Clinical Application Aalue Of Carotid Plaque Contrast-enhanced Altrasound Combined With Neutrophil-to-lymphocyte Ratio(NLR)in Acute Ischemic Stroke

Objective: To investigate the relationship between quantitative parameters of cont rast-enhanced ultrasound(CEUS)and NLR and acute ischemic stroke,and to eva luate the vulnerability of carotid plaque by CEUS combined with NLR analysis i n acute ischemic stroke.Method: From October 2021 to November 2022,patients with acute ischemic stroke who were accompanied by carotid plaque and the plaque was hypoechoic or mixed echoic under two-dimensional ultrasound in the Department of Neurology,Taizhou People’s Hospital of Jiangsu were selected as the experimental group(N=154).At the same time,110 inpatients without cerebrovascular disease with carotid plaque and low echo or mixed echo of plaque under two-dimensional ultrasound were selected as the control group.Each case underwent routine carotid two-dimensional ultrasound examination,and the region of interest of carotid plaque was selected for contrast-enhanced ultrasound examination,and the quantitative parameters of contrast-enhanced ultrasound were recorded.Routine blood tests were taken from all patients at admission,and the basic medical history of each patient was collected,such as gender,age,smoking history,drinking history,body mass index(BMI),and body mass index(BMI).BMI),hyperlipidemia,hypertension,diabetes,family history of stroke,atrial fibrillation,fibrinogen,white blood cell count,neutrophil count,lymphocyte count,neutrophil to lymphocyte ratio(neutrophil to lymphocyte ratio,NLR),C-reactive protein(CRP),homocysteine(Hcy),total cholesterol(TC),high-density lipoprotein cholesterol(HDLC),low-density lipoprotein cholesterol(LDL-C)and triglyceride(TG).The data were compared between the two groups.To investigate the relationship between quantitative parameters of contrast-enhanced ultrasound and NLR and acute ischemic stroke,and to compare the diagnostic efficacy of contrast-enhanced ultrasound combined with NLR in acute ischemic stroke.IBM SPSS 26.0 was used for data analysis.Logistic regression was used to analyze the risk factors of acute ischemic stroke.The Receiver operator characteristic curve(ROC curve)was drawn to analyze the diagnostic efficacy of CEUS quantitative parameters,NLR and combined diagnosis in evaluating acute ischemic stroke,and the Youden index was used to obtain the best diagnostic cut-off value.Pearson correlation analysis was used for correlation analysis.P < 0.05 was considered statistically significant.Results: 1.There was no significant difference in gender,age,smoking history,drinking history,BMI,atrial fibrillation,fibrinogen,C-reactive protein and homocysteine between the experimental group and the control group(P > 0.05).There were significant differences in hyperlipidemia,hypertension,diabetes,family history of stroke,white blood cell count,neutrophil count,lymphocyte count and NLR between the two groups(P < 0.05).The white blood cell count,neutrophil count and NLR in the experimental group were higher than those in the control group(P < 0.05).The lymphocyte count in the experimental group was lower than that in the control group(P < 0.05).2.Logistic regression analysis showed that NLR(OR=1.298),hyperlipidemia(OR=2.485),diabetes(OR=1.957),and family history of stroke(OR=1.542)were independent risk factors for acute ischemic stroke.3.The peak time of the experimental group was lower than that of the control group,and the peak intensity and the area under the time intensity curve were higher than those of the control group,and the differences were statistically significant(P < 0.05).4.The AUC of ROC curve of quantitative parameters of CEUS combined with NLR in the diagnosis of acute ischemic stroke was 0.870(95%CI: 0.834-0.913),the maximum value of Youden index was 0.684,and the peak time was ≤21.709 s.When the peak intensity was ≥16.237 d B,the area under the time-intensity curve was ≥351.660 d B*s and NLR was ≥2.914,the diagnostic sensitivity was 81.0% and the specificity was 87.4%.5.Pearson correlation analysis showed that the correlation coefficients between NLR and peak time,peak intensity,and area under the time intensity curve were-0.261,0.384,and 0.489,respectively(P < 0.001),that is,NLR was positively correlated with peak intensity and area under the time intensity curve,and NLR was negatively correlated with the time to peak.Conclusions: 1.Hyperlipidemia,diabetes,family history of stroke and NLR are independent risk factors for acute ischemic stroke.2.Contrast-enhanced ultrasound can evaluate the vulnerability of carotid plaque more intuitively and quantitatively evaluate the neovascularization in the plaque.The neovascularization of carotid plaque in patients with acute ischemic stroke is more abundant and more vulnerable.3.Quantitative assessment of carotid plaque by contrast-enhanced ultrasound combined with NLR has higher clinical value for the diagnosis of acute ischemic stroke.4.Quantitative parameters of contrast-enhanced ultrasound have a good correlation with NLR.