosis group were higher than those in the good prognosis group,while the FT3 levels and FT3/FT4 levels were lower than those in the good prognosis group,and the differences were statistically significant(P<0.05);there were no statistically significant differences in the levels of Apo A1 and FT4 between the two groups(P>0.05).The area under the curve(AUC)of TVA,WA,LA,NWI,Apo B/Apo A1 and FT3/FT4 in evaluating the short term poor prognosis of ischemic stroke were 0.725(95%CI:0.601-0.849),0.746(95%CI:0.640-0.852),0.905(95%CI:0.842-0.968),0.893(95%CI:0.823-0.963),0.957(95%CI:0.918-0.996),0.868(95%CI:0.790-0.946),and the AUC of carotid plaque load indexes combined Apo B/Apo A1 and FT3/FT4 detection was 0.964(95%CI:0.930-0.998),which were higher than those detected alone.Conclusion Carotid plaque load indexes such as TVA,WA,LA,NWI,and Apo B/Apo A1,FT3/FT4 ratio showed significant differences in ischemic stroke patients with different prognosis,which can be used to evaluate the short-term prognosis,and the combined detection of all indexes can further improve the predictive value.