Correlation between Carotid Atherosclerotic Plaques and Acute Ischemic Stroke
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摘要: 目的：运用颈动脉CTA分析颈动脉粥样硬化斑块，探讨斑块性质及部分因素与急性缺血性脑卒中的相关性，从而为急性缺血性脑卒中的预防和治疗提供参考和依据。方法：回顾性分析行颈动脉CTA检查、且在颈动脉CTA检查前或后一周内行磁共振DWI检查的患者，根据磁共振DWI判断有无前循环急性缺血性脑卒中，将患者分为急性缺血性脑卒中组（95例）和非急性缺血性脑卒中组（102例）；对两组患者的临床资料、实验室资料和CTA显示的颈动脉斑块性质、斑块表面形态进行分析，比较两组之间有无统计学差异，对P<0.05的指标纳入急性缺血性脑卒中发生的多因素Logistic回归分析。结果：两组间在年龄、高血压病史、TC、TG、HDL、HCY、CysC、HbA1c指标中差异有统计学意义；两组间在斑块性质及斑块表面形态间差异有统计学意义，在颈动脉管腔狭窄程度间差异无统计学意义；多因素回归分析提示年龄≥65岁、高血压、TC、HDL、HCY及脂质斑块是急性缺血性脑卒中发生的危险因素。结论：颈动脉粥样硬化与急性缺血性脑卒中发生相关，脂质斑块是急性缺血性脑卒中发生的危险因素；颈动脉CTA可以对斑块性质进行判断，结合部分实验室指标，可以为急性缺血性脑卒中的防治提供参考和依据。Abstract: Objective: Carotid artery computed tomography angiography (CTA) was used to analyze carotid atherosclerotic plaques and explore the correlation of plaque properties and other factors with the occurrence of acute ischemic stroke. The aim was to provide a basis for the prevention and treatment of acute ischemic stroke. Methods: Patients who underwent carotid artery CTA and magnetic resonance diffusion-weighted imaging (DWI) within 2 weeks before or after carotid artery CTA were analyzed retrospectively. Based on magnetic resonance DWI data, these patients were divided into the acute ischemic stroke group (n=95) and non-acute ischemic stroke group (n=102). The clinical data, laboratory data, and nature and surface morphology of the carotid plaques on CTA were compared between the two groups. Variables with P<0.05 were included in a multivariate logistic regression analysis to determine the risk factors of acute ischemic stroke. Results: Age, hypertension history, and levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), homocysteine (Hcy), cystatin C (Cys-C), and glycated hemoglobin (HbA1c) differed significantly between the two groups. Multivariate regression analysis revealed that age ≥65 years (odds ratio [OR]: 4.95), hypertension (OR: 9.91), high TC (OR: 2.78), high Hcy (OR: 3.07), high HbA1c (OR: 4.60), and lipid plaque (OR: 4.89) were the independent risk factors for acute ischemic stroke. A high HDL level (OR of 0.13) was identified as a protective factor for the development of acute ischemic stroke. Conclusion: Carotid atherosclerosis is related to acute ischemic stroke occurrence. Furthermore, the presence of lipid plaques is a risk factor for acute ischemic stroke. Combined with some laboratory indicators, carotid artery CTA can judge the nature of carotid plaques and provide a basis for the prevention and treatment of acute ischemic stroke.
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Key words:
- carotid CTA /
- carotid plaque /
- acute ischemic stroke
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图 1 同一患者：（a）和（b）显示右侧颈总动脉脂质、溃疡斑块，（c）显示右侧基底节区及颞顶叶急性大面积脑梗塞，（d）显示右侧颈总动脉脂质斑块所致管腔中度狭窄（黑箭头所示）
Figure 1. In the same patient: (a) and (b) show lipid and ulcerative plaques in the right common carotid artery, respectively; (c) shows acute massive cerebral infarction of the right basal ganglia and temporo-parietal lobe; and (d) shows moderate stenosis of the right common carotid artery due to lipid plaques (black arrow)
图 2 同一患者：（a）和（b）显示左侧颈总动脉脂质、不规则斑块，（c）显示左侧颞顶叶急性脑梗塞，（d）显示左侧颈总动脉脂质斑块所致管腔中度狭窄（黑箭头所示）
Figure 2. In the same patient: (a) and (b) show lipid and irregular plaques in the left common carotid artery, respectively; (c) shows acute cerebral infarction of the left temporo-parietal lobe; and (d) shows moderate stenosis of the left common carotid artery lumen due to lipid plaques (black arrow)
图 3 同一患者。（a）和（b）显示左侧颈总动脉脂质、光滑斑块，（c）显示左侧侧脑室旁小片状急性脑梗塞，（d）显示左侧颈总动脉脂质斑块所致管腔轻度狭窄（黑箭头所示）
Figure 3. In the same patient: (a) and (b) show lipid and smooth plaques in the left common carotid artery, respectively; (c) shows small patchy acute cerebral infarction near the left lateral ventricle; and (d) shows mild stenosis of the left common carotid artery lumen due to lipid plaques (black arrow)
图 4 为同一患者：（a）和（b）显示左侧颈动脉分叉处纤维斑块，（c）显示该患者DWI未见明显急性脑梗塞，（d）显示左侧颈动脉分叉处纤维斑块所致管腔中度狭窄（黑箭头所示）
Figure 4. In the same patient: (a) and (b) show fibrous plaques at the left carotid bifurcation, (c) shows no significant acute cerebral infarction on DWI, and (d) shows moderate stenosis of the lumen at the left carotid bifurcation due to fibrous plaques (black arrow)
图 5 同一患者：（a）和（b）显示为左侧颈总动脉混合斑块、脂质成分为主，（c）显示左侧顶叶皮层下急性脑梗塞（黑箭头所示），（d）显示左侧颈总动脉混合斑块所致管腔中度狭窄（黑箭头所示）
Figure 5. In the same patient: (a) and (b) show mixed plaques in the left common carotid artery with a predominance of lipid components, (c) shows left parietal subcortical acute cerebral infarction (black arrow), and (d) shows moderate stenosis of the left common carotid artery lumen due to mixed plaques (black arrow)
表 1 病例组与对照组一般临床资料和实验室指标比较
Table 1. Comparison of general clinical data and laboratory indicators between the case and control groups
项目 参数 组别 统计检验 病例组（n=95）
例（％）或$\bar x \pm s$对照组（n=102）
例（％）或$\bar x \pm s$t/χ2 P 性别 男 71（81.4） 83（74.7） 1.269 0.260 女 24（18.6） 19（25.3） 年龄/岁 ＜50 5（5.3） 25（24.5） 32.672 ＜0.001 50～64 25（26.3） 25（24.5） ≥65 65（68.4） 52（51.0） 高血压* 是 66（69.5） 35（34.3） 24.339 ＜0.001 否 29（30.5） 67（65.7） 糖尿病 是 26（27.4） 17（16.7） 3.301 0.069 否 69（72.6） 85（83.3） 吸烟 是 14（14.7） 9（8.8） 1.668 0.197 否 81（85.3） 93（91.2） 饮酒 是 13（13.7） 7（6.9） 2.509 0.133 否 82（86.3） 95（93.1） TC/（mmol/L） 6.417±3.681 5.050±2.447 3.047 0.002 TG/（mmol/L） 2.235±1.849 1.742±1.504 2.043 0.042 HDL/（mmol/L） 1.241±0.344 1.086±0.302 3.337 0.001 LDL/（mmol/L） 2.609±0.837 2.385±0.918 1.789 0.075 HCY/（umol/L） 20.502±11.495 16.614±9.592 2.567 0.011 CysC/（mg/L） 1.143±0.251 1.073±0.245 1.978 0.049 HbA1c/％ 正常 47（49.5） 81（79.4） 19.372 ＜0.001 不正常 48（50.5） 21（20.6） 
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表 2 病例组与对照组颈动脉斑块检出情况和颈动脉管腔狭窄程度比较
Table 2. Comparison of the features of carotid plaques and carotid artery stenosis
项目 参数 组别 统计检验 病例组（n=95）
例（％）或$\bar x \pm s$对照组（n=102）
例（％）或$\bar x \pm s$t/χ2 P 斑块类型* 无斑块 14a（14.7） 16a（15.7） 28.109 ＜0.001 钙化斑块 17a（17.9） 37a（36.3） 脂质斑块 46a（48.4） 15b（14.7） 纤维斑块 13a（13.7） 23a（22.5） 混合斑块 5a（5.3） 11a（10.8） 斑块表面形态* 无斑块 14a（14.7） 16a（15.7） 9.136 0.028 光滑斑块 34a（35.8） 56b（54.9） 不规则斑块 30a（31.6） 18b（17.6） 溃疡斑块 17a（17.9） 12a（11.8） 斑块数量/个* 4.37±3.252 3.00±2.325 3.415 0.001 管腔狭窄程度 无狭窄 15（15.8） 16（15.7） 1.153 0.679 轻度狭窄 47（49.5） 44（43.1） 中度狭窄 30（31.6） 40（39.2） 重度狭窄 3（3.2） 2（2.0） 注：* 表示P＜0.05；a和b表示该因素在两组间经两两比较后存在统计学差异，字母相同则不存在统计学差异。
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表 3 急性缺血性脑卒中发生的多因素相关Logistic回归分析
Table 3. Multivariate logistic regression analysis of the risk factors for acute ischemic stroke
因素 β $S_{\bar {\rm{x}}} $ χ2 P OR（95％CI） 年龄/岁 ＜50 1.000 50～65 1.294 0.946 1.871 0.171 3.647（0.571～23.281） ≥65* 1.892 0.799 5.600 0.018 6.632（1.384～31.777） 高血压* 否 1.000 是 2.341 0.507 21.309 ＜0.001 10.395（3.847～28.090） TC* 0.169 0.076 4.920 0.027 1.184（1.020～1.375） HDL* 1.803 0.797 5.144 0.024 6.067（1.272～28.940） HCY* 0.062 0.023 7.125 0.008 1.064（1.017～1.114） 脂质斑块* 否 1.000 是 1.328 0.494 7.217 0.007 3.773（1.432～9.938） 注：* 为P<0.05，差异有统计学意义。
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