吴曙, 黄娟, 胡佳圆, 常嫣格, 焦晟, 赵锡海, 宋焱. 基于CARE-Ⅱ的颈动脉轻度狭窄患者易损斑块人群分布研究[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202403013-00401
引用本文: 吴曙, 黄娟, 胡佳圆, 常嫣格, 焦晟, 赵锡海, 宋焱. 基于CARE-Ⅱ的颈动脉轻度狭窄患者易损斑块人群分布研究[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202403013-00401
Shu Wu, Juan Huang, Jiayuan Hu, Yange Chang, Sheng Jiao, Xihai Zhao, Yan Song. The distribution of vulnerable plaque in patients with mild carotid stenosis based on CARE-Ⅱ[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202403013-00401
Citation: Shu Wu, Juan Huang, Jiayuan Hu, Yange Chang, Sheng Jiao, Xihai Zhao, Yan Song. The distribution of vulnerable plaque in patients with mild carotid stenosis based on CARE-Ⅱ[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202403013-00401

基于CARE-Ⅱ的颈动脉轻度狭窄患者易损斑块人群分布研究

The distribution of vulnerable plaque in patients with mild carotid stenosis based on CARE-Ⅱ

  • 摘要:
    目的 基于中国动脉粥样硬化风险评估第Ⅱ期(CARE-Ⅱ)研究探讨不同性别、年龄的颈动脉轻度狭窄患者易损斑块的分布差异,以期为该类人群进行分层管理提供依据。
    方法 回顾性分析2012年1月至2014年12月间CARE-Ⅱ研究数据库中颈动脉狭窄率<50%的627例患者的临床资料,其中男性399例、女性228例,年龄(60.92±9.96)岁。采用颈动脉粥样硬化斑块的MRI评估双侧颈动脉狭窄率<50%的斑块特征。患者按照性别进行分组,根据北美症状性颈部动脉内膜切除试验(NASCET)指南,计算颈动脉的平均管壁厚度、平均管壁面积、平均标准化管壁指数、管壁体积、管壁体积百分比、狭窄程度,并评估斑块相关的病理特征。对患者年龄进行分层(≤55岁、>55岁),分析颈动脉斑块特征的性别差异。2组间临床资料的比较采用t检验及χ2检验;2组间斑块特征的比较采用Mann-Whitney U检验及χ2检验;轻度狭窄的颈动脉易损斑块相关的临床及影像学因素分析采用多因素Logistic回归分析。
    结果 男性组患者的体重指数(t=−2.896,P=0.004)、舒张压(t=−4.163,P<0.001)以及吸烟比例(χ2=222.008,P<0.001)均明显高于女性组;但年龄(t=3.098,P=0.002)、总胆固醇(t=4.720,P<0.001)及低密度脂蛋白水平(t=4.152,P<0.001)均低于女性组组,且差异均有统计学意义。男性患者颈动脉的平均管壁厚度1.10(0.96,1.26)(mm)对1.00(0.88,1.13)(mm),、平均管壁面积32.82(27.08,37.62)(mm2)对26.66(22.38,31.46)(mm2)及管壁体积1024.72(834.96,1184.12)(mm3)对831.64(705.22,959.57)(mm3)均显著高于女性,差异均有统计学意义(Z=−6.009,9.217,8.847,均P<0.001);且斑块中更容易出现斑块内富含脂质的坏死核心、斑块内出血及薄纤维帽,这种情况更多见于年龄>55岁的人群。Logistic多因素回归分析表明,年龄、狭窄程度及斑块负荷是美国心脏协会(AHA)Ⅵ 型斑块的独立危险因素。
    结论 在中国颈动脉轻度狭窄人群中,男性、高龄患者的颈动脉斑块负荷更大,易损斑块更多。年龄、斑块负荷以及狭窄程度与轻度狭窄的颈动脉易损斑块独立相关。对于大于55岁且具有颈动脉轻度狭窄的男性人群,需要密切随访以评估其斑块的稳定性。

     

    Abstract:
    Objective To investigate the variations in plaque distribution among individuals with mild carotid artery stenosis, with a focus on gender and age, utilizing data from the Chinese Atherosclerosis Risk Assessment phase Ⅱ (CARE-Ⅱ) study and carotid atherosclerotic plaque magnetic resonance imaging. This research seeks to provide the basis for implementing stratified management strategies for this specific patient population.
    Methods Data from 627 patients 399 males and 228 females, aged (60.92±9.96) yearswith carotid artery stenosis < 50% in the CARE-Ⅱ study from January 2012 to December 2014 were analyzed. The patients were stratified into two cohorts based on gender. Following the protocols outlined in the North American Symptomatic Carotid Endarterectomy Trial (NASCET), various metrics including mean wall thickness, mean wall area, mean standardized wall index, wall volume, wall volume percentage, and degree of stenosis of the carotid artery were computed, alongside an assessment of the pathological features of plaque. The patients were categorized based on age (≤55 years and >55 years), and an analysis was conducted to examine gender disparities in carotid plaque characteristics. Logistic regression analysis was conducted to examine the associations between clinical and imaging factors and the presence of mild carotid artery vulnerable plaque.
    Results The results of the study indicate that in the male group, body mass index (t=−2.896, P=0.004), diastolic blood pressure (t=−4.163, P<0.001), and the proportion of smoking (χ2=222.008, P<0.001) were significantly higher compared to the female group. Conversely, age (t=3.098, P=0.002), total cholesterol (t=4.720, P<0.001), and low density lipoprotein (t=4.152, P<0.001) were significantly higher in the male group compared to the female group. Additionally, levels of high density lipoprotein (t=4.152, P< 0.001) were lower in the male group compared to the female group. The results indicate that male patients (Z=−6.009,9.217, 8.847, P<0.001) exhibited significantly higher average wall thickness 1.10(0.96,1.26)(mm)vs. 1.00(0.88, 1.13)(mm) , average wall area 32.82(27.08, 37.62) (mm2)vs. 26.66(22.38, 31.46) (mm2), and wall volume 1024.72(834.96, 1184.12) (mm3)vs. 831.64(705.22, 959.57) (mm3) in the carotid artery compared to female patients. Additionally, the presence of lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and thin fibrous cap was more prevalent in individuals over the age of 55. Furthermore, multivariate logistic regression analysis identified age, degree of stenosis, and plaque burden as independent risk factors for AHA Type Ⅵ plaque formation.
    Conclusions The present study found that male and advanced age were associated with larger and more vulnerable carotid plaques in the Chinese population with mild carotid stenosis. Furthermore, age, plaque burden, and the severity of stenosis exhibit independent associations with the presence of vulnerable carotid plaques in cases of mild stenosis.For men over 55 years old with mild carotid stenosis, close follow-up is needed to evaluate the stability of their plaques.

     

/

返回文章
返回