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近年来脑卒中的发病率逐年升高,因其可导致患者瘫痪、失能甚至死亡等严重后果,已成为威胁人们健康的重大疾病。脑动脉粥样硬化是引起脑卒中的主要和直接原因。已有研究结果证明,吸烟是导致动脉粥样硬化的独立危险因素[1]。因烟雾中含有的有害化学成分尼古丁、焦油、碳氧化物等可刺激血管收缩、损伤血管内皮细胞、暴露内皮下胶原组织、激活血小板,导致血栓形成;同时可以导致脂质代谢紊乱,促进内皮下脂质沉积,从而促进动脉粥样硬化斑块形成。除主动吸烟外,尚有部分人群长期暴露于烟雾场合,成为被动吸烟者,此类人群的颈部动脉粥样硬化情况有待研究。多层螺旋CT的发展使得颈部动脉CT血管成像(CT angiography,CTA)成为可能,且随着成像技术的不断提高,其对于斑块的显示及血管狭窄程度的测量相较于数字减影血管造影(DSA)、超声具有独特的优势[2-3]。本研究旨在通过对比吸烟、被动吸烟、非吸烟者的多层螺旋颈部CTA图像上颈部动脉粥样硬化斑块的特征,无创性评价吸烟和被动吸烟对颈部动脉粥样硬化斑块的影响。
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由表1可知,吸烟组男性比例(83.2%,79/95)高于被动吸烟组(31.0%,27/87)和非吸烟组(26.5%,27/102),差异均有统计学意义(χ2= 10.03、9.77,均P<0.05)。被动吸烟组和非吸烟组的性别组成差异无统计学意义。3组受检者的年龄,体重指数,高血压、糖尿病及高血脂的发病率的差异均无统计学意义(F=0.30、0.43;χ2=1.58、0.19、0.56,均P>0.05)。
组别 年龄(岁) 性别[例(%)] 体重指数(kg/m2) 疾病发生率[例(%)] 女 男 糖尿病 高血压 高血脂 吸烟组(n=95) 59.3±10.1 16(16.8) 79(83.2) 22.3±9.2 20(21.1) 40(42.1) 35(36.8) 被动吸烟组(n=87) 60.2±12.0 60(69.0) 27(31.0)a 22.5±8.9 19(21.8) 38(43.7) 33(37.9) 非吸烟组(n=102) 61.5±9.5 75(73.5) 27(26.5)a 21.5±9.5 22(21.6) 45(44.1) 37(36.3) 检验值 F=0.30 χ2=10.65 F=0.43 χ2=0.19 χ2=1.58 χ2=0.56 P值 0.82 0.01 0.74 0.66 0.80 0.43 注:表中,a:与吸烟组比较,差异均有统计学意义(χ2=10.03、9.77,均P<0.05) 表 1 3组受检者临床资料的比较
Table 1. General conditions of the smoking, passive smoking and nonsmoking groups
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3组受检者共检测2840个动脉节段,其中2058(72.5%)个节段存在斑块。钙化斑块、混合型斑块、非钙化斑块的典型CTA图像分别见图1~3。由表2可知,吸烟组和被动吸烟组的总斑块、非钙化斑块、混合型斑块累及节段比例均高于非吸烟组,差异均有统计学意义(χ2=7.43~21.33,均P<0.05)。吸烟组总斑块、非钙化斑块累及节段比例高于被动吸烟组,差异均有统计学意义(χ2=7.40、9.77,均P<0.05)。3组受检者钙化斑块累及节段比例的差异无统计学意义(χ2=0.82,P>0.05)。
图 1 吸烟者(男性,65岁)左侧颈总动脉分叉处钙化斑块CT血管成像图 图中,最大密度投影(A)、容积重建(B)、多平面重组(C)图像均显示左侧颈总动脉分叉处多发钙化斑块(箭头所示)。CT:计算机体层摄影术
Figure 1. CT angiography images showing calcified plaques at the left common carotid bifurcation of a 65-year-old male smoker
组别 动脉节段数 累及节段数 总斑块 钙化斑块 非钙化斑块 混合型斑块 吸烟组(n=95) 950 765(80.5)a,b 534(56.2) 445(46.8)a,b 433(45.6)b 被动吸烟组(n=87) 870 650(74.7)b 480(55.2) 348(40.0)b 360(41.4)b 非吸烟组(n=102) 1020 643(63.0) 568(55.7) 213(20.9) 314(30.8) χ2值 8.56 0.82 9.40 10.61 P值 0.04 0.78 0.03 0.02 注:表中,a:与被动吸烟组比较,差异均有统计学意义(χ2=7.40、9.77,均P<0.05);b:与非吸烟组比较,差异均有统计学意义(χ2=7.43~21.33,均P<0.05) 表 2 3组受检者斑块分型和累及节段数的比较[个(%)]
Table 2. Plaque types and numbers of involved segments in the smoking, passive smoking and nonsmoking groups (%)
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3组受检者斑块测量指标的比较结果见表3。吸烟组和被动吸烟组所有类型斑块的最大横截面积、斑块负荷、重构指数均明显高于非吸烟组,差异均有统计学意义(t=6.54~20.11,均P<0.05)。吸烟组混合型斑块和非钙化斑块的最大横截面积、斑块负荷、重构指数均明显高于被动吸烟组,差异均有统计学意义(t=9.05~15.64,均P<0.05)。
组别 动脉
节段数斑块最大横截面积(mm2) 斑块负荷(%) 重构指数 钙化斑块 混合型斑块 非钙化斑块 钙化斑块 混合型斑块 非钙化斑块 钙化斑块 混合型斑块 非钙化斑块 吸烟组(n=95) 950 12.45±4.22a 12.30±4.34a,b 12.25±4.34a,b 40.34±12.02a 42.56±12.02a,b 41.22±12.02a,b 1.09±0.17a 1.12±0.02a,b 1.11±0.06a,b 被动吸烟组(n=87) 870 11.82±2.35a 10.00±2.55a 9.34±2.55a 40.87±9.88a 36.33±9.43a 37.65±8.20a 1.08±0.11a 1.09±0.10a 1.07±0.05a 非吸烟组(n=102) 1020 8.23±2.20 8.32±2.13 8.50±2.55 32.78±7.69 29.67±7.65 30.05±6.67 0.94±0.02 0.88±0.01 0.90±0.01 F值 10.73 9.54 11.00 12.80 8.59 9.03 13.50 18.99 14.55 P值 0.05 0.05 0.04 0.04 0.05 0.04 0.03 0.01 0.02 注:表中,a:与非吸烟组比较,差异均有统计学意义(t=6.54~20.11,均P<0.05);b:与被动吸烟组比较,差异均有统计学意义(t=9.05~15.64,均P<0.05) 表 3 3组受检者斑块测量指标的比较(
±s)$\bar x $ Table 3. Quantitative measurements of plaques in the smoking, passive smoking and nonsmoking groups (
±s)$\bar x $ -
吸烟组和被动吸烟组的吸烟指数与总斑块、非钙化斑块、混合型斑块的累及节段数均呈正相关(吸烟组:r=0.52、0.57、0.48,均P<0.05;被动吸烟组:r=0.40、0.42、0.43,均P<0.05),2组吸烟指数与钙化斑块的累及节段数无相关性(r=0.03~0.08,均P>0.05)。
CTA评估吸烟和被动吸烟对颈部动脉粥样硬化斑块的影响
Effects of smoking and passive exposure to cigarette smoke on atherosclerotic plaques in extracranial arteries assessed by computed tomography angiography
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摘要:
目的 通过CT血管成像(CTA)评估吸烟和被动吸烟对颈部动脉粥样硬化斑块的影响。 方法 回顾性分析2017年1月至2019年7月于山东省聊城市茌平区人民医院行颈部CTA的拟诊为脑血管病的受检者284名,其中男性133名、女性151名,年龄42~79(60.3±12.5)岁。根据是否吸烟或被动吸烟将受检者分为吸烟组(95名)、被动吸烟组(87名)、非吸烟组(102名)。比较3组受检者的颈部动脉粥样硬化斑块的累及节段数、类型、最大横截面积、斑块负荷、重构指数,并分析吸烟指数与斑块累及节段数之间的相关性。定性资料的组间比较采用χ2检验;定量资料的多组间比较采用单因素方差分析,2组间比较采用独立样本t检验;吸烟指数与斑块累及节段数的相关性分析采用Spearman秩相关检验。 结果 3组受检者的年龄,体重指数,高血压、糖尿病及高血脂的发病率的差异均无统计学意义(F=0.30、0.43;χ2=1.58、0.19、0.56,均P>0.05)。吸烟组男性比例(83.2%,79/95)高于被动吸烟组(31.0%,27/87)和非吸烟组(26.5%,27/102),差异均有统计学意义(χ2=10.03、9.77,均P<0.05)。284名受检者共检测2840个动脉节段,其中2058个(72.5%)节段存在斑块。吸烟组和被动吸烟组的总斑块[80.5%(765/950)、74.7%(650/870)]、非钙化斑块[46.8%(445/950)、40.0%(348/870)]、混合型斑块[45.6%(433/950)、41.4%(360/870)]累及节段比例均高于非吸烟组[63.0%(643/1020)、20.9%(213/1020)、30.8%(314/1020)],且差异均有统计学意义(χ2=7.43~21.33,均P<0.05);吸烟组总斑块、非钙化斑块累及节段比例高于被动吸烟组,且差异均有统计学意义(χ2=7.40、9.77,均P<0.05)。吸烟组、被动吸烟组所有类型斑块的最大横截面积、斑块负荷、重构指数均明显高于非吸烟组,且差异均有统计学意义(t=6.54~20.11,均P<0.05)。吸烟组混合型斑块及非钙化斑块的最大横截面积、斑块负荷、重构指数均明显高于被动吸烟组,且差异均有统计学意义(t=9.05~15.64,均P<0.05)。吸烟组和被动吸烟组的吸烟指数与总斑块、非钙化斑块、混合型斑块的累及节段数均呈正相关(吸烟组:r=0.52、0.57、0.48,均P<0.05;被动吸烟组:r=0.40、0.42、0.43,均P<0.05)。 结论 吸烟、被动吸烟均可导致颈部动脉粥样硬化斑块数量增多、斑块量化指标增大;且吸烟量越大、年限越长颈部动脉斑块的累及节段数越多。 -
关键词:
- 颈动脉疾病 /
- 计算机体层摄影血管造影术 /
- 吸烟 /
- 斑块,动脉粥样硬化
Abstract:Objective To explore differences in the morphology of atherosclerotic plaques among active smokers, passive smokers, and nonsmokers using CT angiography (CTA). Methods A retrospective analysis was performed on 284 patients (133 males and 151 females aged 42−79 (60.3±12.5) years old) with suspected cerebrovascular disease, including 95 active smokers and 87 passive smokers, and 102 nonsmokers who underwent 64-slice extracranial CTA in Chiping People's Hospital in Liaocheng City of Shandong Province from January 2017 to July 2019. Numbers of plaque involved segments, plaque type, area, burden, and remodeling index were compared among the three groups. Correlations between smoking index and numbers of plaque involved segments in the smoking and passive smoking groups were also calculated. Rates and the χ2 test were used to analyze qualitative data, while t test and one-way ANOVA were used to assess quantitative data. Spearman’s rank correlation test was used to analyze the relationship between smoking index and numbers of plaque involved segments. Results No difference in age, body mass index, incidence rates of diabetes, hypertension, hyperlipidemia was observed between groups (F=0.30, 0.43; χ2=1.58, 0.19, 0.56, all P>0.05). More males belonged to the active smoking group (83.2%, 79/95) than to the passive smoking (31.0%, 27/87) and nonsmoking (26.5%, 27/102) groups (χ2=10.03, 9.77, both P<0.05). A total of 2840 segments from 284 patients were studied, and 2058 (72.5%) segments revealed plaques. Total plaques (80.5% (765/950), 74.7% (650/870)), noncalcified plaques (46.8% (445/950), 40.0% (348/870)), and mixed plaques (45.6% (433/950), 41.4% (360/870)) involved segments percentages were more higher in the smoking and passive smoking groups than in the nonsmoking group (total plaques, 63.0% (643/1020); noncalcified plaques, 20.9% (213/1020); mixed plaques, 30.8% (314/1020)) (χ2=7.43−21.33, all P<0.05). Total plaques, noncalcified plaques involved segments percentages in the smoking group were more higher than in the passive smoking groups(χ2=7.40, 9.77, both P<0.05). Smokers and passive smokers had a higher plaque area, plaque burden, and remodeling index than nonsmokers in three types of plaques(t=6.54−20.11, all P<0.05), while smokers had a higher plaque area, plaque burden, and remodeling index than passive smokers in noncalcified and mixed plaques (t=9.05−15.64, all P<0.05). A positive correlation between smoking index and total plaques, noncalcified plaques, mixed plaques involved segments numbers in the smoking and passive smoking groups (smoking: r=0.52, 0.57, 0.48, all P<0.05; passive smoking: r=0.40, 0.42, 0.43, all P<0.05) were observed. Conclusions Active and passive exposure to smoke can lead to more atherosclerotic plaques and higher quantitative index. The greater the amount of smoking and the longer the age, the more segments involved in carotid artery plaque will be found. -
表 1 3组受检者临床资料的比较
Table 1. General conditions of the smoking, passive smoking and nonsmoking groups
组别 年龄(岁) 性别[例(%)] 体重指数(kg/m2) 疾病发生率[例(%)] 女 男 糖尿病 高血压 高血脂 吸烟组(n=95) 59.3±10.1 16(16.8) 79(83.2) 22.3±9.2 20(21.1) 40(42.1) 35(36.8) 被动吸烟组(n=87) 60.2±12.0 60(69.0) 27(31.0)a 22.5±8.9 19(21.8) 38(43.7) 33(37.9) 非吸烟组(n=102) 61.5±9.5 75(73.5) 27(26.5)a 21.5±9.5 22(21.6) 45(44.1) 37(36.3) 检验值 F=0.30 χ2=10.65 F=0.43 χ2=0.19 χ2=1.58 χ2=0.56 P值 0.82 0.01 0.74 0.66 0.80 0.43 注:表中,a:与吸烟组比较,差异均有统计学意义(χ2=10.03、9.77,均P<0.05) 表 2 3组受检者斑块分型和累及节段数的比较[个(%)]
Table 2. Plaque types and numbers of involved segments in the smoking, passive smoking and nonsmoking groups (%)
组别 动脉节段数 累及节段数 总斑块 钙化斑块 非钙化斑块 混合型斑块 吸烟组(n=95) 950 765(80.5)a,b 534(56.2) 445(46.8)a,b 433(45.6)b 被动吸烟组(n=87) 870 650(74.7)b 480(55.2) 348(40.0)b 360(41.4)b 非吸烟组(n=102) 1020 643(63.0) 568(55.7) 213(20.9) 314(30.8) χ2值 8.56 0.82 9.40 10.61 P值 0.04 0.78 0.03 0.02 注:表中,a:与被动吸烟组比较,差异均有统计学意义(χ2=7.40、9.77,均P<0.05);b:与非吸烟组比较,差异均有统计学意义(χ2=7.43~21.33,均P<0.05) 表 3 3组受检者斑块测量指标的比较(
±s)$\bar x $ Table 3. Quantitative measurements of plaques in the smoking, passive smoking and nonsmoking groups (
±s)$\bar x $ 组别 动脉
节段数斑块最大横截面积(mm2) 斑块负荷(%) 重构指数 钙化斑块 混合型斑块 非钙化斑块 钙化斑块 混合型斑块 非钙化斑块 钙化斑块 混合型斑块 非钙化斑块 吸烟组(n=95) 950 12.45±4.22a 12.30±4.34a,b 12.25±4.34a,b 40.34±12.02a 42.56±12.02a,b 41.22±12.02a,b 1.09±0.17a 1.12±0.02a,b 1.11±0.06a,b 被动吸烟组(n=87) 870 11.82±2.35a 10.00±2.55a 9.34±2.55a 40.87±9.88a 36.33±9.43a 37.65±8.20a 1.08±0.11a 1.09±0.10a 1.07±0.05a 非吸烟组(n=102) 1020 8.23±2.20 8.32±2.13 8.50±2.55 32.78±7.69 29.67±7.65 30.05±6.67 0.94±0.02 0.88±0.01 0.90±0.01 F值 10.73 9.54 11.00 12.80 8.59 9.03 13.50 18.99 14.55 P值 0.05 0.05 0.04 0.04 0.05 0.04 0.03 0.01 0.02 注:表中,a:与非吸烟组比较,差异均有统计学意义(t=6.54~20.11,均P<0.05);b:与被动吸烟组比较,差异均有统计学意义(t=9.05~15.64,均P<0.05) -
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