BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke.Contrast-enhanced ultrasound(CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening ...BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke.Contrast-enhanced ultrasound(CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging(SMI) offers the possibility of clinically screening for unstable plaque AIM To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques.METHODS Patients with carotid atherosclerotic plaques(luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication.The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not.Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years.RESULTS In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level(P =0.013) and enhancement intensity(P = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity(r = 0.737, P = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level Ⅱ, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually(X^2 = 108.931, P = 0.000).CONCLUSION SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.展开更多
Background Hypertension associated with hyperhomocysteinernia （HHcy） is defined as H-type hypertension.Hypertension and HHcy has a strong synergy that could lead to the risk of vascular disease, such as carotid rem...Background Hypertension associated with hyperhomocysteinernia （HHcy） is defined as H-type hypertension.Hypertension and HHcy has a strong synergy that could lead to the risk of vascular disease, such as carotid remodeling. However, the relation of inflammatory factors and adhesion molecule with carotid remodeling in H-type hypertension is unknown. Methods Fifty-six patients with H-type hypertension and 52 without hyperhomocysteinemia hypertension were enrolled in this study, with 42 healthy volunteers as the control group. All the subjects underwent color Doppler ultrasound examination of carotid artery. The expression of ICAM-1 in peripheral blood monocytes was measured by direct immunofluorescence technique in combination with flow cytometry. The levels of high sensitivity C-reactive protein （hs-CRP）, Monocyte chemoattractant protein-1 （MCP-1） and sICAM-1 were measured. The correlations between carotid vascular remodeling and these biomarkers were analyzed. Results The intima-media thickness （IMT）, circulating levels of hs-CRP and MCP-1, and monocyte ICAM-1 were significantly increased in H-type hypertension group （P 〈 0.05）. There were no significant difference in those measurements between the simple hypertension group and the control group （P 〉 0.05）. The levels of sICAM-1 showed no significance among the three groups （P 〉 0.05）. Correlation analyses revealed a positive correlation of carotid plaque index with homocysteine, hs-CRPand MCP-1, and the expression of ICAM-1 in the monocytes in the H-type hypertension group. Multivariate logistic regression analysis revealed that Hcy and hs-CRP were the independent risk factors of IMT in the H-type hypertension group. Conclusion The patients with H-type hypertension are more likely to have carotid vascular remodeling with higher levels of inflammation and adhesion molecules which might lead to the development of atherosclerosis.展开更多
基金Supported by Shanghai Jiading District Health and Family Planning Commission Health Planning Commission Scientific Research Project,No.KYXM,2015-KY-02
文摘BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke.Contrast-enhanced ultrasound(CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging(SMI) offers the possibility of clinically screening for unstable plaque AIM To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques.METHODS Patients with carotid atherosclerotic plaques(luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication.The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not.Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years.RESULTS In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level(P =0.013) and enhancement intensity(P = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity(r = 0.737, P = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level Ⅱ, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually(X^2 = 108.931, P = 0.000).CONCLUSION SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.
基金supported partly by the Medical Research Fund of Guangdong Province(No.B2009121)
文摘Background Hypertension associated with hyperhomocysteinernia （HHcy） is defined as H-type hypertension.Hypertension and HHcy has a strong synergy that could lead to the risk of vascular disease, such as carotid remodeling. However, the relation of inflammatory factors and adhesion molecule with carotid remodeling in H-type hypertension is unknown. Methods Fifty-six patients with H-type hypertension and 52 without hyperhomocysteinemia hypertension were enrolled in this study, with 42 healthy volunteers as the control group. All the subjects underwent color Doppler ultrasound examination of carotid artery. The expression of ICAM-1 in peripheral blood monocytes was measured by direct immunofluorescence technique in combination with flow cytometry. The levels of high sensitivity C-reactive protein （hs-CRP）, Monocyte chemoattractant protein-1 （MCP-1） and sICAM-1 were measured. The correlations between carotid vascular remodeling and these biomarkers were analyzed. Results The intima-media thickness （IMT）, circulating levels of hs-CRP and MCP-1, and monocyte ICAM-1 were significantly increased in H-type hypertension group （P 〈 0.05）. There were no significant difference in those measurements between the simple hypertension group and the control group （P 〉 0.05）. The levels of sICAM-1 showed no significance among the three groups （P 〉 0.05）. Correlation analyses revealed a positive correlation of carotid plaque index with homocysteine, hs-CRPand MCP-1, and the expression of ICAM-1 in the monocytes in the H-type hypertension group. Multivariate logistic regression analysis revealed that Hcy and hs-CRP were the independent risk factors of IMT in the H-type hypertension group. Conclusion The patients with H-type hypertension are more likely to have carotid vascular remodeling with higher levels of inflammation and adhesion molecules which might lead to the development of atherosclerosis.
