脑梗死患者颈动脉粥样硬化斑块形态变化、狭窄程度变化的超声表现特点及超声诊断价值分析

Cerebral infarction patients with carotid atherosclerotic plaque morphology changes,degree of stenosis of ultrasound performance characteristics and the value of ultrasonic diagnosis analysis

目的分析脑梗死患者颈动脉粥样硬化斑块形态变化、狭窄程度变化的超声表现特点及超声诊断价值。方法回顾性选取自2021年7月至2023年12月滁州市中西医结合医院收治的60例脑梗死患者纳入观察组,另选同期的60名体检健康者纳入对照组。所有入选者均接受颈动脉超声检查,比较两组颈动脉斑块检出以及分布情况、斑块类型、斑块性质、颈动脉狭窄检出率、颈动脉血流参数[收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、阻力指数(RI)],使用受试者工作特征(ROC)曲线分析颈动脉血流参数对脑梗死的诊断效能。结果两组颈动脉粥样硬化斑块分布情况比较,差异无统计学意义(P>0.05)。观察组软斑占比为45.71%,高于对照组(5.88%),观察组硬斑占比为25.71%,低于对照组(58.82%),差异均有统计学意义(P<0.05)。观察组易损斑块占比为65.71%,高于对照组(11.76%),差异有统计学意义(P<0.05)。观察组颈动脉狭窄检出率为76.67%,高于对照组(10.00%),差异有统计学意义(P<0.05)。观察组PSV、EDV分别为(55.30±3.37)、(10.51±2.76)cm/s,均小于对照组[(60.12±4.28)、(15.91±3.53)cm/s],观察组RI为0.81±0.14,大于对照组(0.73±0.11),组间比较差异均有统计学意义(P<0.05)。经ROC曲线分析,颈动脉PSV、EDV联合RI诊断脑梗死的敏感度为89.76%,特异度为60.34%,AUC为0.920,大于单项指标PSV的0.631、EDV的0.675和RI的0.609(P<0.05)。结论脑梗死患者存在明显的颈动脉粥样硬化斑块形态变化和狭窄程度变化,通过超声检查显示其血流动力学改变,对诊断脑梗死具有一定提示作用。

Objective To analyze cerebral infarction patients with carotid atherosclerotic plaque morphology changes,degree of stenosis of ultrasonic characteristics and the value of ultrasonic diagnosis.Methods Sixty cases of cerebral infarction patients treated in Chuzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2021 to December 2023 were retrospectively selected and included in the observation group,60 cases of medical healthy subjects during the same period were selected and included in the control group.All entrants accept carotid ultrasound examination,carotid plaques detection and distribution properties,carotid stenosis,the types of plaque,plaque detection rate,carotid artery blood flow parameters[peak systolic velocity(PSV),peak diastolic velocity(EDV),resistance index(RI)]of the two groups were compared.The diagnostic efficacy of carotid artery blood flow parameters for cerebral infarction was analyzed using the receiver operating characteristic(ROC)curve.Results There was no statistically significant difference in the distribution of carotid atherosclerotic plaques between the two groups(P>0.05).The proportion of soft spots in the observation group was 45.71%,which was higher than that in the control group(5.88%),and the proportion of hard spots was 25.71%,which was lower than that in the control group(58.82%),the differences were statistically significant(P<0.05).The proportion of vulnerable plaques in the observation group was 65.71%,which was higher than that in the control group(11.76%),and the difference was statistically significant(P<0.05).The detection rate of carotid artery stenosis in the observation group was 76.67%,which was higher than that in the control group(10.00%),and the difference was statistically significant(P<0.05).The PSV and EDV in the observation group were(55.30±3.37)and(10.51±2.76)cm/s,respectively,which were lower than those in the control group[(60.12±4.28)and(15.91±3.53)cm/s],and RI in the observation group was 0.81±0.14,which was higher than that in the control group(0.73±0.11),the differences between the two groups were statistically significant(P<0.05).The ROC curve analysis,carotid artery,PSV,EDV joint RI the sensitivity of the diagnosis of cerebral infarction was 89.76%,60.34%,AUC was 0.920,was greater than the single index of PSV(0.631),EDV(0.675),and RI(0.609)(P<0.05).Conclusion Cerebral infarction patients with obvious morphological changes of carotid atherosclerotic plaques and narrow degree of change,through ultrasound the hemodynamic change obviously,implications for diagnosis of cerebral infarction.