摘要
目的探究颈动脉超声血流参数对缺血性脑卒中患者预后的预测价值及影响因素。方法选取2021-01—2023-01皖北煤电集团总医院收治的缺血性脑卒中患者120例,其中轻度狭窄54例,中度狭窄42例,重度狭窄24例,对3组患者的临床资料开展回顾性分析,并按2∶1比例选取同期体检健康者60名为对照组,比较各组颈动脉超声血流参数,分析颈动脉超声血流参数与颈动脉狭窄程度的相关性。根据研究组患者预后状况进行分组(预后良好组78例,预后不良组42例),分析预后的影响因素,并通过ROC曲线分析颈动脉超声血流参数对缺血性脑卒中患者预后的预测价值。结果各组PSV、IMT、EDV比较差异均有统计学意义(F=39.135、31.515、104.601,P<0.05),且重度狭窄组PSV<中度狭窄组<轻度狭窄组<对照组,重度狭窄组IMT、EDV>中度狭窄组>轻度狭窄组>对照组(P<0.05)。Pearson相关分析显示,PSV与颈动脉狭窄程度呈负相关(r=—0.748,P<0.05),IMT、EDV与颈动脉狭窄程度呈正相关(r=0.392、0.569,P<0.05)。二元Logistic回归分析显示,年龄≥70岁、高血压、糖尿病、颈动脉狭窄程度(中度/重度)、发病至入院时间(12~24 h)、斑块稳定性(混合斑块/不稳定斑块)、NIHSS评分、IMT、EDV为预后的危险因素,规律使用降压药物、PSV为预后保护因素(P<0.05)。ROC曲线分析显示,PSV、IMT、EDV预测缺血性脑卒中患者预后的AUC分别为0.844、0.844、0.835。颈动脉超声参数联合预测缺血性脑卒中患者预后的AUC为0.926,敏感度、特异度分别为83.3%、89.7%。结论年龄≥70岁、高血压、糖尿病、颈动脉狭窄程度(中度/重度)、发病至入院时间(12~24 h)、斑块稳定性(混合斑块/不稳定斑块)、NIHSS评分、IMT、EDV为预后的危险因素。规律使用降压药物、PSV为预后保护因素,且颈动脉超声血流参数与缺血性脑卒中患者颈动脉狭窄程度关系密切,可作为预测缺血性脑卒中预后的有效指标,且联合预测的准确性更好。
Objective To probe the predictive value of carotid artery ultrasound blood flow parameters on the prognosis of ischemic stroke patients and its influencing factors.Methods A retrospective analysis was con⁃ducted on the clinical data of 120 ischemic stroke patients admitted to Wan Bei General Hospital of Wanbei Coal Power Group from January 2021 to January 2023,including 54 cases of mild stenosis,42 cases of moderate steno⁃sis,and 24 cases of severe stenosis.Sixty healthy individuals who underwent physical examination at the same time were selected as the control group in a 2∶1 ratio,and the differences in carotid ultrasound blood flow parame⁃ters between each group were compared.The correlation between carotid ultrasound blood flow parameters and the degree of carotid stenosis was analyzed,and the study group was divided into groups based on the prognosis of the patients(78 cases in the good prognosis group and 42 cases in the poor prognosis group).The influencing factors for prognosis and the predictive value of carotid ultrasound blood flow parameters on the prognosis of ischemic stroke patients were analyzed through ROC curve analysis.Results There were statistically significant differences in PSV,IMT,and EDV among each group(F=39.135,31.515,104.601,P<0.05),and PSV in the severe stenosis group<moderate stenosis group<mild stenosis group<control group,while IMT and EDV in the severe stenosis group>moderate stenosis group>mild stenosis group>control group(P<0.05).Pearson correlation analysis showed that PSV was negatively correlated with the degree of carotid artery stenosis(r=—0.748,P<0.05),while IMT and EDV were positively correlated with the degree of carotid artery stenosis(r=0.392,0.569,P<0.05).Binary Logis⁃tic regression analysis showed that age≥45 years old,hypertension,diabetes,degree of carotid stenosis(moderate/severe),time from onset to admission(12-24 hours),plaque stability(mixed plaque/unstable plaque),NIHSS score,IMT,EDV were risk factors for prognosis,and regular use of antihypertensive drugs and PSV were protective factors for prognosis(P<0.05).ROC curve analysis showed that the AUC of PSV,IMT,and EDV predicting the prognosis of ischemic stroke patients was 0.844,0.844,and 0.835,respectively.The combined data of ca⁃rotid artery ultrasound parameters predict the prognosis of ischemic stroke patients,with an AUC of 0.926,sensi⁃tivity and specificity of 83.3%and 89.7%,respectively.Conclusion Age≥45 years old,hypertension,diabe⁃tes,degree of carotid stenosis(moderate/severe),time from onset to admission(12-24 hours),plaque stability(mixed plaque/unstable plaque),NIHSS score,IMT,EDV are prognostic risk factors,regular use of antihyperten⁃sive drugs,PSV are prognostic protective factors,and carotid ultrasound blood flow parameters are closely related to the degree of carotid stenosis in ischemic stroke patients,which can be used as an effective indicator for pre⁃dicting the prognosis of ischemic stroke,and the combined prediction accuracy is better.
作者
龙花
韩路
方开峰
LONG Hua;HAN Lu;FANG Kaifeng(Wan Bei General Hospital of Wanbei Coal Power Group/The Third Affiliated Hospital of Bengbu Medical College,Suzhou 234000,China)
出处
《中国实用神经疾病杂志》
2023年第9期1102-1107,共6页
Chinese Journal of Practical Nervous Diseases
基金
安徽省科学技术厅公益性联动计划项目(编号:15011d04068)。
关键词
缺血性脑卒中
预后
影响因素
颈动脉超声
血流参数
预测价值
Ischemic stroke
Prognosis
Influencing factors
Carotid artery ultrasound
Blood flow parame⁃ters
Predictive value
作者简介
通信作者:方开峰。
