Correlation between Carotid Artery Fat Density and Atherosclerosis
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摘要:
目的：本文旨在探讨颈动脉周围脂肪密度与动脉粥样硬化型狭窄及脑缺血事件的相关性，为颈动脉粥样硬化型狭窄的早期识别提供临床参考。方法：回顾性收集盘锦市中心医院2023年1月至2023年8月接受颈动脉计算机断层血管成像（CTA）检查具有完整临床资料有明确诊断的患者，共224侧血管纳入研究，根据是否有动脉粥样硬化分为狭窄组及对照组，狭窄组细分为轻度、中重度狭窄，根据不同年龄划分为Ⅰ、Ⅱ、Ⅲ组，根据患者有无症状分为有症状组及无症状组，探讨血管周围脂肪密度（PFD）与颈动脉粥样硬化型狭窄及脑血管事件的相关性。结果：临床资料中高血压、高血脂及年龄与颈动脉粥样硬化狭窄有关，差异有统计学意义。随颈动脉狭窄程度的加重，颈动脉PFD会逐渐升高。PFD随年龄增长而逐渐增加。相关性分析显示：PFD、年龄、高血压病史、高血脂病史与颈动脉狭窄间存在正相关。狭窄侧血管有症状组PFD高于无症状组，二元Logistic矫正混杂因素后差异仍有统计学意义。结论：颈动脉PFD是颈动脉粥样硬化型狭窄的独立危险因素，且症状性颈动脉狭窄患者颈动脉周围脂肪密度高。
Abstract:Objective: In this study, we aim to investigate the correlation between carotid artery fat density and atherosclerotic stenosis, providing a clinical reference for the early identification of carotid atherosclerotic stenosis. Methods: A retrospective analysis was conducted on patients with complete clinical data and confirmed diagnoses who underwent carotid computed tomography angiography (CTA) at Panjin Central Hospital between January 2023 and August 2023. A total of 224 blood vessels were included in the study. Patients were divided into a stenosis group and a control group based on the presence or absence of atherosclerosis. The stenosis group was further categorized into mild, moderate, and severe stenosis, and classified into Groups I, II, and III based on age. Additionally, patients were classified into symptomatic and asymptomatic groups based on their symptom status, and the correlation between perivascular fat density (PFD), carotid atherosclerotic stenosis, and cerebrovascular events was explored. Results: Hypertension, hyperlipidemia, and age were significantly associated with carotid atherosclerotic stenosis. PFD increased with the degree of stenosis and age. Correlation analysis revealed a positive correlation between PFD, age, history of hypertension, history of hyperlipidemia, and carotid artery stenosis. The PFD in the symptomatic group was higher than in the asymptomatic group, and the difference remained statistically significant after binary logistic correction for confounding factors. Conclusion: Carotid artery PFD is an independent risk factor for carotid atherosclerotic stenosis. Patients with symptomatic carotid artery stenosis exhibit higher carotid fat density compared to their asymptomatic counterparts.
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图 1 颈动脉旁脂肪密度测量
注：该患者左侧颈内动脉狭窄，○处测得PFD为-66.30 HU，−71.99 HU，（b）为（a）的放大影像，○面积为2.5 mm2，ROI距离血管外缘≥1 mm。
Figure 1. Measurement of fat density near the carotid artery
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图 2 配对t检验两组间差异比较
注：***表示P < 0.001。
Figure 2. Differences between two groups analyzed using a paired t-test
表 1 患者一般情况比较
Table 1 Comparison of general conditions of patients
指标 狭窄组（n=111） 对照组（n=113） Z/$\chi^2 $ P 性别，男性 73.87%（82/29） 63.72%（72/41） 2.689 0.101 年龄/岁 65（57,72） 57（46,65.5） 5.026 < 0.001 高血压 70.27%（78/33） 50.44%（57/56） 9.193 0.002 糖尿病 16.22%（18/93） 20.35%（23/90） 0.641 0.423 高同型半胱氨酸 7.21%（8/103） 2.65%（3/110） 2.485 0.115 高血脂 14.41%（16/95） 5.31%（6/107） 5.241 0.022 烟酒史 12.61%（14/97） 6.19%（7/106） 2.715 0.099 冠心病 13.51%（15/96） 7.96%（9/104） 1.802 0.179 PFD/HU −71.61（−77.55,−66.84） −82.96（−86.23,−79.61） 10.334 < 0.001 
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表 2 不同狭窄程度PFD比较
Table 2 Comparison of PFD across different degrees of stenosis
组别 对照组（n=113） 轻度狭窄组（n=81） 中重度狭窄（n=30） H P PFD −82.96（−86.32，−79.61） −75.08（−77.96，−69.38） ▲ −65.64（−69.37，−59.61）*# 114.911 < 0.001 注：*表示对照组与中重度狭窄组相比P < 0.05；#表示轻度狭窄组与中重度狭窄组相比P < 0.05；▲表示对照组与轻度狭窄组相比P < 0.05。
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表 3 同一患者狭窄组与对照组PFD比较
Table 3 Comparison of PFD between stenosis and control groups in the same patients
组别 狭窄组（n=18） 对照组（n=18） t P值 PFD均值 −72.79±6.43 −82.79±4.90 6.59 < 0.001
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表 4 不同年龄段PFD比较
Table 4 Comparison of PFD across different age groups
Ⅰ组（n=30） Ⅱ组（n=103） Ⅲ组（n=91） H P值 PFD −82.46（−86.14，−78.55） −78.75（−83.69，−72.69）▲ −76.53（−80.01，−67.82）*# 17.743 < 0.001 注：Ⅰ组与Ⅲ组相比*P < 0.05；Ⅱ组与Ⅲ组相比#P < 0.05；Ⅰ组与Ⅱ组相比▲P < 0.05。
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表 5 各指标与颈动脉狭窄的相关性分析
Table 5 Correlation analysis between various indices and carotid artery stenosis
指标 r P PFD 0.692 < 0.001 年龄 0.337 < 0.001 性别 0.110 0.101 冠心病 0.090 0.179 高血脂 0.153 0.022 高同型半胱氨酸 0.105 0.115 糖尿病 −0.053 0.426 烟酒史 0.110 0.099 高血压 0.203 0.002
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表 6 二元Logistic回归分析
Table 6 Binary logistic regression analysis
调整前 调整后 OR 95%CI P OR 95%CI P PFD 1.366 1.258-1.485 < 0.001 1.357 1.242-1.484 < 0.001 年龄 1.070 1.042-1.099 < 0.001 1.045 1.009-1.083 0.014
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表 7 有症状与无症状患者PFD均值比较
Table 7 Comparison of mean PFD between symptomatic and asymptomatic patients
PFD 有症状 无症状 Z P 狭窄组 −68.74（−76.96，−64.52） −74.97（−77.71，−69.43） −2.327 0.020 对照组 −83.00（−86.25，−79.91） −82.74（−86.05，−79.00） −0.367 0.714
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表 8 狭窄组中有症状与无症状患者二元Logistic回归
Table 8 Binary logistic regression analysis of symptomatic and asymptomatic patients in the stenosis group
调整前 调整后 OR 95%CI P OR 95%CI P PFD 1.060 1.010-1.113 0.019 1.073 1.013-1.136 0.017
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