颈动脉超声定量参数、sd-LDL、LDL亚型与急性脑梗死患者脑动脉狭窄的相关性及诊断价值研究OA

Objective:To investigate the association of integrated carotid ultrasound quantitative parameters,small dense low-density lipoprotein(sd-LDL),and low-density lipoprotein(LDL)subfractions with significant cerebral artery stenosis in patients with acute cerebral infarction,and to identify independent influencing factors and construct a combined diagnostic model to overcome the limitations of single indicators.Methods:347 patients with acute cerebral infarction admitted to our hospital from January 1,2023,to January 31,2024 were enrolled.Stenosis rate was calculated according to the NASCET criteria.Patients were categorized into:no stenosis group(n=42),mild stenosis(1％～29％)group(n=118),moderate stenosis(30％～69％)group(n=104),and severe stenosis(70％～99％)group(n=83).Using a 50％stenosis rate as the cutoff,the 305 patients with cerebral artery stenosis were further divided into a significant stenosis group(n=165)and a non-significant stenosis group(n=140).General data,carotid ultrasound parameters(intima-media thickness,plaque number/area),and serological markers(sd-LDL,LDL subfractions,apolipoprotein B,etc.)were collected.Spearman rank correlation and multivariate Logistic analysis were used to examine the correlation between indicators and stenosis degree,and to identify influencing factors for significant cerebral artery stenosis.Receiver operating characteristic curves were plotted to evaluate the diagnostic performance of indicators for significant stenosis.Results:Intima-media thickness,plaque number,plaque area,sd-LDL,and LDL-B subtype were positively correlated with stenosis degree(all P＜0.001),while LDL-A subtype was negatively correlated(P＜0.001).LDL-Ⅰ subtype showed a weak negative correlation(P＜0.05).Multivariate Logistic regression analysis identified diabetes mellitus,intima-media thickness,plaque number,plaque area,apolipoprotein B(Apo-B),sd-LDL,LDL-A,and LDL-B as independent influencing factors for significant cerebral artery stenosis(all P＜0.05).LDL-C did not enter the final regression model,indicating it is not an independent influencing factor.The Hosmer-Lemeshow goodness-of-fit test showed x2=6.669,P=0.573,indicating good model fit.The area under the curve for the combined prediction of significant stenosis by the above indicators was 0.849,with a sensitivity of 76.40％and a specificity of 80.70％,outperforming the diagnostic efficacy of any single indicator.Conclusion:Carotid ultrasound quantitative parameters,sd-LDL levels,and LDL subfraction distribution are closely associated with significant cerebral artery stenosis in patients with acute cerebral infarction.The combined diagnostic model demonstrates excellent performance and may provide a reference for early clinical identification of high-risk patients.