颈动脉超声及血清HbA1c、FIB对急性前循环脑梗死的评估价值分析

doi:10.11958/20220168

天津医药 ›› 2022, Vol. 50 ›› Issue (9): 948-952.doi: 10.11958/20220168

颈动脉超声及血清HbA1c、FIB对急性前循环脑梗死的评估价值分析

朱云林¹^,²(), 殷广莉³^,^△(), 戴平涛³

1 安徽省滁州市全椒县人民医院神经内科（邮编239500）
2 滁州城市职业学院护理学院内科教研室
3 安徽省滁州市全椒县人民医院超声科

收稿日期:2022-01-28 修回日期:2022-03-26 出版日期:2022-09-15 发布日期:2022-09-05
通讯作者: 殷广莉 E-mail:scuky2011@126.com;443539894@qq.com
作者简介:朱云林（1983）,男,主治医师,主要从事脑血管病的诊治与预防研究。E-mail： scuky2011@126.com

Evaluation value of carotid ultrasound combined with serum HbA1c and FIB in acute anterior circulation cerebral infarction

ZHU Yunlin¹^,²(), YIN Guangli³^,^△(), DAI Pingtao³

1 Department of Neurology, the People's Hospital of Quanjiao, Chuzhou 239500, China
2 Department of Internal Medicine, College of Nursing, Chuzhou City Vocation College
3 Department of Ultrasonography, the People's Hospital of Quanjiao

Received:2022-01-28 Revised:2022-03-26 Published:2022-09-15 Online:2022-09-05
Contact: YIN Guangli E-mail:scuky2011@126.com;443539894@qq.com

朱云林, 殷广莉, 戴平涛. 颈动脉超声及血清HbA1c、FIB对急性前循环脑梗死的评估价值分析[J]. 天津医药, 2022, 50(9): 948-952.

ZHU Yunlin, YIN Guangli, DAI Pingtao. Evaluation value of carotid ultrasound combined with serum HbA1c and FIB in acute anterior circulation cerebral infarction[J]. Tianjin Medical Journal, 2022, 50(9): 948-952.

摘要/Abstract

摘要：

目的探讨颈动脉超声定量参数联合血清糖化血红蛋白（HbA1c）、纤维蛋白原（FIB）在急性前循环脑梗死评估中的应用价值。方法收集93例前循环脑梗死患者（脑梗死组）及50例健康体检者（对照组）,采用颈动脉超声检测2组颈内动脉收缩期峰值流速（PSV）、舒张末期血流速度（EDV）、颈动脉内膜中层厚度（IMT）等指标,测定血清HbA1c、FIB水平,分析不同病情脑梗死患者指标差异,分析指标与脑梗死、病情的关系及指标单独或联合诊断以评估病情的价值。结果脑梗死组患者PSV、EDV、IMT颈动脉超声参数及血清HbA1c、FIB均显著高于对照组（P<0.05）;Logistic回归分析示,较高水平的EDV、IMT、HbA1c、FIB为脑梗死的危险因素（P<0.05）,EDV、IMT、HbA1c、FIB单独及4项联合诊断脑梗死的曲线下面积（AUC）及95%CI分别为0.770（0.683~0.857）、0.852（0.788~0.917）、0.799（0.717~0.880）、0.829（0.762~0.896）、0.970（0.947~0.992）;中度、重度脑梗死患者IMT、FIB高于轻度组,重度组HbA1c高于轻度组及中度组,而FIB高于中度组（P<0.05）;相关性分析显示,PSV、IMT、HbA1c、FIB与NIHSS评分呈正相关（P<0.05）;Logistic回归分析示,较高水平的IMT、FIB是中重度脑梗死的危险因素;IMT、FIB单独及2项联合诊断中重度脑梗死患者的AUC及95%CI分别为0.840（0.758~0.923）、0.784（0.687~0.880）、0.882（0.809~0.954）。结论前循环脑梗死患者可有颈动脉超声定量参数及血清HbA1c、FIB水平的变化,EDV、IMT、HbA1c、FIB与脑梗死发生有关,IMT、FIB与脑梗死病情严重程度有关。

关键词: 脑梗死, 动脉粥样硬化, 超声检查,多普勒,彩色, 血红蛋白A,糖基化, 颈动脉内膜中膜厚度, 纤维蛋白原, 前循环, 糖化血红蛋白

Abstract:

Objective To investigate the application value of carotid ultrasound quantitative parameters combined with serum glycosylated hemoglobin (HbA1c) and fibrinogen (FIB) in the assessment of acute anterior circulation cerebral infarction. Methods Ninety-three patients with acute anterior circulation cerebral infarction were collected as the cerebral infarction group, and 50 healthy individuals were used as the control group. The peak systolic flow velocity (PSV),end-diastolic flow velocity (EDV) and carotid intima-media thickness (IMT) of internal carotid artery were measured by carotid ultrasound. Serum HbA1c and FIB levels were determined. The above-mentioned indicators in patients with cerebral infarction in different conditions were compared. The relationship between these indicators and cerebral infarction and its condition and these indicators alone or in combination in diagnosis and condition evaluation were analyzed. Results The PSV, EDV, IMT, serum HbA1c and FIB levels were significantly larger/higher in the cerebral infarction group than those of the control group (P<0.05). Logistic regression analysis showed that the higher levels of EDV, IMT, HbA1c and FIB were risk factors for cerebral infarction (P<0.05). The area under the curve values and 95%CI of EDV, IMT, HbA1c, FIB alone and combined to diagnose cerebral infarction were 0.770 (0.683-0.857), 0.852 (0.788-0.917), 0.799 (0.717-0.880), 0.829 (0.762-0.896) and 0.970 (0.947-0.992). The IMT and FIB were significantly higher in the moderate group and the severe group than those in the mild group. The HbA1c was significantly higher in the severe group than that in the mild group and the moderate group, and the FIB was higher than that in the moderate group (P<0.05). Pearson correlation analysis showed that PSV, IMT, HbA1c and FIB were positively correlated with the NIHSS score (P<0.05). Logistic regression analysis showed that the higher IMT and FIB were risk factors for moderate and severe cerebral infarction. The area under the curve values and 95%CI of IMT, FIB alone and combined to diagnose moderate to severe cerebral infarction were 0.840 (0.758-0.923), 0.784 (0.687-0.880) and 0.882 (0.809-0.954). Conclusion Patients with anterior circulation cerebral infarction may be accompanied by changes in carotid artery ultrasound quantitative parameters and serum HbA1c and FIB levels. EDV, IMT, HbA1c and FIB are related to the occurrence of cerebral infarction, and IMT and FIB are related to the severity of cerebral infarction.

Key words: cerebral infarction, atherosclerosis, ultrasonography,doppler,color, hemoglobin A,glycosylated, carotid intima-media thickness, fibrinogen, anterior circulation, glycosylated hemoglobin

中图分类号:

R743.33

图/表 9

参考文献 24

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组别	n	PSV （cm/s）	EDV （cm/s）	IMT （mm）	HbA1c （%）	FIB （g/L）
对照组	50	69.1±8.3	18.59±4.37	0.94±0.10	7.83±1.54	2.83±0.51
脑梗死组	93	77.8±8.9	23.05±3.02	1.12±0.14	9.33±1.03	4.01±1.08
t		5.689^＊＊	7.160^＊＊	8.189^＊＊	6.937^＊＊	7.294^＊＊

组别	n	PSV （cm/s）	EDV （cm/s）	IMT （mm）	HbA1c （%）	FIB （g/L）
对照组	50	69.1±8.3	18.59±4.37	0.94±0.10	7.83±1.54	2.83±0.51
脑梗死组	93	77.8±8.9	23.05±3.02	1.12±0.14	9.33±1.03	4.01±1.08
t		5.689^＊＊	7.160^＊＊	8.189^＊＊	6.937^＊＊	7.294^＊＊

指标	β	SE	Wald χ²	P	OR	OR 95%CI
PSV	0.076	0.044	2.939	0.086	1.079	0.989~1.176
EDV	0.364	0.108	11.363	0.001	1.438	1.164~1.777
IMT	10.716	3.068	12.198	<0.001	45 092.968	110.241~1.844×10⁷
HbA1c	1.243	0.332	14.053	<0.001	3.466	1.810~6.639
FIB	1.285	0.641	4.014	0.045	3.615	1.028~12.710
常量	-37.976	7.457	25.934	<0.001	<0.001	-

指标	β	SE	Wald χ²	P	OR	OR 95%CI
PSV	0.076	0.044	2.939	0.086	1.079	0.989~1.176
EDV	0.364	0.108	11.363	0.001	1.438	1.164~1.777
IMT	10.716	3.068	12.198	<0.001	45 092.968	110.241~1.844×10⁷
HbA1c	1.243	0.332	14.053	<0.001	3.466	1.810~6.639
FIB	1.285	0.641	4.014	0.045	3.615	1.028~12.710
常量	-37.976	7.457	25.934	<0.001	<0.001	-

指标	AUC及95%CI	截断值	敏感度（%）	特异度（%）	约登指数
EDV	0.770（0.683~0.857）	19.6 cm/s	93.50	58.00	0.515
IMT	0.852（0.788~0.917）	1.02 mm	73.10	84.00	0.571
HbA1c	0.799（0.717~0.880）	8.42%	82.80	70.00	0.528
FIB	0.829（0.762~0.896）	3.04 g/L	76.30	82.00	0.583
联合诊断	0.970（0.947~0.992）	-	83.90	96.00	0.799

颈动脉超声及血清HbA1c、FIB对急性前循环脑梗死的评估价值分析

Evaluation value of carotid ultrasound combined with serum HbA1c and FIB in acute anterior circulation cerebral infarction

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组别	n	PSV（cm/s）	EDV（cm/s）	IMT（mm）	HbA1c（%）	FIB（g/L）
轻度组	37	75.9±7.2	22.35±2.11	1.02±0.10	9.15±0.96	3.35±0.91
中度组	34	77.9±9.1	23.79±3.74	1.17±0.13^a	9.01±1.17	4.03±1.02^a
重度组	22	80.9±10.7	23.08±2.92	1.22±0.10^a	10.10±0.16^ab	5.06±0.46^ab
F		2.259	2.083	25.089^＊＊	10.134^＊＊	26.177^＊＊

指标	β	SE	Wald χ²	P	OR	OR 95%CI
PSV	0.043	0.026	2.765	0.096	1.044	0.992~1.098
EDV	0.138	0.077	3.193	0.074	1.148	0.987~1.336
IMT	13.676	2.850	23.022	<0.001	8.694×10⁵	3.259×10³~2.319×10⁸
HbA1c	0.284	0.211	1.808	0.179	1.328	0.878~2.008
FIB	1.107	0.257	18.503	<0.001	3.025	1.827~5.010

指标	β	SE	Wald χ²	P	OR	OR 95%CI
IMT	11.630	2.949	15.554	<0.001	1.124×10⁵	347.276~3.638×10⁷
FIB	0.759	0.294	6.660	0.010	2.136	1.200~3.802
常量	-15.305	3.292	21.609	<0.001	-	-

指标	AUC及95%CI	截断值	敏感度（%）	特异度（%）	约登指数
IMT	0.840（0.758~0.923）	1.03 mm	92.90	64.90	0.578
FIB	0.784（0.687~0.880）	3.90 g/L	71.40	81.10	0.525
联合诊断	0.882（0.809~0.954）	-	82.10	81.10	0.632

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