不同年龄患者CT腹部脂肪定量参数与颈动脉斑块稳定性的相关性研究  

The Correlation between Quantitative Parameters of Abdominal Adipose Tissue on CT and Composition of Carotid Atherosclerotic Plaque in Patients with Different Ages

作　　者：孙潇楠 孟闫凯 陈希田 于攀 余苗 张贺 谢丽响 李绍东 徐凯 SUN Xiaonan;MENG Yankai;CHEN Xitian(Department of Radiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu Province 221002,P.R.China)

机构地区：[1]徐州医科大学附属医院影像科,221002 [2]徐州医科大学影像学院,221002 [3]徐州医科大学医学影像与数字医学研究所,221002

出　　处：《临床放射学杂志》2023年第5期733-738,共6页Journal of Clinical Radiology

基　　金：江苏省医学会伦琴影像科研专项资金项目(编号:SYH-3201150-0013);徐州市科学技术局重点研发计划(社会发展)(编号:KC20159);江苏省中医药科技发展计划项目(编号:MS2021100)。

摘　　要：目的分析不同年龄分组患者CT腹部脂肪定量与颈动脉斑块稳定性的关系。方法回顾性分析160例患者的临床及影像学资料,所有患者均于1个月内行腹部CT和头颈CTA检查。将腹部CT原始数据上传至GE AW 4.7工作站,分别在后处理工作站上测量平脐水平腹部内脏脂肪面积(VFA)、皮下脂肪面积(SFA),计算内脏脂肪面积/皮下脂肪面积比值(VFA/SFA)。基于头颈部CT血管成像(CTA),由一名影像科高级职称医师评估颈动脉斑块。依据美国心脏病协会(AHA)关于动脉粥样斑块分型标准,将软斑块和以脂肪成分为主的混合斑块归为不稳定斑块,将钙化斑块归为稳定斑块。将患者分为年龄<70岁、年龄≥70岁两个不同亚组,分别比较稳定斑块、不稳定斑块患者亚组间临床实验室指标、腹部脂肪定量参数的差异。多因素Logistic回归分析颈动脉不稳定斑块发生的危险因素。利用受试者工作特征(ROC)曲线评估变量预测效能。以P<0.05为差异有统计学意义。结果在年龄<70岁亚组中,不稳定斑块组VFA>151.65 cm^(2)的患者比例高于稳定斑块组,两组间差异有统计学意义(P=0.019);SFA、VFA/SFA在两组间差异无统计学意义(P=0.523、0.288)。在年龄≥70岁亚组中,单因素分析结果显示,性别、SFA在两组间差异具有统计学意义(P=0.005、0.003)。性别、SFA、VFA/SFA在两组间P值均<0.1,纳入多因素Logistic回归分析。多因素分析结果显示,相对于SFA≤156.27 cm^(2)的患者,SFA>156.27 cm^(2)的患者发生颈动脉不稳定斑块的OR值为0.264(95%CI=0.079~0.887,P=0.031),差异有统计学意义。男性(OR=3.676,95%CI:1.164~11.609,P=0.026)是颈动脉不稳定斑块发生的独立危险因素。ROC曲线分析表明,SFA>156.27 cm^(2)预测颈动脉不稳定斑块发生的曲线下面积为0.684。结论在年龄<70岁的患者中,VFA与斑块稳定性有关。在年龄≥70岁的患者中,男性、SFA较低的患者颈动脉不稳定斑块发生的风险Objective To analyze the correlation between quantitative parameters of abdominal adipose tissue on CT and composition of carotid atherosclerotic plaque in patients divided by age.Methods The clinical and imaging data of 160 patients were retrospectively evaluated.All patients underwent abdominal CT and head-neck computed tomography angiography(CTA)examination,and the time interval of two examinations was less than one month.All raw data of original abdominal CT were uploaded to postprocessing workstation(GE AW4.7).Visceral fat area(VFA)and subcutaneous fat area(SFA)were measured at umbilical level on workstation by one radiologist.Then,the ratio of visceral to subcutaneous fat area(VFA/SFA)was calculated according to the results of VFA and SFA.Carotid plaques were evaluated according CTA by one senior radiologist.According to the American Heart Association(AHA)guidelines,soft plaques and mixed plaques mainly composed of fat were classified as vulnerable carotid plaques while calcified plaques were classified as stable plaques.Patients were divided into age<70 years subgroup and age≥70 years subgroup.The differences of clinical characteristics and quantitative parameters of abdominal adipose tissue were separately compared between stable plaque group and vulnerable plaque group.Multivariate Logistic regression analysis was used to analyze the risk factors of vulnerable carotid plaque.ROC curve analysis was used for indicating the predictive performance of different variables for vulnerable carotid plaque.P value less than O.05 was considered statistically significant difference.Results In the subgroup of patients aged<70 years subgroup,the proportion of patients with VFA>151.65 cm²in the vulnerable plaque group was higher than that in the stable plaque group(P=O.019).Nevertheless,there was no significant difference in VFA and SFA between the two groups(P=0.523,0.288).In the subgroup of patients aged≥70 years subgroup,gender and SFA showed significant difference between vulnerable plaque group and stable plaq

关 键 词：斑块稳定性 内脏脂肪面积 皮下脂肪面积 年龄 

分 类 号：R743[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]