多模态超声联合评估冠心病患者颈动脉斑块易损性的价值

The Value of Multimodal Ultrasound Combined Assessment of Carotid Artery Plaque Vulnerability in Patients with Coronary Heart Disease

目的:探讨多模态超声联合评估冠心病患者颈动脉斑块易损性的价值。方法:选取2022年2月-2023年12月在承德医学院第二附属医院神经诊断科采用冠脉造影对确诊为冠状动脉粥样硬化导致的冠状动脉狭窄的患者110例作为研究对象,按照斑块性质将颈动脉斑块分为易损斑块组(n=35)与稳定斑块组(n=75),用常规颈动脉超声检查、剪切波弹性成像和超声造影方法研究颈动脉斑块的性质,比较不同参数差异性;多因素Logistic回归分析发生冠心病颈动脉斑块易损性的独立危险因素,并绘制ROC曲线。结果:两组患者年龄、高血压史、吸烟史、LDL-C、Hcy、hs-CRP相比,差异具有统计学意义(P<0.05);两组患者回声、极低回声、钙化、钙化结节差异具有统计学意义(P<0.05);稳定斑块组平均、最小、最大杨氏模量均高于对照组,差异具有统计学意义(P<0.05);冠心病颈动脉斑块易损性有影响的是年龄、高血压史、吸烟史、LDL-C、Hcy、hs-CRP、超声造影增强程度、钙化结节、斑块回声、平均剪切波弹性杨氏模量。结论:多模态超声联合应用可以有效提升冠心病患者颈动脉斑块易损性的效能,为临床诊断和治疗提供重要参考依据。

Objective:To explore the value of multimodal ultrasound combined assessment of carotid artery plaque vulnerability in patients with coronary heart disease.Methods:From February 2022 to December 2023,110 patients with coronary artery stenosis caused by coronary atherosclerosis who were diagnosed by coronary angiography in the Neurodiagnostic Department of the Second Affiliated Hospital of Chengde Medical College were selected as the research objects.According to the plaque nature,carotid plaque was divided into vulnerable plaque group(n=35)and stable plaque group(n=75).The properties of carotid plaque were studied by conventional carotid ultrasound,shear wave elastography and contrast-enhanced ultrasound,and the differences of different parameters were compared;Multivariate logistic regression analysis was conducted to identify independent risk factors for the vulnerability of carotid artery plaques in coronary heart disease,and ROC curves were plotted.Results:There was a statistically significant difference in age,history of hypertension,smoking history,LDL-C,Hcy,and hs CRP between the two groups of patients(P<0.05);The difference in echo,extremely low echo,calcification,and calcified nodules between the two groups of patients was statistically significant(P<0.05);The average,minimum,and maximum Young's modulus of the stable plaque group were higher than those of the control group,and the difference was statistically significant(P<0.05);Age,history of hypertension,smoking history,LDL-C,Hcy,hs CRP,degree of contrast-enhanced ultrasound,calcified nodules,plaque echo,and mean shear wave elastic Young's modulushave an impact on the vulnerability of carotid plaques in coronary heart disease.Conclusion:The combined application of multimodal ultrasound can effectively improve the vulnerability of carotid plaques in patients with coronary heart disease,providing important reference for clinical diagnosis and treatment.