颈动脉斑块SMI分级联合血清超敏C-反应蛋白在急性缺血性脑卒中风险评估中的应用价值

doi:10.3969/j.issn.1007-3205.2023.03.017

河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (3): 329-333.doi: 10.3969/j.issn.1007-3205.2023.03.017

颈动脉斑块SMI分级联合血清超敏C-反应蛋白在急性缺血性脑卒中风险评估中的应用价值

1.河北北方学院附属第一医院超声医学科，河北张家口 075000；2.河北省深州市医院超声科，河北深州 053800

出版日期:2023-03-25 发布日期:2023-03-24
作者简介:张力维（1986-），女，河北张家口人，河北北方学院附属第一医院主治医师，医学硕士，从事医学超声诊断研究。
基金资助:
河北省医学科学研究课题计划（20210404）

Application value of carotid plaque SMI classification combined with serum hypersensitive C-reactive protein in risk assessment of acute ischemic stroke

1.Department of Ultrasound, the First Affiliated Hospital of Hebei North University, Hebei Province,
Zhangjiakou 075000, China; 2.Department of Ultrasound, Shenzhou Municipal Hospital,
Hebei Province, Shenzhou 053800, China

Online:2023-03-25 Published:2023-03-24

摘要/Abstract

摘要： 目的探讨颈动脉斑块超微血流成像（superb micro-vascular imaging, SMI）分级联合血清超敏C反应蛋白（hypersensitive C-reactive protein, hs-CRP）在急性缺血性脑卒中（acute ischemic stroke, AIS)风险评估中的应用价值。
方法纳入就诊于我院神经内科且存在颈动脉斑块的患者156例，依据MRI检查结果及临床诊断分为AIS组（72例）和非急性缺血性脑卒中（non-acute ischemic stroke,NAIS）组（84例）。2组患者均进行颈动脉常规超声检查、SMI检查及血清hs-CRP水平检测。基于Logistic回归模型及受试者工作特征曲线分析斑块内新生血管SMI分级、血清hs-CRP单独及联合诊断预测AIS发生的风险，并确定其截断值。
结果 2组间SMI分级比较，差异有统计学意义（P＜0.05）。AIS组患者血清hs-CRP水平较NAIS组高，差异有统计学意义（P＜0.05）。2组间斑块的厚度和面积狭窄率差异均无统计学意义（P均＞0.05）。SMI分级（OR=4.015，95%CI：2.426~6.646，P＜0.001）、血清hs-CRP（OR=1.809，95%CI：1.313~2.498，P＜0.001）均为影响AIS发生的独立危险因素（P均＜0.05）。以SMI分级≥2级作为预测发生AIS的诊断标准，其曲线下面积（area under curve, AUC）为0.787，敏感度、特异度分别为81.97%、66.66%。以血清hs-CRP≥4.7 mg/L作为预测发生AIS的诊断标准，其AUC为0.699，敏感度、特异度分别为66.67%、65.48%。二者联合诊断预测发生AIS的AUC为0.842，敏感度、特异度分别为90.28%、66.67%。
结论颈动脉斑块SMI分级联合血清hs-CRP能够提高预测AIS发生风险的准确性。

关键词: 缺血性卒中, 颈动脉狭窄, C反应蛋白质

Abstract: Objective To investigate the application value of carotid plaque superb micro-vascular imaging (SMI) classification combined with serum hypersensitive C-reactive protein (hs-CRP) in risk assessment of acute ischemic stroke(AIS).
Methods A total of 156 patients with carotid plaque in the Department of Neurology of our hospital were included. According to MRI examination results and the clinical diagnosis, they were divided into AIS group (n=72) and non-AIS group (n=84). All the patients underwent routine carotid ultrasonography examination and SMI examination, and serum hs-CRP level was measured. Based on logistic regression model and receiver operating characteristic(ROC) curve, SMI classification of neovascularization in plaque and serum hs-CRP alone or in combination were analyzed to predict the risk of AIS, and its cut-off value was determined.
Results There was significant difference in SMI classification between two groups (P＜0.05). The level of serum hs-CRP in AIS group was significantly higher than that in NAIS group (P＜0.05). There was no significant difference in plaque thickness and area stenosis rate between two groups (both P＞0.05). SMI classification(OR=4.015, 95%CI: 2.426-6.646, P＜0.001) and serum hs-CRP (OR=1.809, 95%CI: 1.313-2.498, P＜0.001) were independent risk factors for the occurrence of AIS(both P＜0.05). Taking SMI classification≥2 as the diagnostic standard for predicting the occurrence of AIS, the area under ROC curve (AUC) was 0.787, and the sensitivity and specificity were 81.97% and 66.66% respectively. Taking serum hs-CRP ≥ 4.7 mg/L as the diagnostic standard for predicting the occurrence of AIS, the AUC was 0.699, and the sensitivity and specificity were 66.67% and 65.48% respectively. The AUC of the combined diagnosis for predicting the occurrence of AIS was 0.842, and the sensitivity and specificity were 90.28% and 66.67% respectively.
Conclusion Carotid plaque SMI classification combined with serum hs-CRP can improve the accuracy of predicting the risk of AIS.

Key words: ischemic stroke, carotid stenosis, C-reactive protein

张力维, 李德鑫, 王义成, 韩潮, 马姝颖, 王嫒嫒. 颈动脉斑块SMI分级联合血清超敏C-反应蛋白在急性缺血性脑卒中风险评估中的应用价值[J]. 河北医科大学学报, 2023, 44(3): 329-333.

ZHANG Li-wei, LI De-xin, WANG Yi-cheng, HAN Chao, MA Shu-ying, WANG Ai-ai. Application value of carotid plaque SMI classification combined with serum hypersensitive C-reactive protein in risk assessment of acute ischemic stroke[J]. Journal of Hebei Medical University, 2023, 44(3): 329-333.

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颈动脉斑块SMI分级联合血清超敏C-反应蛋白在急性缺血性脑卒中风险评估中的应用价值

Application value of carotid plaque SMI classification combined with serum hypersensitive C-reactive protein in risk assessment of acute ischemic stroke

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