天津医药

天津医药 ›› 2025, Vol. 53 ›› Issue (4): 439-443.doi: 10.11958/20242130

• 应用研究 • 上一篇    下一篇

颈动脉粥样硬化斑块近心端角度与新生血管评分对脑梗死的预测价值

胡紫月1(), 郑茹瑜1, 刘丹1, 唐姗1, 阚艳敏1,△(), 经翔1, 李倩2   

  1. 1 天津市第三中心医院超声科（邮编300170）
    2 神经内科,天津市重症疾病体外生命支持重点实验室（邮编300170）;天津市人工细胞工程技术研究中心，天津市肝胆疾病研究所（邮编300170）
  • 收稿日期:2024-12-05 修回日期:2025-02-20 出版日期:2025-04-15 发布日期:2025-04-17
  • 通讯作者: △ E-mail：wuxiny_2009@163.com
  • 作者简介:胡紫月(1986)，女，主治医师，主要从事心血管超声方面研究。E-mail：2478389869@qq.com
  • 基金资助:
    天津市医学重点学科（专科）建设项目(TJYXZDXK-074C)

Predictive value of proximal angle of atherosclerosis carotid plaque and distribution of neovascularization in evaluating the recurrence of cerebral infarction

HU Ziyue1(), ZHENG Ruyu1, LIU Dan1, TANG Shan1, KAN Yanmin1,△(), JING Xiang1, LI Qian2   

  1. 1 Department of Ultrasound
    2 Department of Neurology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China
  • Received:2024-12-05 Revised:2025-02-20 Published:2025-04-15 Online:2025-04-17
  • Contact: △ E-mail：wuxiny_2009@163.com

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摘要：

目的 探讨颈动脉粥样硬化斑块近心端角度与新生血管评分的相关性，及二者对预测脑梗死再发的临床价值。方法 选取行颈动脉斑块超声检查患者88例。根据CT或MRI结果分为非脑梗死组（45例）和脑梗死组（43例），进行常规超声检查后均行超声造影检查，常规超声测量斑块长度、厚度及近心端角度，超声造影模式显示斑块近心端新生血管评分情况，并进行比较分析。结果 脑梗死组斑块厚度、近心端角度及新生血管评分大于非脑梗死组（P<0.05），而斑块长度无统计学意义；脑梗死组斑块近心端新生血管评分2或3分者比例高于非脑梗死组（79.1% vs. 24.4%，P<0.01）。所有患者斑块近心端角度与新生血管评分呈正相关（rs=0.374，P<0.01）；新生血管评分预测脑梗死的受试者工作特征（ROC）曲线下面积与近心端角度比较差异无统计学意义（P>0.05），且获得近心端角度最佳临界值为18.8°，预测脑梗死再发的敏感度和特异度分别为93.0%和62.2%。脑梗死组患者1年再发梗死7例（16.3%），再发梗死患者的颈动脉斑块近心端新生血管评分均较高，角度均大于18.8°。结论 颈动脉斑块近心端角度与新生血管评分有较强相关性，对脑梗死的再发有积极预警作用，可为临床提供可靠的辅助诊断依据。

关键词: 脑梗死, 颈动脉, 动脉粥样硬化, 新生血管评分, 斑块近心端角度

Abstract:

Objective To explore the correlation between the proximal angle of carotid atherosclerotic plaques and neovascularization scores, and their clinical application value in predicting recurrent cerebral infarction. Methods A total of 88 patients who underwent carotid plaque ultrasound examination in our hospital were selected. According to CT/MRI results, patients were divided into the non-cerebral infarction group (45 cases) and the cerebral infarction group (43 cases). Conventional ultrasound examination was performed followed by contrast-enhanced ultrasound. Plaque length, thickness and proximal angle were measured, and the neovascularization score of the proximal end was evaluated using contrast-enhanced ultrasound, and the results were compared and analyzed. Results In the cerebral infarction group, plaque thickness, proximal angle, and neovascularization score were significantly higher than those in the non-cerebral infarction group (P<0.05), while there was no significant difference in plaque length. The proportion of plaques with a proximal neovascularization score of 2 or 3 was higher in the cerebral infarction group than those of the non-cerebral infarction group (79.1% vs. 24.4%, P<0.01). A positive correlation was found between the proximal angle and neovascularization score in all patients (rs=0.374, P<0.01). There was no significant difference between the area under the ROC curve for neovascularization score in predicting recurrent cerebral infarction and the proximal angle (P>0.05). The optimal cutoff value of the proximal angle was 18.8, and the sensitivity and the specificity for predicting recurrent cerebral infarction were 93.0% and 62.2%. In the cerebral infarction group, seven patients (16.3%) had recurrent infarction within one year, and these patients had higher proximal neovascularization scores, with angles greater than 18.8°. Conclusion There is a strong correlation between proximal angle of carotid plaques and neovascularization score, which has a positive predictive role in the recurrence of cerebral infarction, providing a reliable auxiliary diagnostic basis for clinical practice.

Key words: brain infarction, carotid arteries, atherosclerosis, neovascularization score, proximal angle

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