超声造影时间- 强度曲线联合Essen 卒中风险 评分预测缺血性脑卒中复发风险的价值

Evaluation of carotid plaque by time-intensity curve quantitative analysis of contrast-enhanced ultrasound combined with Essen stroke risk score in predicting the risk of recurrence of ischemic stroke

摘要:

目的 探讨超声造影时间- 强度曲线定量评估颈动脉斑块稳定性联合Essen 卒中风险评分（ESRS） 预测缺血性脑卒中复发的效能。方法 选取2017 年8 月—2018 年12 月湖南省人民医院收治的第1 次缺血 性脑卒中发作患者134 例。对患者进行颈动脉斑块超声造影时间- 强度曲线分析及Essen 评分。随访1 年， 以是否复发分为复发组与未复发组，比较反映颈动脉斑块新生血管的超声造影显影分级、增强强度值及联 合Essen 评分对缺血性脑卒中复发的预测效能。结果 复发组≥ 70 岁患者占比、ESRS 评分较未复发组高 （P <0.05）。两组斑块超声造影显影分级比较，差异有统计学意义（P <0.05）。复发组斑块超声造影的峰值 强度及强度增强值较未复发组高（P <0.05）。显影分级[Ol ^ R=2.490（95% CI ：0.897，6.913）]、强度增强值 [Ol ^ R=22.740（95% CI ：6.673，77.487）] 和ESRS 评分[Ol ^ R=5.173（95% CI ：1.677，15.953）] 是影响缺血性 脑卒中复发的独立因素。Essen 评分、显影分级及强度增强值联合预测缺血性脑卒中再发的AUC 为0.910，敏 感性为82.2%（95% CI ：0.695，0.899），特异性为93.9%（95% CI ：0.841，0.976）。结论 超声造影时间- 强度 曲线联合ESRS 评分能够提高预测缺血性脑卒中复发风险的效能。

Abstract:

Objective To investigate whether combination with evaluation of carotid plaque stability by time-intensity curve (TIC) quantitative analysis of contrast-enhanced ultrasound can improve the efficacy of Essen stroke risk score (ESRS) in predicting recurrence of ischemic stroke. Methods TIC analysis of carotid plaque and ESRS were performed in 134 patients with first onset of ischemic stroke admitted to our hospital from August 2017 to December 2018. All the patients were followed up for one year and were divided into two groups based on whether the disease relapsed. To compare the predictive efficacy of ESRS, contrast-enhanced ultrasound grading of neovascularization and enhanced intensity (EI) in carotid plaque, and their combination in the recurrence of ischemic stroke. Results Univariate analysis showed that age, neovascularization grade, EI and ESRS were associated with the recurrence of ischemic stroke (P < 0.05). Multivariate logistic regression analysis showed that neovascularization grade [Ol ^ R=2.490 (95% CI: 0.897, 6.913)], EI [Ol ^ R=22.740 (95% CI: 6.673, 77.487)], ESRS [Ol ^ R=5.173 (95% CI: 1.677, 15.953)] were risk factors for IS recurrence. Receiver operating characteristic curve (ROC) analysis showed that the Youden index was the largest when the cutoff value of ESRS was 3, the neovascularization grade was III and the EI was 23, with the corresponding area under the curve (AUC) being 0.810, 0.668 and 0.812. Besides, the sensitivity of the above tests was 79.3% (95% CI: 67.8%, 88.7%), 77.4% (95% CI: 65.9%, 86.6%) and 66.1% (95% CI: 51.1%, 75.7%), while the specificity thereof was 68.6% (95% CI: 56.4%, 79.1%), 54.1% (95% CI: 41.8%, 66.2%) and 95.2% (95% CI: 86.0%, 98.4%), respectively. The AUC of the combination of three factors for predicting ischemic stroke recurrence was the largest (0.910), and the sensitivity and specificity were 82.2% (95% CI: 69.5%, 89.9%) and 93.9% (95% CI: 84.1%, 97.6%), respectively. Conclusions Evaluation of carotid plaque by TIC analysis and EI of contrast-enhanced ultrasound combined with ESRS can enhance the effectiveness of predicting t he risk of recurrence of ischemic stroke.