摘要
目的探讨颈动脉支架置入术(CAS)对颈动脉狭窄患者疗效的术前超声量化评估方法与价值。方法选择颈动脉狭窄行CAS的患者77例,分别于CAS前3d和术后30d行颈动脉超声检查,根据手术前后狭窄部位与近段颈总动脉流速比值判断疗效,其中疗效欠佳(改善率<50%)17例和疗效理想(改善率≥50%)60例。对术前不稳定斑块积分比、斑块最大偏心比、溃疡斑、斑块最大长度和厚度、面积狭窄率、血管重构、僵硬度指数、狭窄处峰值流速和阻力指数等10项超声指标不同水平测值赋值0、1、2和3分,建立超声量化评分量表(SUS)评价CAS疗效,并绘制ROC曲线判断疗效理想与否的最佳切割值。结果 77例患者CAS前10项超声指标的SUS值为2~23(9.34±4.50)分。CAS后的改善率为19%~93%,平均改善率为(60.67±19.77)%;SUS值与改善率极强度相关(r=0.802,P=0.000)。ROC曲线获得的SUS疗效最佳界值为10.5分,该量表信度系数为0.822,建构的效度检验KMO值为0.868,10项指标分析Extraction值为0.639~0.841,均>0.5(χ2=162.588,P=0.000)。SUS预测CAS疗效的敏感性为88.2%,特异性为86.7%。结论术前SUS可能对评估CAS疗效有重要作用。
Objective To study the method and value of ultrasound score scale in preoperative assessment of CAS.Methods Seventy-seven patients who underwent carotid artery ultrasonography on day 3 before CAS and on day 30 after CAS were divided into poor outcome group（n=17）with an improvement rate50% and good outcome group（n=60）with an improvement rate≥50%.ROC curves were plotted for judging the best cutting value of good outcome.Results The ultrasound score scale score was 2-23（9.34±4.50）for ratio of total thickness of unstable plaque to that of stable plaque,maximal plaque deconcentration,ulcerative plaques,maximal plaque length and thickness,stenosis area,vascular remodeling,stiffness index,etc.The improvement rate of CAS was 19%-93% with a mean improvement rate of 60.67% ±19.77% after CAS.The ultrasound score scale score was closely related the improvement rate of carotid artery stenosis（r=0.802,P=0.000）.The optimum cutting value was 10.5 for CAS under the ROC curve.The coefficient of ultrasound score scale score was 0.822.The peak KMO value was 0.868 and the extraction value was 0.639-0.841 for unstable plaques,maximal plaque deconcentration,ulcerative plaques,maximal plaque length and thickness,stenosis area,vascular remodeling,stiffness index,peak fow velocity at stenosis sites and resistance index（P=0.000）.The sensitivity and specificity of ultrasound score scale for CAS were 88.2% and 86.7%respectively.Conclusion Ultrasound score scale plays an important role in preoperative assessmen of CAS.
作者
陈胜江
Chen Shengjiang(Department of Ultrasound,First Affiliated Hospital of Henan University of Science and Technology,Luoyaang 471000,Henan Province,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2018年第7期720-723,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
洛阳市科技计划项目(1503007A-1)
