颈动脉周围脂肪密度与斑块内出血的相关性研究

Associations between Pericarotid Fat Density Evaluated by CTA and Intraplaque Hemorrhage

目的评估颈动脉周围脂肪炎症与斑块内出血(IPH)之间的关联,利用计算机断层扫描血管造影(CTA)技术,测量血管周围脂肪密度(PFD),以此反应脂肪组织的炎症情况。方法收集我院连续行颈动脉CTA、颈动脉HR-MRI检查的患者的临床基线资料及影像资料。测量患者颈动脉CTA斑块侧、对侧PFD。选取每位患者管腔狭窄最严重的颈动脉段进行分析,计算斑块侧PDF、非斑块侧PDF及二者PFD差值(ΔPFD)。根据颈动脉高分辨MRI结果将患者分为斑块内出血组(IPH组)、非斑块内出血组(非IPH组)。比较2组患者临床基线资料、PFD的差异。采用SPSS 26.0进行统计分析。先通过独立样本t检验评估IPH组和非IPH组患者斑块侧与对侧PFD之间的差异,再通过配对样本t检验评估两组患者斑块侧与对侧PFD之间差异,最后将斑块侧颈动脉PFD纳入二元logistic回归分析并绘制ROC曲线。P<0.05为差异具有统计学意义。结果本研究共纳入64例患者,平均年龄(67.9±8.9)岁。IPH组患者颈动脉斑块侧PFD高于非IPH组[(-44.21±14.75)HU vs(-64.87±13.25)HU],差异具有统计学意义(P<0.001),IPH组患者颈动脉ΔPFD高于非IPH组[(53.91±24.82)HU vs(35.88±14.52)HU],差异具有统计学意义(P=0.001),IPH组患者最大斑块厚度高于非IPH组[(4.76±1.97)mm vs(3.88±1.49)mm],差异具有统计学意义(P=0.046)。两组患者配对t检验结果显示,IPH组患者颈动脉斑块侧PFD均值[(-44.21±14.75)vs(-97.20±20.43),P<0.001]高于对侧,非IPH组患者颈动脉斑块侧PFD均值[(-64.87±13.25)vs.(-99.14±11.21),P<0.001]同样高于对侧。二元logistic回归分析显示,调整混杂因素后颈动脉斑块侧PFD(OR=1.194,95%CI:1.059~1.347)差异具有统计学意义(P<0.05)。ROC曲线分析显示,颈动脉PFD均值[ROC曲线下面积(AUC)为0.853,95%CI:0.761~0.946,P<0.001]对IPH的发生具有较高预测价值。结论颈动脉PFD与颈动脉易损斑块特征IPH存在相关,PFD为IPH的早期预测和风险分层提供了依据。

Objective Evaluate the association between carotid peri adipoinflammation and intra plaque hemorrhage(IPH),and measure perivascular fat density(PFD)using computed tomography angiography(CTA)technology to reflect the inflammatory status of adipose tissue.Methods Collect clinical baseline and imaging data of patients who underwent continuous carotid artery CTA and carotid artery HR-MRI examinations in our hospital.Measure the lateral and contralateral PFD of the patient's carotid artery CTA plaque.Select the carotid artery segment with the most severe stenosis in each patient for analysis,calculate the plaque side PDF,non plaque side PDF,and the difference in PFD(ΔPFD)between the two.According to the high-resolution MRI results of the carotid artery,patients were divided into two groups:the plaque hemorrhage group(IPH group)and the non plaque hemorrhage group(non IPH group).Compare the differences in clinical baseline data and PFD between two groups of patients.Statistical analysis was conducted using SPSS 26.0.First,the differences in plaque side and contralateral PFD between patients in the IPH and non IPH groups were evaluated using independent sample t-tests.Then,the differences in plaque side and contralateral PFD between the two groups were evaluated using paired sample t-tests.Finally,plaque side carotid PFD was included in binary logistic regression analysis and ROC curves were plotted.P<0.05 indicates a statistically significant difference.Results This study included a total of 64 patients with an average age of(67.9±8.9)years.The PFD on the carotid artery plaque side of patients in the IPH group was higher than that in the non IPH group[(-44.21±14.75)HU vs(-64.87±13.25)HU],with statistical significance(P<0.001).TheΔPFD on the carotid artery of patients in the IPH group was higher than that in the non IPH group[(53.91±24.82)HU vs(35.88±14.52)HU],with statistical significance(P=0.001).The maximum plaque thickness in patients in the IPH group was higher than that in the non IPH group[(4.76±1.97)mm vs(3.88±1.49)mm],with statistical significance(P=0.046).The paired t-test results of two groups of patients showed that the mean PFD on the carotid plaque side of patients in the IPH group was higher than that on the contralateral side(-44.21±14.75)vs(-97.20±20.43),(P<0.001),while the mean PFD on the carotid plaque side of patients in the non IPH group was higher than that on the contralateral side[(-64.87±13.25)vs(-99.14±11.21),P<0.001]is also higher than the opposite side.Binary logistic regression analysis showed that after adjusting for confounding factors,there was a statistically significant difference in PFD on the carotid plaque side(OR=1.194,95%CI:1.059~1.347)(P<0.05).ROC curve analysis shows that the mean carotid artery PFD (area under the ROC curve(AUC)is 0.853,95%CI:0.761~0.946,P<0.001)has high predictive value for the occurrence of IPH.Conclusion There is a correlation between carotid artery PFD and carotid vulnerable plaque characteristic IPH,and PFD provides a basis for early prediction and risk stratification of IPH.