摘要
目的:研究颈动脉超声造影联合血清含Ⅰ型血小板结合蛋白基序列的解聚蛋白样金属基质蛋白酶4(ADAMTS-4及骨保护素(OPG)在判断脑卒中患者颈动脉斑块稳定性中的价值。方法:采用前瞻性研究,将我院2019年6月—2020年6月因近半年内发生非致死性缺血性脑卒中而择期行颈动脉内膜剥脱术的82例患者纳为研究对象,患者术前行颈动脉斑块超声造影检查,并采集其血液样本,检测血清ADAMTS-4、OPG水平,并以术后病理检查结果为"金标准",分析颈动脉斑块超声造影与血清ADAMTS-4、OPG在术前预测斑块稳定性中的价值。结果:病理检查结果提示,82例患者中易损斑块者共36例,稳定斑块者共46例,以病理检查结果为"金标准",常规超声检查易损斑块漏诊12例,误诊10例,诊断灵敏度、特异度及准确度分别为78.00%、67.00%、73.00%,超声造影检查易损斑块漏诊3例,误诊4例,诊断灵敏度、特异度及准确度分别为91.00%、92.00%、91.00%,超声造影与常规超声的诊断一致性较高,Kappa值为0.93,在常规超声检查中被诊断为稳定斑块的3例斑块在超声造影检查中表现出不稳定特征,被诊断为易损斑块。易损斑块患者血清ADAMTS-4、OPG水平均显著高于稳定斑块者(P<0.05)。绘制ROC曲线发现,血清ADAMTS-4、OPG在诊断颈动脉斑块稳定性中均具有良好的性能,两者联合可有效提高各指标单独应用时的效能,联合诊断曲线下面积(AUC)为0.832、95%CI为0.737~0.927,而超声造影联合血清ADAMTS-4、OPG及ADAMTS-4+OPG,均可提高超声造影单独应用时诊断颈动脉斑块稳定性的效能。结论:超声造影联合血清ADAMTS-4及OPG在诊断颈动脉粥样硬化斑块稳定性中具有良好效能,有助于提高临床对斑块性质的判断,预防心脑血管意外事件,提高患者生存质量。
Objective: To investigate the value of contrast-enhanced ultrasound combined with serum a disintegrin-like and metalloproteinase with thrombospondin type Ⅰ motifs-4(ADAMTS-4) and osteoprotegerin(OPG) in judging stability of carotid plaque of patients with cerebral stroke. Methods: A total of 82 patients underwent carotid endarterectomy due to non-fatal ischemic stroke from June 2019 to June 2020 were prospectively enrolled. Contrast enhanced ultrasound, serum ADAMTS-4 and OPG examinations were performed before operation. The value of contrast-enhanced ultrasound, serum ADAMTS-4 and OPG in predicting the stability of carotid plaque was analyzed based on postoperative pathological examination results as “gold standard”. Results: Pathological examination showed that there were 36 vulnerable plaques and 46 stable plaques in 82 patients. Routine ultrasound examination missed 12 cases of vulnerable plaques and misdiagnosed 10 cases of vulnerable plaques, with its diagnostic sensitivity, specificity and accuracy of 78.00%, 67.00%, and 73.00%, respectively. Contrast-enhanced ultrasound missed diagnosis of vulnerable plaque in 3 cases and misdiagnosed in 4 cases, with its sensitivity,specificity and accuracy of 91.00%, 92.00%, and 91.00%, respectively. The consistency between contrast-enhanced ultrasound and conventional ultrasound was high(Kappa=0.93). Three stable plaques diagnosed by conventional ultrasound were classified as vulnerable plaques because of their unstable characteristics on CEUS. Serum levels of ADAMTS-4 and OPG in patients with vulnerable plaques were significantly higher than those in patients with stable plaque(P<0.05). ROC curve showed that both serum ADAMTS-4 and OPG had good efficacy in the diagnosis of carotid plaque stability. The diagnostic efficacy of combined detection of two serum indicators was significantly higher than that of single detection(AUC=0.832, 95%CI=0.737~0.927). Compared with contrast-enhanced ultrasound examination, its combination with ADAMTS-4, OPG, or ADAMTS-4+OPG could significantly improve the efficacy in the diagnosis of carotid plaque. Conclusion: Contrast-enhanced ultrasound combined with serum ADAMTS-4 and OPG has a good efficacy in the diagnosis of the stability of carotid atherosclerotic plaques of patients with cerebral stroke, and the accurate judgment of plaque properties can prevent adverse cardiovascular and cerebrovascular events and improve the quality of life of patients.
作者
郑章增
王彦平
杨讯
ZHENG Zhang-zeng;WANG Yan-ping;YANG Xun(Nanyang Central Hospital,Nanyang Henan 473000,China)
出处
《中国临床医学影像杂志》
CAS
CSCD
2021年第12期841-845,共5页
Journal of China Clinic Medical Imaging
基金
河南省科技攻关项目(LHGJ20200979)。
