超声造影结合血清标志物对不稳定斑块及混合斑块的鉴别价值研究王辉,张强,申向辉,尹素芳,侯晓英河北省邯郸市中心医院超声医学科 河北省 邯郸市 056000

目的：探讨超声造影(CEUS)结合血清标志物对于不稳定斑块及混合斑块的鉴别价值研究。方法：选取2018年2月-2020年8月于本院行常规超声检查发现颈动脉粥样硬化斑块的190例患者,术前均行超声造影、血清Lp-PLA2、hs-CRP检测。以病理结果为金标准,根据斑块稳定性分为不稳定斑块(138例)和稳定斑块(52例)；根据斑块性质分为软斑块组(138例)、硬斑块组(20例)以及混合斑块组(32例)。比较超声造影、血清Lp-PLA2、hs-CRP水平各组之间的差异。采用准确性、敏感度、特异度、阳性预测值、阴性预测值指标表达超声造影、血清标志物单独或联合诊断不稳定斑块的诊断效能差异。结果：CUES诊断斑块稳定性的差异具有统计学意义(x_²=93.479,P=0.000)。不同性质颈动脉粥样硬化斑块的CUES增强分级不同,当斑块回声越低,其强化越明显,分级也越高,且分布差异具有统计下意义(x_²=21.837,P=0.000)。不稳定斑块组患者血清hs-CRP[(23.17±0.53)mg/L]、Lp-PLA2[(57.36±4.22)ug/L]显著高于稳定斑块组[(16.32±0.56)mg/L]、[(46.73±4.14)ug/L],且差异具有统计学意义(t=0.347、8.432,P=0.000、0.000)。CUES结合血清标志物诊断不稳定斑块的准确性、敏感度、特异度、阳性预测值、阴性预测值最高,且差异具有统计学意义(P<0.05)。结论：超声造影结合血清hs-CRP、Lp-PLA2水平对不稳定斑块及混合斑块具有一定的鉴别诊断价值,有助于早期鉴别不稳定斑块以及混合斑块,进一步指导临床治疗方案的选择。

The value of contrast-enhanced ultrasound combined with serum markers in the identification of unstable plaques and mixed plaques

Objective: To explore the value of contrast-enhanced ultrasound (CEUS) combined with serum markers for the identification of unstable plaques and mixed plaques. Methods:190 patients with carotid atherosclerotic plaques were selected from February 2018 to August 2020 in our hospital who underwent routine ultrasound examination. All patients underwent contrast-enhanced ultrasound, serum Lp-PLA2, and hs-CRP detection before surgery. Taking pathological results as the gold standard, it was divided into unstable plaques (138 cases) and stable plaques (52 cases) according to the stability of plaques; according to the nature of plaques, it was divided into soft plaque group (138 cases) and hard plaque group (20 cases) and mixed plaque group (32 cases). Compare the differences of contrast-enhanced ultrasound, serum Lp-PLA2, hs-CRP levels among the groups. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value index expression of contrast-enhanced ultrasound, serum markers alone or in combination in the diagnosis of unstable plaques are different in diagnostic efficiency.Results: The difference of CUES diagnosis of plaque stability was statistically significant (x_²=93.479, P=0.000). Different types of carotid atherosclerotic plaques have different CUES enhancement grades. When the echo of the plaque is lower, its enhancement is more obvious, and the grade is higher, and the distribution difference has statistical significance (x_²=21.837, P=0.000). Serum hs-CRP[(23.17±0.53)mg/L] and Lp-PLA2[(57.36±4.22)ug/L] in the unstable plaque group were significantly higher than those in the stable plaque group [(16.32±0.56)mg/L ], [(46.73±4.14)ug/L], and the difference was statistically significant (t=0.347, 8.432, P=0.000, 0.000). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CUES combined with serum markers in the diagnosis of unstable plaque were the highest, and the difference was statistically significant (P<0.05). Conclusion: Contrast-enhanced ultrasound combined with serum hs-CRP and Lp-PLA2 levels have a certain value in the differential diagnosis of unstable plaques and mixed plaques, which can help to identify unstable plaques and mixed plaques early and further guide the choice of clinical treatment options.