2025 年第 9 期 第 20 卷

血脂谱联合CT血管造影对脑梗死患者颈动脉斑块的诊断评估

Diagnostic evaluation of blood lipid profile combined with CT angiography for carotid plaque in patients with cerebral infarction

作者：戴云蛟1刘晓翠2任倩玉3徐文丽4

英文作者：Dai Yunjiao1 Liu Xiaocui2 Ren Qianyu3 Xu Wenli4

单位：1河北省张家口市第一医院神经内科，张家口075000；2华北理工大学附属医院神经内三科，唐山063210；3河北省张家口市第一医院神经内一科，张家口075000；4河北省沧州中西医结合医院影像三科，沧州061013

英文单位：1Department of Neurology Zhangjiakou First Hospital Hebei Province Zhangjiakou 075000 China; 2Third Department of Neurology North China University of Science and Technology Affiliated Hospital Tangshan 063210 China; 3First Department of Neurology Zhangjiakou First Hospital Hebei Province Zhangjiakou 075000 China; 4Third Department of Imaging Cangzhou Hospital of Integrated TCM-WM·Hebei Cangzhou 061013 China

关键词：脑梗死；颈动脉斑块；CT血管造影；血脂指标

英文关键词：Cerebralinfarction;Carotidplaque;CTangiography;Lipidindicators

• 摘要：

• 目的 探讨血脂谱联合CT血管造影(CTA)在脑梗死患者颈动脉斑块诊断中的应用价值。方法 选取2021年5月至2022年12月河北省张家口市第一医院神经内科收治的200例脑梗死患者作为观察组，另选取同期进行体检的100例体检健康者作为对照组。根据数字减影血管造影检查结果，将观察组患者分为斑块组（108例）和无斑块组（92例）。收集比较性别、年龄、吸烟史、高血压病、糖尿病、心脏病史、肾脏病史比例、血脂指标等。以数字减影血管造影结果为金标准，评估CTA单独及联合血脂指标诊断颈动脉斑块的效能。结果 观察组和对照组患者基线资料比较，差异均无统计学意义（均P＞0.05）。观察组血清基质金属蛋白酶9（MMP-9）、总胆固醇、甘油三酯、低密度脂蛋白胆固醇（LDL-C）水平均高于对照组，组织金属蛋白酶抑制剂1（TIMP-1）、高密度脂蛋白胆固醇（HDL-C）水平均低于对照组，差异均有统计学意义（均P＜0.05）。斑块组血清MMP-9、总胆固醇、甘油三酯、LDL-C水平均高于无斑块组，TIMP-1、HDL-C水平均低于无斑块组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归结果显示MMP-9、甘油三酯均是颈动脉斑块的独立危险因素，TIMP-1为保护因素（均P＜0.05）。CTA联合血清MMP-9、TIMP-1、总胆固醇、甘油三酯、HDL-C、LDL-C诊断颈动脉斑块的曲线下面积（AUC）为0.993。CTA联合血清MMP-9、TIMP-1诊断颈动脉斑块的AUC为0.981。CTA单独诊断颈动脉斑块的AUC为0.935，联合诊断效能均高于CTA单独诊断。结论 血脂谱联合CTA及MMP-9、TIMP-1能显著提高脑梗死患者颈动脉斑块的诊断效能，为临床提供更全面、精准的诊断依据，有助于脑梗死的早期干预及个体化治疗。

• Objective To investigate the application value of profile blood lipid combined with CT angiography (CTA) in the diagnosis of carotid plaque in patients with cerebral infarction. Methods A total of 200 patients with cerebral infarction admitted to the Department of Neurology, Zhangjiakou First Hospital, Hebei Province from May 2021 to December 2022 were selected as the observation group, and 100 healthy people who underwent physical examination during the same period were selected as the control group. According to the results  of digital subtraction angiography, the patients in the observation group were divided into plaque group (108 cases) and non-plaque group (92 cases). Gender, age, smoking history, hypertension, diabetes, heart disease history, kidney disease history, and blood lipid indexes were collected and compared. The results  of digital subtraction angiography were used as the gold standard to evaluate the efficacy of CTA alone and combined with blood lipid indexes in the diagnosis of carotid plaque. Results There were no statistically significant differences in baseline data between the observation group and the control group (all P>0.05). The levels of serum matrix metalloproteinase-9 (MMP-9), total cholesterol, triglyceride and low-density lipoprotein cholesterol (LDL-C) in the observation group were higher than those in the control group, and the levels of tissue inhibitor of metalloproteinase-1 (TIMP-1) and high-density lipoprotein cholesterol (HDL-C) were lower than those in the control group (all P<0.05). The levels of serum MMP-9, total cholesterol, triglyceride and LDL-C in the plaque group were higher than those in the non-plaque group, and the levels of TIMP-1 and HDL-C in the plaque group were lower than those in the non-plaque group (all P<0.05). Multivariate Logistic regression showed that MMP-9 and triglyceride were independent risk factors for carotid plaque, and TIMP-1 was protective factor (all P<0.05). The area under the curve (AUC) of CTA combined with serum MMP-9, TIMP-1, total cholesterol, triglyceride, HDL-C and LDL-C in the diagnosis of carotid plaque was 0.993. The AUC of CTA combined with serum MMP-9 and TIMP-1 in the diagnosis of carotid plaque was 0.981. The AUC of CTA alone in the diagnosis of carotid plaque was 0.935, and the diagnostic efficacy of combined diagnosis was higher than that of CTA alone. Conclusion Blood lipid profile combined with CTA, MMP-9 and TIMP-1 can significantly improve the diagnostic efficiency of carotid plaque in patients with cerebral infarction, provide a more comprehensive and accurate diagnostic basis for clinical practice, and contribute to early intervention and individualized treatment of cerebral infarction.