南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (6): 892-898.doi: 10.12122/j.issn.1673-4254.2022.06.13

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颈动脉斑块内新生血管与PCI术后患者再次血运重建具有相关性

韩艳艳，费 翔，任 玲，汪晶晶，陈 韬，郭 军，汪 奇   

  1. 中国人民解放军总医院第六医学中心心血管病医学部，北京 100048；解放军医学院，北京 100853；中国人民解放军总医院第一医学中心超声诊断科，北京 100853；兰州大学第二临床医学院，甘肃 兰州 730030
  • 出版日期:2022-06-20 发布日期:2022-06-27

Carotid intraplaque neovascularization is correlated with the risk of revascularization following percutaneous coronary intervention

HAN Yanyan, FEI Xiang, REN Ling, WANG Jingjing, CHEN Tao, GUO Jun, WANG Qi   

  1. Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China; Medical School of Chinese PLA, Beijing 100853, China; Department of Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Second Medical College of Lanzhou University, Lanzhou 730030, China
  • Online:2022-06-20 Published:2022-06-27

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摘要： 目的 应用超声造影（CEUS）评估经皮冠状动脉介入治疗术（PCI）后患者颈动脉斑块内新生血管（IPN）与再次血运重建之间的关系。方法 选取105名PCI术后≥12月随访患者，接受CEUS检查，观察斑块形成情况及IPN，并根据患者是否接受再次血运重建分为再次血运重建组（REV，n=27）和非再次血运重建组（N-REV，n=78）。应用受试者工作特征曲线评价CEUS相关参数预测PCI术后再次血运重建的诊断效能，logistic回归分析危险因素。结果 REV组患者IPN 0分、1分、2分、3分分别为1（3.7%）、8（29.6%）、15（55.6%）、3（11.1%）。两组间斑块长度（15.70±6.93 vs 12.10±6.64，P<0.05）、斑块最大厚度（3.69±1.12 vs 3.14±1.18，P<0.05）、IPN（1.74±0.71 vs 0.87±0.63，P<0.001）差异具有统计学意义。IPN与PCI术后再次血运重建显著相关，logistic回归分析表明IPN是PCI术后再次血运重建的独立危险因素。选取IPN=1.5为截断值时，PCI术后患者发生再次血运重建的灵敏度、特异度、阳性预测值、阴性预测值分别为74%、89%、69%、91%，其曲线下面积为0.848（95% CI：0.703~0.905，P<0.001）。结论 CEUS可以无创的半定量评估PCI术后患者颈动脉斑块内新生血管情况，IPN与PCI术后发生再次血运重建具有相关性，有一定的临床预测价值。

关键词: 超声造影；颈动脉斑块；新生血管；冠心病；再次血运重建

Abstract: Objective To investigate the correlation of intraplaque neovascularization (IPN) detected by carotid contrast-enhanced ultrasound (CEUS) with revascularization in patients following percutaneous coronary intervention (PCI). Methods This study was conducted among 105 patients who were followed up for more than 12 months after PCI. All the patients received CEUS examination for assessment of carotid plaque formation and IPN, which were compared between patients with revascularization (REV group, n=27) and those without revascularization (N-REV group, n=78). ROC curve was used to analyze the diagnostic efficacy of CEUS for predicting revascularization. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with revascularization. Results In the REV group, the IPN score was 0 in 1 (3.7%) patient, 1 in 8 (29.6%) patients, 2 in 15 (55.6%) patients and 3 in 3 (11.1%) patients. Significant differences were noted between REV and N-REV groups in plaque length (15.70±6.93 vs 12.10±6.64, P<0.05), maximum plaque thickness (3.69±1.12 vs 3.14±1.18, P<0.05) and IPN (1.74±0.71 vs 0.87±0.63, P<0.001). IPN score was identified as an independent risk factor for revascularization in patients following PCI, and at the cutoff value of 1.5, its sensitivity, specificity, positive predictive value, and negative predictive value for predicting the occurrence of revascularization were 74%, 89%, 69%, and 91% , respectively, with an AUC of 0.848 (95% CI: 0.703-0.905, P<0.001). Conclusion CEUS allows noninvasive and semi-quantitative assessment of neovascularization in carotid artery plaques, and IPN detected by CEUS is correlated with the risk of revascularization in patients following PCI.

Key words: contrast-enhanced ultrasound; carotid plaque; intraplaque neovascularization; coronary artery disease; revascularization