The potential mechanism and clinical application value of remote ischemic conditioning in stroke

Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.

Risk factors for progressive ischemic stroke: A retrospective analysis

BACKGROUND： Progressive ischemic stroke has higher fatality rate and disability rate than common cerebral infarction, thus it is very significant to investigate the early predicting factors related to the occurrence of progressive ischemic stroke, the potential pathological mechanism and the risk factors of early intervention for preventing the occurrence of progressive ischemic stroke and ameliorating its outcome. OBJECTIVE： To analyze the possible related risk factors in patients with progressive ishcemic stroke, so as to provide reference for the prevention and treatment of progressive ishcemic stroke. DESIGN： A retrospective analysis. SETTING： Department of Neurology, General Hospital of Beijing Coal Mining Group. PARTICIPANTS： Totally 280 patients with progressive ischemic stroke were selected from the Department of Neurology, General Hospital of Beijing Coal Mining Group from March 2002 to June 2006, including 192 males and 88 females, with a mean age of （62±7） years old. They were all accorded with the diagnostic standards for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, and confired by CT or MRI, admitted within 24 hours after attack, and the neurological defect progressed gradually or aggravated in gradients within 72 hours after attack, and the aggravation of neurological defect was defined as the neurological deficit score decreased by more than 2 points. Meanwhile, 200 inpatients with non-progressive ischemic stroke （135 males and 65 females） were selected as the control group. METHODS： After admission, a univariate analysis of variance was conducted using the factors of blood pressure, history of diabetes mellitus, fever, leukocytosis, levels of blood lipids, fibrinogen, blood glucose and plasma homocysteine, cerebral arterial stenosis, and CT symptoms of early infarction, and the significant factors were involved in the multivariate non-conditional Logistic regression analysis. MAIN OUTCOME MEASURES： Results of the univariate analysis of variance of the factors related to progressive ischemic stroke; Results of the multivariate regression analysis. RESULTS： All the 480 patients were involved in the analysis of results. ① Results of the univariate analysis variance： There were significantly more patients with fever, leukocytosis, history of diabetes mellitus, cerebral arterial stenosis and CT symptoms of early infarction in the progressive ischemic stroke group than in the control group （P 〈 0.01）; The levels of blood glucose and fibrinogen in the progressive ischemic stroke group were significantly higher than those in the control group, while the level of blood pressure was significantly lower than that in the control group （P 〈 0.05 - 0.01）. ② Results of the multivariate Logistic regression analysis： The independent predicting factors for progressive ischemic stroke were history of diabetes mellitus, fever, leukocytosis, cerebral arterial stenosis, CT symptoms of early infarction, blood glucose and blood pressure （OR =2.61,2.96, 3.79, 1.03, 3.57, 2.68, 95% CI 0.92 - 3.59, P 〈 0.05 - 0.01）. CONCLUSION： History of diabetes mellitus, fever, leukocytosis, levels of blood pressure, blood glucose, cerebral arterial stenosis and CT symptoms of early infarction are the risk factors for progress ischemic stroke

CZL-80,a novel caspase-1 inhibitor,pro⁃motes functional recovery after progressive ischemic stroke

OBJECTIVE Progressive isch⁃emic stroke is characterized by aggravation of neurological dysfunction and poor prognosis.Neuroinflammation is involved in the pathological process of cerebral ischemia.Inflammasomes-activated caspase-1 has thus been considered a promising target for stroke therapy.However,it remains not fully understood how caspase-1 ag⁃gravates progressive functional impairment.We previously identified a novel caspase-1 inhibitor CZL-80,the present study is to explore whether CZL-80 protects against progressive ischemic stroke.METHODS Male C57/BL6 mice and cas⁃pase-1-/-mice were subjected to photothrombotic(PT)-induced cerebral ischemia.CZL-80 was in⁃traperitoneally injected daily during 1-7 d,1-4 d,4-7 d after PT.The grid-walking task and the cyl⁃inder task were used to determine the motor function.RESULTS Mice developed primary and the secondary neurological dysfunction at 1 d and 4-7 d after PT onset.The activation of cas⁃pase-1 peaked at 7 d after ischemic stroke and caspase-1 was mainly derived from activated microglia.Treatment with CZL-80(30 mg·kg-1)during 1-7 d significantly improved motor func⁃tion.Administration of CZL-80 during 1-4 d could not ameliorate motor function loss while administration during 4-7 d after PT onset signifi⁃cantly reduced foot faults and forelimb symme⁃try.Remarkably,treatment with CZL-80 during 4-7 d showed no significant difference in efficacy compared with the its administration during 1-7 d,which indicated a key therapeutic window.More⁃over,the neuroprotective effect of CZL-80 during 4-7 d was available at least until 43 d after isch⁃emic stroke,indicating CZL-80 can improve the long-term neurological function after cerebral ischemia.Furthermore,administration of CZL-80(30 mg·kg-1)during 4-7 d after PT onset in cas⁃pase-1-/-mice failed to improve the motor func⁃tion,which suggested that the neuroprotective effect of CZL-80 was caspase-1-dependent.The results showed that CZL-80 did not inhibit the expression of GSDMD and failed to reduce neu⁃ronal loss after ischemia.These results indicated the effect of CZL-80 was not attributable to inhib⁃it pyroptosis.We further found that CZL-80 signif⁃icantly reduced the number of activated microglia in the peri-infarct brain cortex after ischemic stroke,which might be involved in its neuropro⁃tective effect.CONCLUSION CZL-80,a novel caspase-1 inhibitor,improved motor function after progressive ischemic stroke in mice.The effective therapeutic window of CZL-80 would be 4-7 d after ischemia,when the secondary neuro⁃logical dysfunction occurred.Therefore,the inter⁃vention by targeting caspase-1 in this window phase provides a novel strategy for the function⁃al recovery of stroke survivors.

Inhibition of microRNA-29b suppresses oxidative stress and reduces apoptosis in ischemic stroke

MicroRNAs(miRNAs) regulate protein expression by antagonizing the translation of mRNAs and are effective regulators of normal nervous system development, function, and disease. Micro RNA-29 b(mi R-29 b) plays a broad and critical role in brain homeostasis. In this study, we tested the function of mi R-29 b in animal and cell models by inhibiting mi R-29 b expression. Mouse models of middle cerebral artery occlusion were established using the modified Zea-Longa suture method. Prior to modeling, 50 nmol/kg mi R-29 b antagomir was injected via the tail vein. Mi R-29 b expression was found to be abnormally increased in ischemic brain tissue. The inhibition of mi R-29 b expression decreased the neurological function score and reduced the cerebral infarction volume and cell apoptosis. In addition, the inhibition of mi R-29 b significantly decreased the malondialdehyde level, increased superoxide dismutase activity, and Bcl-2 expression, and inhibited Bax and Caspase3 expression. PC12 cells were treated with glutamate for 12 hours to establish in vitro cell models of ischemic stroke and then treated with the mi R-29 antagomir for 48 hours. The results revealed that mi R-29 b inhibition in PC12 cells increased Bcl-2 expression and inhibited cell apoptosis and oxidative damage. These findings suggest that the inhibition of mi R-29 b inhibits oxidative stress and cell apoptosis in ischemic stroke, producing therapeutic effects in ischemic stroke. This study was approved by the Laboratory Animal Care and Use Committee of the First Affiliated Hospital of Zhengzhou University(approval No. 201709276 S) on September 27, 2017.

δ-Opioid receptor as a potential therapeutic target for ischemic stroke

Ischemic stroke is a global epidemic condition due to an inadequate supply of blood and oxygen to a specific area of brain either by arterial blockage or by narrowing of blood vessels.Despite having advancement in the use of thrombolytic and clot removal medicine,significant numbers of stroke patients are still left out without option for treatment.In this review,we summarize recent research work on the activation ofδ-opioid receptor as a strategy for treating ischemic stroke-caused neuronal injury.Moreover,as activation ofδ-opioid receptor by a non-peptidicδ-opioid receptor agonist also modulates the expression,maturation and processing of amyloid precursor protein andβ-secretase activity,the potential role of these effects on ischemic stroke caused dementia or Alzheimer’s disease are also discussed.

Advances in the application of optical coherence tomography in the assessment of ischemic stroke

Ischemic stroke has high morbidity,mortality,disability rate and recurrence.It is the one of the main diseases that threaten people's health in China.Its etiology,pathogenesis,and reaction mechanism has been the research hotspot and difficulty of related studies have shown that the optical coherence tomography technology is an effective measure to evaluate ischemic cerebral apoplexy.Optical coherence tomography(OCT)is a gradually developed and mature imaging technology in recent years,and there are related studies on internal carotid artery,retina and coronary artery.Based on the above background,this paper reviews the research progress of optical coherence tomography in the assessment of the etiology,pathogenesis and response mechanism of ischemic stroke.

Experimental Study on the Effect of Acupuncture on ERM/PI3/Akt Signal Pathway in Rats with Ischemic Stroke

Objective: To observe the effect of acupuncture on the expression of ERM/PI3K/Akt signaling pathway in the brain tissue around the infarct focus of ischemic stroke model rats. Methods: According to the block randomization method, 80 male SD rats were divided into normal group (n = 10), sham operation group (n = 24), model group (n = 23) and acupuncture group (n = 23). The normal group was bred routinely without any intervention. In the sham operation group, only the skin was cut to find and the nerves and blood vessels were stripped and sutured. The model group and the acupuncture group were sutured to prepare the MCAO model. After the model was successfully established, acupuncture of the acupuncture group rats was given once a day, and the needles were kept for 30 minutes each time. The rats in the sham operation group and the model group only imitated capture and return, and were treated with acupuncture for 2 consecutive courses, each course was 5 days, and the two courses were rested for 2 days. After that, Western blot was used to detect ERM, changes in the concentration of PI3K and Akt proteins. Results: Compared with the normal group, the expression levels of ERM, PI3K, and Akt proteins in the sham operation group were reduced. Compared with the sham operation group, the expression levels of ERM, PI3K, and Akt proteins in the model group were significantly down-regulated. Compared with the model group, the protein expression levels of ERM, PI3K and Akt were significantly up-regulated in the acupuncture group, and the difference was statistically significant (P < 0.05). Conclusion: Acupuncture can significantly up-regulate the expression of ERM, PI3K and Akt proteins, and its effect mechanism may be related to the transduction of ERM/PI3K/Akt signaling pathway in cells.

Research Advances in Acupuncture in the Acute Phase of Ischemic Stroke

In recent years,the incidence of ischemic stroke has been increasing.Patients are prone to many complications after half a year of onset or has slow recovery of neuromotor function of one limb on one side of hemiplegia.The clinical effect of acupuncture in treating this disease is remarkable.According to research,acupuncture combined with medication and rehabilitation can reduce the degree of nerve defects in the early stage of the disease,improve daily life,and improve prognosis.This article summarizes the research on acupuncture in the treatment of acute ischemic stroke for future reference.

神经超声在急性缺血性卒中机械性血栓切除术后监测的应用进展

机械性血栓切除术(MT)是目前针对大血管闭塞所致的急性缺血性卒中(AIS)血管再通最有效的手段。但是MT术后对患者并发症的监测及管理成为目前棘手的问题,也受到广泛的关注。神经超声技术以无创、灵活及快速诊断等优势在脑血流动力学和结构病理学评估监测领域中已建立完善的体系。随着技术和设备的更新,针对AIS患者MT术后开启了无创监测颅内压、脑血流自动调节、颅内出血监测及其他占位性病变的导向模式,逐步成为MT术后管理的重要工具。本文对AIS患者MT术后神经超声监测技术的应用发展进行综述,目的是为临床实施前瞻性干预措施提供依据,使MT术后管理达到最大获益化,减低AIS患者病死率。

中医药调控线粒体质量控制治疗缺血性卒中的研究进展

缺血性卒中是一种常见的脑血管意外,日益成为严重的全球性健康问题。线粒体质量控制失调是脑缺血诱导神经元死亡的重要机制,维持线粒体功能对于促进神经元存活和改善神经功能至关重要。线粒体质量控制主要涉及线粒体氧化应激、线粒体动力学、线粒体自噬、线粒体生物发生等方面,是稳定线粒体正常结构、发挥线粒体正常功能的重要条件。近年来,中医药通过多角度、多通路、多靶点调控线粒体质量控制,通过影响线粒体结构与功能,能显著改善缺血性卒中患者临床症状,受到了学者们的广泛关注。本文通过对近年来应用中药有效化合物成分及中药复方调控线粒体质量控制治疗缺血性卒中的实验研究和临床观察进行归纳总结,进一步阐释缺血性卒中的发病机制,明确中医药对线粒体质量控制的调控机制,总结中医药治疗缺血性卒中的科学内涵与不足之处,以期为临床进一步应用中医药参与治疗缺血性卒中提供一定的思路与方法。

风痰阻络型急性缺血性脑卒中病人血脂、血凝水平与脑卒中进展的关系

目的:研究风痰阻络型急性缺血性脑卒中病人血脂、血凝水平与脑卒中进展的关系。方法:通过采集医院电子病例系统信息和电话随访的方式收集2020年1月1日—2020年12月31日于北京中医药大学东直门医院通州院区脑病科入院治疗的缺血性脑卒中病人453例,分为风痰阻络型组(299例)和非风痰阻络型组(154例)。收集病人的一般资料,统计分析两组进展性脑卒中的发生率。对比分析风痰阻络证进展性脑卒中与非进展性脑卒中病人血脂、凝血指标及与脑卒中进展的相关性。结果:风痰阻络型组进展性脑卒中115例,非进展性脑卒中184例,脑卒中进展发生率为38.5%;非风痰阻络型组进展性脑卒中43例,非进展性脑卒中111例,脑卒中进展发生率为27.9%。风痰阻络证组脑卒中进展发生率明显高于非风痰阻络证组(χ^(2)=4.971,P=0.026)。风痰阻络证进展性脑卒中组与非进展性脑卒中组总胆固醇、低密度脂蛋白比较,差异有统计学意义(P<0.05)。总胆固醇、低密度脂蛋白与风痰阻络型脑卒中进展呈正相关(r=0.145,P=0.016;r=0.127,P=0.034)。结论:风痰阻络证脑卒中进展发生率明显高于非风痰阻络证。总胆固醇、低密度脂蛋白升高是导致脑卒中进展的直接相关因素,在临床诊治风痰阻络型进展性脑卒中病人时需要严格控制好病人胆固醇及低密度脂蛋白水平。

急性缺血性脑卒中损伤机制及其治疗研究进展

随着医学科技水平的发展和人口老龄化进程的加快,我国老年人口数量逐年攀升。随着人年龄的增长,身体各项机能也随之减退,患上心脑血管疾病的概率也随之增高。其中缺血性脑卒中是一种脑血管常见疾病,有着高患病率、高致残率和高死亡率的特点,其致死率位居各种死因首位,对人的身心健康和生活质量造成极大的影响。本文主要综述缺血性脑卒中临床治疗的研究进展,以期为临床治疗提供参考。

颈动脉斑块SMI分级联合血清sICAM-1、CysC对进展性缺血性脑卒中的预测价值

目的探究颈动脉斑块超微血管成像(SMI)分级联合血清可溶性细胞间黏附分子1(sICAM-1)、胱抑素C(CysC)对进展性缺血性脑卒中(PIS)的预测价值。方法纳入2020年3月至2022年11月青海红十字医院神经内科收治且有颈动脉斑块的急性缺血性脑卒中患者216例进行回顾性分析,分为PIS组(66例)和非进展性缺血性脑卒中(NPIS)组(150例)。Logistic回归分析影响PIS的独立危险因素。受试者工作特征(ROC)曲线分析颈动脉斑块SMI分级联合血清sICAM-1、CysC对PIS的诊断价值。结果与NPIS组相比,PIS组同型半胱氨酸(Hcy)水平、纤维蛋白原(FIB)水平、sICAM-1水平、CysC水平、入院美国国立卫生研究院卒中量表(NIHSS)评分较高(P<0.05)。PIS组和NPIS组颈动脉斑块SMI分级比较,差异有统计学意义(P<0.05)。Logistic回归分析发现入院NIHSS评分、sICAM-1、CysC、SMI分级是PIS的独立危险因素(P<0.05)。ROC曲线分析显示,颈动脉斑块SMI分级诊断PIS的曲线下面积(AUC)为0.842,血清sICAM-1、CysC水平诊断PIS的AUC分别为0.803、0.802,三者联合诊断PIS的AUC为0.959。结论PIS患者血清sICAM-1、CysC水平显著升高,颈动脉斑块SMI分级联合血清sICAM-1、CysC可提高预测PIS的效能。

磁共振动脉自旋标记及磁共振弥散加权成像在急性缺血性脑卒中患者中的应用进展

急性缺血性脑卒中(acute ischemic stroke,AIS)是一种高病死率的脑血管疾病,对人类的健康影响极其深远。目前,磁共振动脉自旋标记(three-dimensional arterial spin labeling,3D-ASL)及磁共振弥散加权成像(diffusion weighted imaging,DWI)逐步投入实践之中,在诊断AIS方面已发挥了一定的作用。本文将综述3D-ASL、DWI技术在临床诊治AIS中的应用情况,为接下来的研究提供依据。

大血管病变所致进展性卒中血管内治疗研究现状

进展性卒中(PS)作为缺血性卒中的一种特殊类型,占缺血性卒中的10%~40%,与非PS相比具有更高的病死率和致残率。大血管病变是PS最常见原因,但由于发病时间较长,PS的血管内治疗尚存在较多争议,目前主要以药物治疗为主。作者就大血管病变所致PS血管内治疗研究现状进行了综述,以期为临床诊疗和相关研究提供参考。

缝隙介导干细胞治疗缺血性卒中的研究进展

缺血性卒中仍是当今世界主要的死亡原因之一。传统的治疗方法存在时间窗狭窄的问题,且治疗后卒中幸存者往往存在神经功能缺损症状。干细胞疗法可以通过增强大脑可塑性来减少神经系统后遗症,而缝隙连接在脑发育过程中对细胞的增殖、迁移和分化是必不可少的,利用小分子(如葡萄糖)通过缝隙连接在干细胞与血管内皮细胞之间的转移构成了干细胞治疗缺血性卒中的重要机制。本文干细胞疗法通过缝隙连接介导治疗缺血性卒中的研究进展进行综述,主要总结了间充质干细胞、造血干细胞、神经干细胞与胚胎干细胞的细胞来源、作用机制以及研究成果,以便深入挖掘干细胞疗法治疗卒中的新思路,以期为临床治疗提供辅助。

急性缺血性脑卒中基于CYP2C19基因检测行抗血小板治疗的临床效果

目的 探讨基因检测必要性,通过行CYP2C19基因检测进一步规范精准实施抗血小板治疗。方法 回顾性调查2022年1月—2023年2月就诊于福建省老年医院神经内科的102例急性缺血性脑卒中患者,均使用氯吡格雷抗血小板治疗,按照是否行CYP2C19基因检测,分为对照组63例,观察组39例;其中观察组行基因检测,并根据基因结果调整抗血小板药物。观察2组进展性脑卒中发生率。结果 2组基线资料比较,差异无统计学意义(P> 0.05);氯吡格雷CYP2C19基因有6种代谢类型,主要突变主体为CYP2C19*2、CYP2C19*3;观察组进展性脑卒中发生率为10.26%,低于对照组的26.98%,差异有统计学意义(P <0.05)。结论 CYP2C19基因检测一定程度预测氯吡格雷抵抗,其中CYP2C19*2、CYP2C19*3易出现氯吡格雷抵抗现象。

血栓弹力图联合hs-CRP、HbA1c水平预测进展性缺血性脑卒中的临床价值

目的探究血栓弹力图联合超敏C反应蛋白(hs-CRP)、糖化血红蛋白(HbA1c)水平对进展性缺血性脑卒中的预测价值。方法回顾性分析收治的120例急性缺血性脑卒中患者,分为进展组37例和非进展组83例,同期120例健康体检者作为对照组。收集所有研究对象的一般资料、hs-CRP、HbA1c水平和血栓弹力图参数,对其发生进展性缺血性脑卒中进行L ogistic多因素分析,采用ROC对其hs-CRP、HbA1c和血栓弹力图参数预测价值进行分析。结果进展组美国国立卫生研究院卒中量表评分高于非进展组(P<0.05)。与对照组比较,进展组和非进展组hs-CRP、HbA1c水平更高,且进展组高于非进展组,反应时间和凝固时间更短,且进展组短于非进展组,凝固角和最大振幅更大,且进展组大于非进展组(P<0.05);多因素Logistic回归性分析发现,hs-CRP、HbA1c、凝固时间、凝固角和最大振幅是急性缺血性脑卒中患者出现进展的影响因素(P<0.05)。ROC分析可得,hs-CRP、HbA1c和血栓弹力图3项指标预测急性缺血性脑卒中患者发生进展的AUC分别为0.751、0.732、0.737,其联合预测效能最高,灵敏度和特异度分别为0.703和0.916。结论hs-CRP、HbA1c和血栓弹力图对于进展性缺血性脑卒中的发生均有较高的预测价值,三者联合预测的整体效能最佳。

氯吡格雷联合低分子肝素钙对进展性缺血性脑卒中的治疗效果分析

目的 探究进展性缺血性脑卒中应用氯吡格雷+低分子肝素钙联合治疗的效果。方法 100例进展性缺血性脑卒中患者,依据差异化治疗方案分为对照组(低分子肝素钙单药治疗)和观察组(氯吡格雷+低分子肝素钙联合治疗),各50例。比较两组美国国立卫生研究院卒中量表(NHISS)评分、血液流变学指标、生活质量水平、临床效果及安全性。结果 治疗后两组NIHSS评分均较治疗前明显降低,且观察组NIHSS评分(9.33±2.89)分低于对照组的(12.42±3.11)分,差异值显著(P<0.05)。治疗后两组纤维蛋白原、血浆粘度、血小板聚集率均较治疗前明显降低,且观察组纤维蛋白原(2.12±0.43)g/L、血浆粘度(1.09±0.27)mPa·s、血小板聚集率(34.46±15.62)%低于对照组的(2.73±0.55)g/L、(1.31±0.34)mPa·s、(51.22±20.31)%,差异值显著(P<0.05)。治疗后两组生理维度、心理维度、社会功能维度、物质水平维度评分均较治疗前升高,且观察组明显高于对照组,差异值显著(P<0.05)。观察组临床总有效率96.00%(48/50)高于对照组的82.00%(41/50),差异值显著(P<0.05)。观察组不良反应发生率6.00%低于对照组的20.00%,差异值显著(P<0.05)。结论 针对进展性缺血性脑卒中患者,临床给予氯吡格雷、低分子肝素钙联合治疗,相比单药治疗在改善血液流变学指标、神经功能缺损及降低不良反应方面成效显著,生活质量亦明显提升,值得临床积极推广应用。

多模态超声影像组学联合实验室指标对缺血性脑卒中进展的预测价值

目的分析基于彩色多普勒超声(CDUS)、超声造影(CEUS)、剪切波弹性成像技术(SWE)的多模态超声影像组学联合超敏-C反应蛋白/白蛋白比值(hs-CRP/ALB)预测进展性缺血性脑卒中(PIS)的价值。方法选择2019年8月至2023年5月就诊的100例急性脑卒中患者,患者入院时均接受CDUS、CEUS、SWE检查,测定血脂水平与血清hs-CRP、ALB水平。根据发病6~7 d内美国国立卫生研究院卒中量表(NIHSS)增加是否≥2分将患者分为PIS组、非PIS组(NPIS组)。比较2组一般资料、多模态超声影像参数、hs-CRP/ALB,Logistic回归分析影响PIS发生的因素。基于Logistic多因素建立预测PIS发生模型,绘制ROC曲线分析预测模型预测PIS发生的价值。结果2组性别比、年龄、体重指数(BMI)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及合并高血压、糖尿病、冠心病、吸烟、斑块长度、斑块厚度、斑块回声相比,差异均无统计学意义(P>0.05);PIS组斑块表面形态不规则占比高于NPIS组(P<0.05);PIS组峰值强度比值(P)与斑块内新生血管分级Ⅱ型占比高于NPIS组,达峰值时间(tP)、平均渡越时间(MTT)低于NPIS组(P<0.05);PIS组最大杨氏模量值(Max YM)、最小杨氏模量值(Min YM)、平均杨氏模量组(Mean YM)、hs-CRP、hs-CRP/ALB高于NPIS组,ALB低于NPIS组(P<0.05);Logistic回归分析结果显示,斑块表面形态不规则、P、Max YM、Min YM、Mean YM、hs-CRP、hs-CRP/ALB是PIS发生的危险因素(OR=9.569、1.297、1.082、1.299、1.142、3.797、4.231,P<0.05),tP、MTT、ALB是保护因素(OR=0.733、0.871、0.667,P<0.05),带入回归方程可得:Logit(P)=-6.169+9.569X1+1.297X3+0.733X4+0.871X5+1.082X6+1.299X7+1.142X8+3.797X9+0.667X10+4.231X11;绘制ROC曲线结果显示,基于Logistic回归模型的预测概率预测PIS发生的AUC为0.988(95%CI:0.972~1.000)。结论基于CDUS、CEUS、SWE的多模态超声影像组学联合血清hs-CRP、ALB、hs-CRP/ALB可有效预测PIS发生,可帮助临床筛选PIS高危人群。