基于HR-MRI对富脂坏死核心与颈动脉斑块负荷、临床因素的相关性分析

Analysis of the correlation between lipid-necrotic core and carotid plaque burden and clinical factors based on high-resolution magnetic resonance imaging

目的采用高分辨磁共振成像(HR-MRI)技术分析富脂坏死核心(LRNC)与颈动脉斑块负荷的相关性,并探讨影响LRNC的相关临床因素。方法回顾性收集短暂性脑缺血发作或前循环缺血性卒中病人323例,男235例,女88例,平均年龄(61.75±10.64)岁。所有病人在出现症状2周内完成颈动脉HR-MRI检查,并记录病人临床资料。基于HR-MRI影像测量并计算颈动脉斑块负荷指标,包括平均管腔面积(LA)、平均管壁面积(WA)、管壁体积(WV)、平均标准化管壁指数(NWI)、平均及最大管壁厚度(WT)、管腔狭窄程度,识别LRNC、钙化、斑块内出血(IPH),鉴定高危斑块。根据症状侧颈动脉有无LRNC将全部病人分为LRNC(+)组(178例)和LRNC(-)组(145例)。对2组病人颈动脉斑块特征及临床因素进行比较,2组间计量资料比较采用独立样本t检验或Mann-Whitney U检验,2组间计数资料比较采用卡方检验。采用多因素Logistic回归评估影响LRNC的颈动脉斑块负荷指标及相关临床因素。结果相比LRNC(-)组,LRNC(+)组男性更多,吸烟、高血压、糖尿病者更多,年龄更大、总胆固醇水平更高(均P<0.05);LRNC(+)组平均LA更小,平均WA、WV、平均NWI更大,最大WT、平均WT更厚,管腔更狭窄(均P<0.05);IPH、钙化、高危斑块发生率更高(均P<0.05)。多因素Logistic回归分析显示,最大WT是LRNC的独立预测因素(P<0.05);总胆固醇是LRNC的危险因素(β=0.408,P=0.024),高密度脂蛋白胆固醇是LRNC的保护因素(β=-3.145,P=0.045)。结论最大WT与LRNC密切关联,总胆固醇、高密度脂蛋白胆固醇对LRNC有重要影响。

Objective To analyze the correlation between lipid-rich necrotic core(LRNC)and carotid plaque burden by high-resolution magnetic resonance imaging(HR-MRI),and to explore the related clinical factors affecting LRNC.Methods A total of 323 patients with transient ischemic attack or anterior circulation ischemic stroke were retrospectively collected.There were 235 males and 88 females,with an average age of 61.75±10.64 years.Carotid HR-MRI was performed in all patients within 2 weeks after the onset of symptoms,and clinical data were recorded.Based on HR-MRI images,carotid plaque burden indexes were measured and calculated,including mean lumen area(LA),mean wall area(WA),wall volume(WV),mean normalized wall index(NWI),mean and maximum wall thickness(WT),stenosis degree of lumen.Presences of LRNC,calcification,intraplaque hemorrhage(IPH),and high-risk plaques were recorded.According to the presence or absence of LRNC in the symptomatic carotid arteries,the patients were divided into LRNC(+)group(n=178)and LRNC(-)group(n=145).The characteristics of carotid plaques and clinical factors were compared between the 2 groups.The independent sample t-test or Mann-Whitney U test was used to compare the measurements and the chi-square test was used to compare the categorical data between the 2 groups.Multivariate Logistic regression was used to evaluate the carotid plaque burden indexes and related clinical factors affecting LRNC.Results Compared with the LRNC(-)group,the LRNC(+)group had significantly more male,smoking,hypertension,diabetes,older age,and higher total cholesterol level(all P<0.05),the LRNC(+)group had significantly smaller mean LA,larger mean WA,WV,and NWI,thicker maximum WT and mean WT,narrower lumen,more IPH,calcification,high-risk plaques(all P<0.05).Multivariate Logistic regression analysis showed the maximum WT was an independent predictor of LRNC(P<0.05),total cholesterol was a risk factor of LRNC(β=0.408,P=0.024),and high density lipoprotein cholesterol was an protective factor of LRNC(β=-3.145,P=0.045).Conclusions Maximum WT is closely related to LRNC,total cholesterol and high density lipoprotein cholesterol have important effects on LRNC.