常规颈动脉超声结合超声造影评估大动脉炎活动性的研究

Value of conventional carotid artery sonography combined with contrast-enhanced ultrasound in evaluating the activity of Takayasu arteritis

目的应用超声造影(CEUS)对大动脉炎(TA)患者的颈动脉管壁增强程度进行半定量分级,探讨常规颈动脉超声联合CEUS评估TA活动性的价值。方法根据美国风湿病协会分类标准纳入59例TA患者,根据美国国立研究院评分确定临床活动期及非活动期,根据CEUS增强等级分为3组,分析CEUS等级及常规超声参数与疾病临床活动性参数的相关性,同时探讨对疾病临床活动的预测价值。结果(1)颈动脉CEUS增强等级、管壁厚度及血管外径与NIH评分、红细胞沉降率、C反应蛋白均呈正相关,其中CEUS增强等级相关性最高(r值分别为0.438、0.560、0.471,P<0.01)。(2)CEUS≥2级及CEUS 3级预测疾病临床活动的工作者受试特征曲线下面积(AUC)分别为0.782和0.725(P<0.001),敏感度分别为77%和53%,特异度分别为80%和92%。(3)管壁厚度≥1.95 mm联合CEUS≥2级预测疾病临床活动的AUC为0.804(P<0.001),敏感度为80%,特异度为81%,优于与单独使用管壁厚度的预测效能(Z=2.535,P=0.011)。结论TA患者颈动脉CEUS增强等级及管壁厚度与疾病临床活动性显著相关,管壁厚度结合CEUS增强等级可有效评估TA的临床活动性。

Objective To perform semi-quantitative grading of carotid artery wall enhancement in patients with Takayasu arteritis(TA)using contrast-enhanced ultrasound(CEUS),and to investigate the value of conventional carotid artery sonography combined with CEUS in evaluating the activity of TA.Methods A total of 59 patients with TA were enrolled according to the American College of Rheumatology classification criteria,the clinical active and inactive stages were determined based on the National Institution of Health(NIH)score.The patients were divided into three groups according to the grade of enhancement on CEUS.The correlation of CEUS grade and conventional ultrasound parameters with clinical activity parameters of the disease was analyzed,as well as their value in predicting the clinical activity of the disease.Results The CEUS enhancement grade,wall thickness,and outer diameter of the carotid artery were positively correlated with NIH score,erythrocyte sedimentation rate,and C-reactive protein,among which CEUS enhancement grade showed the highest degree of correlation(r=0.438,0.560,and 0.471,P<0.01).CEUS grade≥2 and CEUS grade 3 had an area under the ROC curve(AUC)of 0.782 and 0.725,respectively,in predicting the clinical activity of the disease(P<0.001),with a sensitivity of 77%and 53%,respectively,and a specificity of 80%and 92%,respectively.Carotid artery wall thickness≥1.95 mm combined with CEUS grade≥2 had an AUC of 0.804 in predicting the clinical activity of the disease(P<0.001),with a sensitivity of 80%and a specificity of 81%,showing a better predictive efficacy than carotid artery wall thickness alone(Z=2.535,P=0.011).Conclusion CEUS enhancement grade and wall thickness of the carotid artery are significantly correlated with the clinical activity of TA,and carotid artery wall thickness combined with CEUS enhancement grade can effectively evaluate the clinical activity of TA.