摘要
目的:探讨颈动脉超声血流参数联合血清分拣蛋白(Sortilin)、对氧磷脂酶1(PON-1)对颈动脉粥样硬化斑块(CAP)稳定性的诊断价值。方法:选取2021年1月至2023年12月如皋市中医院收治的100例CAP患者,依据CAP稳定性将其分为稳定组(54例)和不稳定组(46例)。采用酶联免疫吸附法(ELISA)测定两组患者的血清Sortilin、PON-1表达水平;采用多因素logistic回归分析CAP稳定性的影响因素;绘制受试者工作特征(ROC)曲线分析颈动脉超声血流参数联合Sortilin、PON-1对CAP稳定性的诊断效能。结果:与稳定组相比,不稳定组舒张末期血流速度(EDV)、颈动脉内膜中层厚度(IMT)升高,收缩期峰值血流速度(PSV)降低,两组比较差异有统计学意义(t=7.536、4.680、5.487,P<0.05)。与稳定组相比,不稳定组血清Sortilin水平显著增加,PON-1水平显著降低,两组比较差异有统计学意义(t=8.362、5.581,P<0.05)。多因素logistic分析发现,Sortilin是影响CAP稳定性的危险因素(OR=3.165,P<0.05),而PON-1是影响CAP稳定性的保护因素(OR=0.765,P<0.05)。ROC曲线分析显示,Sortilin、PON-1、EDV、IMT、PSV及5项联合诊断CAP稳定性的ROC曲线下面积(AUC)分别为0.788(95%CI:0.695~0.864)、0.814(95%CI:0.724~0.885)、0.847(95%CI:0.761~0.911)、0.767(95%CI:0.672~0.846)、0.707(95%CI:0.607~0.793)和0.963(95%CI:0.839~0.907)。Sortilin、PON-1、EDV、IMT及PSV 5项联合诊断CAP稳定性的AUC最高,优于单独诊断,其灵敏度为95.65%,特异度为83.33%。结论:超声血流参数EDV、IMT和PSV能够提供CAP的形态学及血流动力学信息,血清Sortilin、PON-1水平能够反映CAP斑块形成与发展的生物学过程,5项指标联合检测可以更好的诊断CAP稳定性。
Objective:To explore the diagnostic value of blood flow parameters of carotid ultrasound combined with serum Sortilin and paraoxonase-1(PON-1)for stability of carotid atherosclerotic plaque(CAP).Methods:A total of 100 CAP patients who admitted to Rugao Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were selected,and they were divided into a stable plaque group(n=54)and a unstable plaque group(n=46).Enzyme linked immunosorbent assay(ELISA)was adopted to determine the expression levels of serum Sortilin and PON-1 of patients in two groups.Multi factor logistic regression was implemented to analyze the influencing factors on CAP stability.The receiver operating characteristic(ROC)curves were drawn to analyze the diagnostic efficiency of blood flow parameters of carotid ultrasound combined with Sortilin and PON-1 on CAP stability.Results:Compared with the end diastolic blood flow velocity(EDV)and intima-media thickness(IMT)of stable plaque group,unstable plaque group showed increased EDV and IMT,and decreased PSV,and the differences were significant(t=7.536,4.680,5.487,P<0.05),respectively.Compared with stable plaque group,the serum Sortilin level in unstable plaque group significantly increased,while the PON-1 level significantly decreased,and the differences of them were significant(t=8.362,5.581,P<0.05),respectively.Multivariate logistic analysis found that Sortilin was a risk factor that affected CAP stability(OR=3.165,P<0.05),while PON-1 was a protective factor that affected CAP stability(OR=0.765,P<0.05).ROC curve analysis indicated that the area under curve(AUC)values of single Sortilin,PON-1,EDV,IMT,PSV,and the combination of them were respectively 0.788(95%CI:0.695-0.864),0.814(95%CI:0.724-0.885),0.847(95%CI:0.761-0.911),0.767(95%CI:0.672-0.846),0.707(95%CI:0.607-0.793)and 0.963(95%CI:0.839-0.907).The AUC value of the combination of above 5 indicators was highest,which was better than that of each single indicator,and its sensitivity and specificity were respectively 95.65%and 83.33%.Conclusion:The EDV,IMT and PSV of blood flow parameters of ultrasound can provide CAP information of morphology and hemodynamics,and serum Sortilin level and PON-1 level can reflect the biological processes of formation and development of CAP.The combined detection of the five indicators can better diagnose CAP stability.
作者
丁颖颖
袁建兴
常娟
章晓伟
吴晓新
丁超
Ding Yingying;Yuan Jianxing;Chang Juan;Zhang Xiaowei;Wu Xiaoxin;Ding Chao(Department of Neurology,Rugao Hospital of Traditional Chinese Medicine,Rugao 226500,China;Department of Gastroenterology,Rugao Hospital of Traditional Chinese Medicine,Rugao 226500,China;Color Ultrasound Room,Rugao Hospital of Traditional Chinese Medicine,Rugao 226500,China;Department of Neurology,Huai'an First People's Hospital,Huai'an 223300,China)
出处
《中国医学装备》
2025年第1期52-57,共6页
China Medical Equipment
基金
江苏省卫生健康委科研项目(ZD2021053)
南通市科学技术局科技计划(MSZ2022093)。
