摘要
目的探讨脑颈一体化超声[颈动脉超声(CU)联合经颅彩色多普勒超声(TCCD)]检测缺血性脑卒中(CIS)颈动脉狭窄及颅内动脉狭窄的临床诊断价值。方法选取2023年7月至2024年10月在新乡医学院第三附属医院超声医学科检查的271例CIS患者作为研究组,选取同期本院神经内科收治的256例非CIS患者作为对照组。所有患者均接受CU、TCCD及CT血管成像检查(CTA)检查,以CTA结果为参考标准。比较两组患者颈动脉和颅内动脉管腔狭窄程度及狭窄率,内-中膜增厚率,斑块检出率和斑块特征;比较研究组患者脑缺血侧与非脑缺血侧斑块特征;比较三种方法诊断颈动脉和颅内动脉狭窄的灵敏度、特异性和准确率。结果研究组患者颈动脉轻度狭窄与对照组比较差异无统计学意义(P>0.05)。研究组患者颈动脉中重度狭窄(闭塞)率、颅内动脉轻度狭窄、颅内动脉中重度狭窄(闭塞)率及内-中膜增厚率分别为35.79%、27.31%、25.46%、91.51%,明显高于对照组的2.34%、9.77%、0.39%、31.64%,内-中膜正常率为8.49%,明显低于对照组的68.36%,差异均有统计学意义(P<0.05)。研究组患者的颈动脉斑块检出率为77.12%,明显高于对照组的28.13%,差异有统计学意义(P<0.05)。研究组患者的颈动脉斑块均质强回声及均质低回声与对照组比较差异均无统计学意义(P>0.05)。研究组患者的颈动脉斑块不均质回声率为66.51%,明显高于对照组的18.06%,均质等回声率为7.66%,明显低于对照组的48.16%,差异均有统计学意义(P<0.05)。研究组患者的颈动脉斑块形态不规则率、溃疡率分别为55.98%、19.62%,明显高于对照组的15.28%、4.17%,差异均有统计学意义(P<0.05)。研究组患者脑缺血侧均质强回声率、均质等回声率及均质低回声率分别为0.71%、0.71%、8.51%,明显低于非脑缺血侧的25.00%、22.06%、35.29%,不均质回声率、形态不规则率和溃疡率分别为90.07%、70.92%、27.66%,明显高于非脑缺血侧的17.65%、25.00%、2.94%,差异均有统计学意义(P<0.05)。CU联合TCCD诊断颈动脉和颅内动脉狭窄的灵敏度、特异性、准确率分别为97.62%、96.26%、97.42%,明显高于单纯CU的86.32%、83.12%、83.03%及单纯TCCD的80.52%、71.88%、81.92%,差异均有统计学意义(P<0.05)。结论脑颈一体化超声诊断CIS的准确率高,能够全面评估颈动脉和颅内动脉狭窄及斑块特点,为CIS鉴别和病情评估提供可靠依据。
Objective To evaluate the clinical diagnostic value of integrated cerebrovascular and carotid ultra-sound(carotid ultrasound[CU]combined with transcranial color-coded Doppler[TCCD])in detecting carotid and intra-cranial artery stenosis in ischemic stroke(CIS)patients.Methods A total of 271 CIS patients examined in the Depart-ment of Ultrasound at the Third Affiliated Hospital of Xinxiang Medical University from July 2023 to October 2024 were enrolled as the study group,while 256 non-CIS patients admitted to the Department of Neurology during the same period served as the control group.All patients underwent CU,TCCD,and CT angiography(CTA),with CTA results as the reference standard.The degree and rate of carotid/intracranial artery stenosis,intima-media thickening rate,plaque detection rate,and plaque characteristics were compared between the two groups.Plaque features were compared be-tween the ischemic and non-ischemic sides in the study group.The sensitivity,specificity,and accuracy of the three meth-ods in diagnosing stenosis were analyzed.Results No significant difference was observed in mild carotid stenosis be-tween the study group and the control group(P>0.05).The study group showed significantly higher rates of moder-ate-to-severe carotid stenosis/occlusion(35.79%),mild intracranial stenosis(27.31%),moderate-to-severe intracranial stenosis/occlusion(25.46%),and intima-media thickening(91.51%)versus the control group(2.34%,9.77%,0.39%,31.64%,respectively;all P<0.05).The normal intima-media rate was lower in the study group(8.49%vs 68.36%,P<0.05).Carotid plaque detection was higher in the study group(77.12%vs 28.13%,P<0.05).There was no statistically sig-nificant difference in the prevalence of homogeneous hyperechoic and homogeneous hypoechoic carotid plaques be-tween the study group and the control group(P>0.05).The heterogeneous echo rate of carotid plaques in the study group was 66.51%,significantly higher than 18.06%in the control group(P<0.05).The homogeneous isoechoic rate was 7.66%,significantly lower than 48.16%in the control group(P<0.05).The irregular shape rate and ulceration rate of ca-rotid plaques in the study group were 55.98%and 19.62%,respectively,significantly higher than 15.28%and 4.17%in the control group(P<0.05).In the study group,the homogeneous hyperechoic rate,homogeneous isoechoic rate,and ho-mogeneous hypoechoic rate on the cerebral ischemic side were 0.71%,0.71%,and 8.51%,respectively,significantly low-er than 25.00%,22.06%,and 35.29%on the non-ischemic side(P<0.05);conversely,the heterogeneous echo rate,irregu-lar shape rate,and ulceration rate on the ischemic side were 90.07%,70.92%,and 27.66%,significantly higher than 17.65%,25.00%,and 2.94%on the non-ischemic side(P<0.05).CU+TCCD demonstrated superior sensitivity(97.62%),specificity(96.26%),and accuracy(97.42%)versus CU alone(86.32%,83.12%,83.03%)or TCCD alone(80.52%,71.88%,81.92%;all P<0.05).Conclusion Integrated cerebrovascular and carotid ultrasound provides high diagnostic accuracy for CIS,enabling comprehensive assessment of carotid/intracranial stenosis and plaque features,thus offering reliable evidence for CIS differentiation and evaluation.
作者
吴向菊
杜好梦
吕荣嗣
杨汇娟
WU Xiang-ju;DU Hao-meng;LYU Rong-si;YANG Hui-juan(Department of Ultrasound Medicine,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453000,Henan,CHINA)
出处
《海南医学》
2025年第13期1918-1923,共6页
Hainan Medical Journal
基金
河南省医学科技攻关计划项目(编号:LHG20210902)。
