颈动脉粥样硬化评分与缺血性卒中的诊断

目的：探讨颈动脉粥样硬化评分在缺血性卒中（ischemic stroke, IS）诊断的应用价值。方法： 选择经头颅CT或MRI确诊的缺血性卒中患者（病例组）151例进行回顾性分析，所有病例组患者在发病1周内完成颈动脉超声检查，同时按年龄和性别匹配151例健康体检者（对照组）， 所有对照组患者经CT或MRI排除缺血性卒中，并完成颈动脉超声检查。颈动脉斑块超声评价包括斑块的大小、部位、回声、质地及其表面是否规则；颈动脉粥样硬化超声评价包括动脉内-中膜厚度（intima-media thickness, IMT)、颈动脉狭窄程度、斑块数量及斑块评价。结果： 病例组与对照组患者IMT分别为（0.946±0.185） mm和（0.863±0.148） mm，差异有统计学意义（P<0.001）；颈动脉斑块参数中，与缺血性卒中相关的参数有斑块回声、斑块质地以及表面是否规则，而与斑块大小、斑块部位无相关性；病例组患者颈动脉斑块评分的中位数与四分位数间距分别为3和2，对照组分别为1和2，两者差异有统计学意义（P<0.001）。在颈动脉粥样硬化参数中，与缺血性卒中发生相关的指标是颈动脉斑块评分、颈动脉狭窄程度及IMT，而与斑块数量无相关性。病例组患者颈动脉粥样硬化评分的中位数与四分位数间距分别为5和4，对照组分别为2和4，两者差异有统计学意义（P<0.001）。IMT、颈动脉斑块数量、颈动脉斑块评分及颈动脉粥样硬化评分对诊断缺血性卒中的ROC曲线下面积分别为0.679、0.677、0.704和0.805（P<0.001），颈动脉粥样硬化评分准确性最高。结论： 颈动脉斑块评分及颈动脉粥样硬化评分是缺血性卒中的诊断客观指标，且后者的准确性更高。

Diagnostic value of carotid atherosclerosis score for ischemic stroke

Objective：To discuss the diagnostic value of carotid atherosclerosis score for ischemic stroke. Methods: In the study, 151 patients with ischemic stroke were enrolled, who were diagnosed by cranial CT scan or cranial MRI scan, and examined with carotid duplex ultrasound, and 151 healthy check-up cases matched by age and sex were chosen as control group, who were excluded ischemic stroke by cranial CT scan or cranial MRI scan. All the control cases were examined with carotid duplex ultrasound also. Intima-media thickness (IMT), the number of carotid plaques, the size of each plaque, the location of the plaque and each plaque’s echo, texture, surface regularity were estimated by carotid duplex ultrasound. Results: The IMT of the case group and the control group were (0.946±0.185) mm and (0.863±0.148) mm, and there were significant differences (P<0.001); The parameters of arterial plaque correlated with ischemic stroke were plaque’s echo, texture and surface regularity, however the plaque size and location were not correlated with ischemic stroke. The median and quartile of carotid artery plaque score were 3 and 2 respectively in case group, 1 and 2 respectively in control group, and there were significant differences (P<0.001); The parameters of carotid arterial atherosclerosis associated with ischemic stroke were carotid artery plaque score，carotid stenosis degree and IMT, but not the number of carotid plaques. The median and quartile of carotid arterial atherosclerosis score were 5 and 4 respectively in case group, 2 and 4 respectively in control group, and there were significant differences (P<0.001); The area under the curve (AUC) for IMT, the number of carotid plaques, carotid artery plaque score and carotid arterial atherosclerosis score were 0.679, 0.677, 0.704 and 0.805，respectively (P<0.001). The accuracy of carotid atherosclerosis score was the highest. Conclusion: Carotid artery plaque score and carotid atherosclerosis score can be used for the diagnosis of ischemic stroke, and the accuracy of carotid atherosclerosis score is higher.