颈部血管彩色超声参数联合血浆低密度脂蛋白对缺血性脑卒中患者颈动脉不稳定性斑块的评估价值

Value of cervical vascular color Doppler ultrasound combined with plasma low-density lipoprotein cholesterol for identifying carotid plaque instability in patients with ischemic stroke

摘要:

目的 分析颈部血管彩色超声（CVUS）参数联合血浆低密度脂蛋白（LDL-C）对缺血性脑卒中（IS）患者颈动脉不稳定性斑块的评估价值。方法 选取2023年1月—2024年1月沧州市中心医院收治的322例IS患者，根据颈动脉斑块的稳定性，分为稳定组（266例）与不稳定组（56例）。比较两组临床资料、LDL-C水平、颈动脉内膜中层厚度（IMT）、血流参数［收缩期峰值流速（VS）、舒张末期流速（VD）、搏动指数（PI）、阻力指数（RI）］，通过多因素一般Logistic回归模型进行影响因素分析，并绘制受试者工作特征（ROC）曲线。结果 不稳定组LDL-C水平、IMT、颈内动脉PI、颈外动脉PI均高于稳定组，颈内动脉VS、颈内动脉VD、颈外动脉VS、颈外动脉VD均低于稳定组（P <0.05）；多因素一般Logistic回归分析结果表明，LDL-C水平高［O^R=2.508（95% CI：1.675，3.755）］、IMT厚［O^R=10.138（95% CI：3.680，27.930）］、颈内动脉PI高［O^R=10.940（95% CI：3.838，31.179）］、颈外动脉PI高［O^R=235.353（95% CI：38.153，1451.426）］均为IS患者发生颈动脉不稳定性斑块的危险因素；颈内动脉VS高［O^R=0.877（95% CI：0.830，0.926）］、颈内动脉VD高［O^R=0.861（95% CI：0.808，0.917）］、颈外动脉VS高［O^R=0.879（95% CI：0.831，0.928）］、颈外动脉VD高［O^R=0.828（95% CI：0.764，0.897）］均为IS患者发生颈动脉不稳定性斑块的保护因素（P <0.05）；ROC曲线结果表明，LDL-C、IMT、颈内动脉VS、颈内动脉VD、颈内动脉PI、颈外动脉VS、外动脉VD、颈外动脉PI联合评估对IS患者颈动脉不稳定性斑块的诊断效能更高，其敏感性为89.3%（95% CI：0.781，0.960），特异性为88.0%（95% CI：0.834，0.916），曲线下面积为89.1%（95% CI：0.845，0.938）。结论 CVUS参数联合LDL-C对IS患者颈动脉不稳定性斑块具有较好的临床诊断价值。

Abstract:

Objective To evaluate the diagnostic value of cervical vascular color Doppler ultrasound (CVUS) parameters combined with plasma low-density lipoprotein cholesterol (LDL-C) levels in assessing carotid plaque instability in patients with ischaemic stroke (IS).Methods A total of 322 patients with IS admitted to Cangzhou Central Hospital between January 2023 and January 2024 were enrolled. Based on carotid plaque stability, they were categorized into stable (n = 266) and unstable (n = 56) groups. Clinical characteristics, LDL-C levels, carotid intima-media thickness (IMT), and hemodynamic parameters [systolic peak velocity (VS), end-diastolic velocity (VD), pulsatility index (PI), resistance index (RI) ] were compared between groups. Multivariable logistic regression analysis identified associated influencing factors, and receiver operating characteristic (ROC) curves were plotted.Results The unstable group exhibited significantly higher LDL-C levels, greater IMT, and higher internal carotid artery PI, and external carotid artery PI, but lower internal carotid artery VS, internal carotid artery VD, external carotid artery VS, and external carotid artery VD compared to the stable group (P < 0.05). Multivariable logistic regression analysis indicated that high LDL-C levels [O^R = 2.508 (95% CI: 1.675, 3.755) ], great IMT [O^R = 10.138 (95% CI: 3.680, 27.930) ], elevated internal carotid artery PI [O^R = 10.940 (95% CI: 3.838, 31.179) ], and elevated external carotid artery PI [O^R = 235.353 (95% CI: 38.153, 1451.426) ] were all risk factors for carotid plaque instability in IS patients. High internal carotid artery VS [O^R = 0.877 (95% CI: 0.830, 0.926) ], high internal carotid artery VD [O^R = 0.861 (95% CI: 0.808, 0.917) ], high external carotid artery VS [O^R = 0.879 (95% CI: 0.831, 0.928) ], and high external carotid artery VD [O^R = 0.828 (95% CI: 0.764, 0.897) ] were protective factors for carotid plaque instability in IS patients (P < 0.05). ROC curve analysis indicated that the combination of LDL-C, IMT, internal carotid artery VS, internal carotid artery VD, internal carotid artery PI, external carotid artery VS, external artery VD, and external carotid artery PI demonstrated higher diagnostic efficacy for carotid plaque instability in IS patients, with a sensitivity of 89.3% (95% CI: 0.781, 0.960), a specificity of 88.0% (95% CI: 0.834, 0.916), and an area under the curve of 89.1% (95% CI: 0.845, 0.938).Conclusion Combining CVUS parameters with LDL-C demonstrates good clinical diagnostic value for identifying carotid plaque instability in patients with IS.