CTA 评估吸烟和被动吸烟对颈部动脉 粥样硬化斑块的影响

Effects of smoking and passive exposure to cigarette smoke on atherosclerotic plaques in extracranial arteries assessed by computed tomography angiography

目的通过CT血管成像(CTA)评估吸烟和被动吸烟对颈部动脉粥样硬化斑块的影响。方法回顾性分析2017年1月至2019年7月于山东省聊城市茌平区人民医院行颈部CTA的拟诊为脑血管病的受检者284名,其中男性133名、女性151名,年龄42~79(60.3±12.5)岁。根据是否吸烟或被动吸烟将受检者分为吸烟组(95名)、被动吸烟组(87名)、非吸烟组(102名)。比较3组受检者的颈部动脉粥样硬化斑块的累及节段数、类型、最大横截面积、斑块负荷、重构指数,并分析吸烟指数与斑块累及节段数之间的相关性。定性资料的组间比较采用χ^(2)检验;定量资料的多组间比较采用单因素方差分析,2组间比较采用独立样本t检验;吸烟指数与斑块累及节段数的相关性分析采用Spearman秩相关检验。结果3组受检者的年龄,体重指数,高血压、糖尿病及高血脂的发病率的差异均无统计学意义(F=0.30、0.43;χ^(2)=1.58、0.19、0.56,均P>0.05)。吸烟组男性比例(83.2%,79/95)高于被动吸烟组(31.0%,27/87)和非吸烟组(26.5%,27/102),差异均有统计学意义(χ^(2)=10.03、9.77,均P<0.05)。284名受检者共检测2840个动脉节段,其中2058个(72.5%)节段存在斑块。吸烟组和被动吸烟组的总斑块[80.5%(765/950)、74.7%(650/870)]、非钙化斑块[46.8%(445/950)、40.0%(348/870)]、混合型斑块[45.6%(433/950)、41.4%(360/870)]累及节段比例均高于非吸烟组[63.0%(643/1020)、20.9%(213/1020)、30.8%(314/1020)],且差异均有统计学意义(χ^(2)=7.43~21.33,均P<0.05);吸烟组总斑块、非钙化斑块累及节段比例高于被动吸烟组,且差异均有统计学意义(χ^(2)=7.40、9.77,均P<0.05)。吸烟组、被动吸烟组所有类型斑块的最大横截面积、斑块负荷、重构指数均明显高于非吸烟组,且差异均有统计学意义(t=6.54~20.11,均P<0.05)。吸烟组混合型斑块及非钙化斑块的最大横截面积、斑块负荷、重构指数均明显高于被动吸烟组,且差异均有统计学意义(t=9.05~15.64,均P<0.05)。吸烟组和被动吸烟组的吸烟指数与总斑块、非钙化斑块、混合型斑块的累及节段数均呈正相关(吸烟组:r=0.52、0.57、0.48,均P<0.05;被动吸烟组:r=0.40、0.42、0.43,均P<0.05)。结论吸烟、被动吸烟均可导致颈部动脉粥样硬化斑块数量增多、斑块量化指标增大;且吸烟量越大、年限越长颈部动脉斑块的累及节段数越多。

Objective To explore differences in the morphology of atherosclerotic plaques among active smokers,passive smokers,and nonsmokers using CT angiography(CTA).Methods A retrospective analysis was performed on 284 patients(133 males and 151 females aged 42−79(60.3±12.5)years old)with suspected cerebrovascular disease,including 95 active smokers and 87 passive smokers,and 102 nonsmokers who underwent 64-slice extracranial CTA in Chiping People's Hospital in Liaocheng City of Shandong Province from January 2017 to July 2019.Numbers of plaque involved segments,plaque type,area,burden,and remodeling index were compared among the three groups.Correlations between smoking index and numbers of plaque involved segments in the smoking and passive smoking groups were also calculated.Rates and theχ^(2) test were used to analyze qualitative data,while t test and one-way ANOVA were used to assess quantitative data.Spearman’s rank correlation test was used to analyze the relationship between smoking index and numbers of plaque involved segments.Results No difference in age,body mass index,incidence rates of diabetes,hypertension,hyperlipidemia was observed between groups(F=0.30,0.43;χ^(2)=1.58,0.19,0.56,all P>0.05).More males belonged to the active smoking group(83.2%,79/95)than to the passive smoking(31.0%,27/87)and nonsmoking(26.5%,27/102)groups(χ^(2)=10.03,9.77,both P<0.05).A total of 2840 segments from 284 patients were studied,and 2058(72.5%)segments revealed plaques.Total plaques(80.5%(765/950),74.7%(650/870)),noncalcified plaques(46.8%(445/950),40.0%(348/870)),and mixed plaques(45.6%(433/950),41.4%(360/870))involved segments percentages were more higher in the smoking and passive smoking groups than in the nonsmoking group(total plaques,63.0%(643/1020);noncalcified plaques,20.9%(213/1020);mixed plaques,30.8%(314/1020))(χ^(2)=7.43−21.33,all P<0.05).Total plaques,noncalcified plaques involved segments percentages in the smoking group were more higher than in the passive smoking groups(χ^(2)=7.40,9.77,both P<0.05).Smokers and passive smokers had a higher plaque area,plaque burden,and remodeling index than nonsmokers in three types of plaques(t=6.54−20.11,all P<0.05),while smokers had a higher plaque area,plaque burden,and remodeling index than passive smokers in noncalcified and mixed plaques(t=9.05−15.64,all P<0.05).A positive correlation between smoking index and total plaques,noncalcified plaques,mixed plaques involved segments numbers in the smoking and passive smoking groups(smoking:r=0.52,0.57,0.48,all P<0.05;passive smoking:r=0.40,0.42,0.43,all P<0.05)were observed.Conclusions Active and passive exposure to smoke can lead to more atherosclerotic plaques and higher quantitative index.The greater the amount of smoking and the longer the age,the more segments involved in carotid artery plaque will be found.