弗明汉危险评分在无症状老年人颈动脉易损斑块筛查中的价值研究  

The Value of Framingham Risk Score for Screening Carotid Vulnerable Atherosclerotic Plaques in the Asymptomatic Elderly

作　　者：姚容 赵锡海 周丹[1] YAO Rong;ZHAO Xi-Hai;ZHOU Dan(Department of Radiology,BenQ Medical Center,Nanjing Medical University,Nanjing 210019,China;Center for Biomedical Imaging Research,Tsinghua University School of Medicine,Beijing 100084,China)

机构地区：[1]南京医科大学附属明基医院放射科,南京210019 [2]清华大学医学院生物医学影像研究中心

出　　处：《中国卒中杂志》2019年第12期1214-1219,共6页Chinese Journal of Stroke

基　　金：国家自然科学基金面上项目（81771825）;北京市科委重大专项（D171100003017003）;科技部“十三五”国家重点研发计划（2017YFC1307904）

摘　　要：目的探讨弗明汉危险评分(Framingham risk score,FRS)在无症状老年人(≥60岁)颈动脉易损斑块筛查中的价值。方法根据颈动脉粥样硬化斑块的3DMR管壁成像特征,将受试者分为有易损斑块组和无易损斑块组,计算每位受试者的FRS并比较两组之间FRS的差异。采用单因素Logistic回归,计算FRS在判别颈动脉易损斑块时的OR和95%CI。采用ROC曲线分析FRS对颈动脉易损斑块的判别能力,并确定合适的截断值。结果共纳入134例受试者,平均年龄72.3±5.5岁,男性62例(46.3%),17例(12.7%)有颈动脉易损斑块。有易损斑块组的FRS高于无易损斑块组[37.8%(27.4%~60.0%)vs 16.6%(8.9%~27.4%),P=0.002]。在判别颈动脉易损斑块时,FRS每升高10%对应的OR=1.556(95%CI 1.204~2.011,P=0.001),ROC曲线下面积为0.732,当截断值FRS=20%时,敏感度和特异度分别为76.5%、59.8%。结论 FRS可用于初步筛查无症状老年人有无颈动脉易损斑块,当FRS>20%时,需对颈动脉易损斑块进行影像学检查及评估。Objective To investigate the value of Framingham risk score(FRS) in screening carotid vulnerable atherosclerotic plaques in the asymptomatic elderly(≥60 years old).Methods FRS of every subject was calculated and the MR imaging characteristics of carotid atherosclerotic plaques on 3 D MR vessel wall imaging were evaluated. All patients were divided into vulnerable plaque group and non-vulnerable plaque group based on the imaging results. FRS was compared between the two groups. Univariate logistic regression was used to calculate the OR and 95%CI of FRS in determining carotid vulnerable plaques. The area under the curve(AUC) of receiver operating characteristic(ROC) was used to evaluate the ability of FRS in assessing carotid vulnerable plaques and determine the appropriate cut-off value.Results A total of 134 subjects were included in this study, with a mean age of 72.3±5.5 years old and 62 males(46.3%). 17 cases(12.7%) had carotid vulnerable plaques. The FRS in vulnerable plaques group was significantly higher than that in non-vulnerable plaques group [37.8%(27.4%-60.0%) vs 16.6%(8.9%-27.4%), P=0.002]. In determining carotid vulnerable plaques, the OR of FRS per an increase of 10% was 1.556(95%CI 1.204-2.011, P=0.001). ROC curve analysis showed that the AUC of FRS in determining the carotid vulnerable plaques was 0.732, and the appropriate cut-off value of FRS was 20%, with the sensitivity of 76.5% and specificity of 59.8%.Conclusions FRS can be preliminarily used to screen carotid vulnerable plaques. An advanced imaging examination is needed to evaluate carotid vulnerable plaques for the asymptomatic elderly when FRS is higher than 20%.

关 键 词：老年人 弗明汉危险评分 颈动脉 易损斑块 磁共振成像 

分 类 号：R54[医药卫生—心血管疾病]