目的 探讨颈动脉超声血流参数联合血清氧化低密度脂蛋白（Oxidized Low Density Lipoprotein，ox-LDL）、脂蛋白 相关磷酯酶A2（Lipoprotein Associated Phosphoesterase A2，Lp-PLA2）水平诊断粥样硬化斑块稳定性的效能。方法 选取 104例颈动脉粥样硬化（Carotid Atherosclerosis，CAS）斑块患者为疾病组、95例健康者为对照组；疾病组按斑块稳定性分 为稳定组和不稳定组。测定颈动脉超声血流参数、血清ox-LDL和Lp-PLA2浓度。分析疾病组与对照组、稳定组与不稳定组 各指标差异。绘制收缩期峰值流速（Peak Systolic Velocity，PSV）、舒张末期流速（End Diastolic Velocity，EDV）、搏动 指数（Pulsatility Index，PI）单项及联合诊断CAS不稳定斑块的受试者工作特征（Receiver Operator Characteristic，ROC） 曲线，绘制超声参数与血清ox-LDL、Lp-PLA2水平单项及联合诊断CAS不稳定斑块的ROC曲线，分析其对CAS斑块稳定性 的诊断效能。结果 疾病组PSV、EDV低于对照组（P<0.05），阻力指数（Resistance Index，RI）、PI及血清ox-LDL、Lp- PLA2水平高于对照组（P<0.05）。不稳定组PSV、EDV低于稳定组（P<0.05），PI及血清ox-LDL、Lp-PLA2水平高于稳定 组（P<0.05）。PSV、EDV、PI联合诊断不稳定斑块的敏感度和特异性均与单项诊断比较无统计学差异（P>0.05），曲线 下面积（Area Under Curve，AUC）高于单项诊断（P<0.05）；超声血流参数及血清ox-LDL、Lp-PLA2水平联合诊断不稳定 斑块的敏感度和AUC均高于单项诊断（P<0.05），特异性与单项诊断无统计学差异（P>0.05）。结论 颈动脉超声血流参数及 血清ox-LDL、Lp-PLA2水平联合对CAS不稳定斑块有良好诊断效能。

Objective To investigate the diagnostic value of carotid ultrasound blood flow parameters combined with serum oxidized low density lipoprotein (ox-LDL) and lipoprotein associated phosphoesterase A2 (Lp-PLA2) levels in the stability of atherosclerotic plaques. Methods A total of 104 patients with carotid atherosclerotic (CAS) plaques were classified as the disease group, while 95 healthy people were classified as the control group. The patients in disease group were divided into stable group and unstable group according to the stability of plaques. The carotid ultrasound blood flow parameters, levels of ox-LDL and Lp-PLA2 in serum of the subjects were measured. The index differences between the disease group and the control group, and the stable group and the unstable group were analyzed. The receiver operator characteristic (ROC) curves of single and joint of peak systolic velocity (PSV), end diastolic velocity (EDV) and pulsatility index (PI) in diagnosis of the atherosclerotic unstable plaques in patients with CAS were drawn, and the ROC curves of single and joint of carotid ultrasound parameters, serum ox-LDL and Lp-PLA2 levels in diagnosis of atherosclerotic unstable plaques in patients with CAS were drawn, and the diagnostic efficiencies of stability of atherosclerotic plaques in patients with CAS were analyzed. Results The PSV and EDV in the disease group were lower than those in the control group (P<0.05), and resistance index (RI), PI and the levels of serum ox-LDL and Lp-PLA2 were higher than those in the control group (P<0.05). The levels of PSV and EDV in unstable group were lower than those in the stable group (P<0.05), while PI and the levels of ox-LDL and Lp-PLA2 in the unstable group were higher than those in the stable group (P<0.05). The sensitivity and the specificity of joint diagnosis of PSV, EDV and PI in unstable plaques were not significantly different from that of single diagnosis (P>0.05), but the area under curve (AUC) was higher than that of single diagnosis (P<0.05). The sensitivity and AUC of joint diagnosis of ox-LDL, Lp-PLA2 levels and carotid ultrasound blood flow parameters in the unstable plaques were higher than that of single diagnosis (P<0.05), but the specificity was not significantly different from that of single diagnosis (P>0.05). Conclusion The combination of carotid ultrasound blood flow parameters, ox-LDL and Lp-PLA2 levels has good diagnostic efficacy for atherosclerotic unstable plaque in patients with CAS.