| Objective:To explore the diagnostic value of contrast-enhanced ultrasound combined with vulnerability score in carotid unstable plaque and the effects of inflammatory factors and neovascularization on plaque instability.Methods:1.According to the inclusion criteria and exclusion criteria,a total of 67 patients with moderate to severe carotid artery stenosis who performed carotid endarterectomy in The First Hospital of Jilin University from November 2021 to August 2022 were collected.The general data,laboratory data and imaging data of the patients were recorded in detail before operation,and the grade of plaque neovascularization indicated by contrast-enhanced ultrasound and the vulnerability score indicated by conventional carotid ultrasound were mainly recorded.2.Carotid atherosclerotic plaque specimens were obtained by carotid endarterectomy.Plaque homogenate and frozen sections were prepared,and the frozen sections were stained with HE.According to the pathological characteristics of the plaques,the plaques were divided into stable group(26 cases)and unstable group(41 cases).3.The differences of neovascularization grade and vulnerability score between the stable group and the unstable group were analyzed,the diagnostic value of contrast-enhanced ultrasonography combined with vulnerability score for unstable plaques was evaluated by ROC curves.4.Cytometric bead array(CBA)was used to measure the expression levels of IL-2,IL-4,IL-6,IL-10,IL-17 A,TNF-α and IFN-γ in the plaque homogenate of the stable group and the unstable group,and the differences between the two groups were compared.The correlation between the expression of inflammatory factors and the grade of neovascularization and vulnerability score was analyzed.5.SPSS 26 and Graphp Pad 9 software were used for statistical analysis and chart drawing.Results:1.Compared with the stable group,the carotid atherosclerotic plaque in the unstable group had significantly higher neovascularization grade and vulnerability score(P<0.05).2.ROC curve analysis of contrast-enhanced ultrasound,vulnerability score and contrast-enhanced ultrasound combined with vulnerability score was performed.The results showed that the AUC of contrast-enhanced ultrasound and vulnerability score were 0.717 and 0.875,respectively,and the AUC of the combined diagnosis of the two could increase to 0.940.Based on contrast-enhanced ultrasound,the sensitivity of diagnosing unstable plaque was 90.9%,but the specificity was only 46.2%.Based on the vulnerability score,the sensitivity and specificity of diagnosing unstable plaque were 79.5% and 90.9%,respectively.The sensitivity and specificity of combined prediction were improved to 85.7% and 91.7%,respectively.Compared with single index,the diagnostic ability of contrast-enhanced ultrasound combined with vulnerability score was stronger.3.Compared with the stable group,the expression levels of pro-inflammatory cytokines IL-6 and TNF-α in the unstable group were significantly increased(P>0.05),while the expression of the remaining cytokines(IL-2,IL-4,IL-10,IL-17 A and IFN-γ)did not show significant differences between the two groups(P>0.05).And IL-6 had a positive correlation with neovascularization grade,IL-6 and TNF-αhad a strong positive correlation with vulnerability score.Conclusion:1.Contrast-enhanced ultrasound combined with vulnerability score has good diagnostic value for the instability of human carotid atherosclerotic plaque,and can be used as a good indicator for the diagnosis of unstable plaque in clinical work.2.The greater the density of neovascularization in the plaque and the higher the expression levels of inflammatory factors IL-6 and TNF-α in the plaque,the more unstable the carotid plaque tends to be and the higher the vulnerability score the carotid plaque has.3.The expression level of IL-6 is correlated with the density of neovascularization in the plaque,and both promote the instability of the plaque in a positive feedback manner. |
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