基于CARE-Ⅱ的颈动脉轻度狭窄患者易损斑块分布研究  

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

作　　者：吴曙 黄娟[1] 胡佳圆 常嫣格 焦晟[1] 宋焱[1] 赵锡海[2] Wu Shu;Huang Juan;Hu Jiayuan;Chang Yange;Jiao Sheng;Song Yan;Zhao Xihai(Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Biomedical Engineering,Center for Biomedical Imaging Research,Tsinghua University School of Medicine,Beijing 100084,China)

机构地区：[1]北京医院放射科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]清华大学医学院生物医学工程系,清华大学生物医学影像研究中心,北京100084

出　　处：《国际放射医学核医学杂志》2024年第4期215-223,共9页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：国家自然科学基金(81771825);中央高水平医院临床科研专项(BJ-2022-131)。

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研究数据库中双侧颈动脉狭窄率<50%的627例患者的临床资料,其中男性399例、女性228例,年龄(60.9±10.0)岁。采用MRI评估双侧颈动脉狭窄率<50%颈动脉粥样硬化斑块的特征。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法,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χ^(2)检验;2组间斑块特征的比较采用Mann-Whitney U检验及χ^(2)检验;轻度狭窄的颈动脉易损斑块相关的临床及影像因素分析采用多因素Logistic回归分析。结果男性组患者的身体质量指数[(24.50±2.87)kg/m2对(23.69±3.52)kg/m2]、舒张压[(88.63±14.68)mm Hg对(84.36±10.81)mm Hg]以及吸烟史比例[(69.2%(276/399)对7.5%(17/288))]均明显高于女性组,且差异均有统计学意义(t=−2.896、−4.163,χ^(2)=222.008,均P<0.01);但年龄[(59.99±9.89)岁对(62.55±9.87岁)]、总胆固醇[(4.48±1.09)mmol/L对(4.91±1.14)mmol/L]及低密度脂蛋白[(2.80±0.90)mmol/L对(3.15±1.06)mmol/L]水平均低于女性组,且差异均有统计学意义(t=3.098、4.720、4.152,均P<0.01)。男性组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]均高于女性组,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、薄纤维帽和美国Objective To investigate the variations in plaque distribution among individuals with mild carotid artery stenosis,with a focus on gender and age,utilizing data based on a Chinese Atherosclerosis Risk EvaluationⅡ(CARE-Ⅱ)study.Methods The clinical data of 627 patients with carotid artery stenosis<50%in the CARE-Ⅱstudy from January 2012 to December 2014 were retrospectively analyzed,including 399 males and 228 females,aged 60.9±10.0 years.The features of carotid atherosclerotic plaque in individuals with bilateral carotid artery stenosis measuring less than 50%were measured using MRI.The patients were stratified into two cohorts based on gender.Following the protocols outlined in the North American Symptomatic Carotid Endarterectomy Trial,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 the assessment of the pathological features of plaque.The patients were categorized on the basis of age(≤55 years and>55 years),and analysis was conducted to examine gender disparities in carotid plaque characteristics.The clinical data of male and female groups were analyzed using t-tests andχ^(2) tests,whereas the plaque characteristics were compared using Mann-Whitney U tests andχ^(2) tests.Multivariate logistic regression analysis was conducted to examine the association between clinical and imaging factors and the presence of mild carotid artery vulnerable plaque.Results The body mass index((24.50±2.87)kg/m2 vs.(23.69±3.52)kg/m2),diastolic blood pressure((88.63±14.68)mm Hg vs.(84.36±10.81)mm Hg),and the proportion of smoking(69.2%(276/399)vs.7.5%(17/288))in the male group were higher than those in the female group,and the differences were statistically significant(t=−2.896,−4.163,χ^(2)=222.008,all P<0.01).Conversely,age((59.99±9.89)years vs.(62.55±9.87)years),total cholesterol((4.48±1.09)mmol/L vs.(4.91±1.14)mmol/L),and low-density lipoprotein((2.80±0.90)mmol/L

关 键 词：动脉粥样硬化 颈动脉 磁共振成像 易损斑块 性别 

分 类 号：R543.5[医药卫生—心血管疾病]