颈动脉粥样硬化狭窄的血管周围脂肪密度与脑梗死之间的关系

doi:​10.3969/j.issn.1006⁃5725.2023.01.018

摘要/Abstract

摘要：

目的评估颈动脉周围脂肪炎症与急性脑梗死之间的关联，通过计算机断层扫描血管造影（CTA）测量血管周围脂肪密度（PFD）反映脂肪组织的炎症情况。方法本研究筛选单侧颈动脉粥样硬化狭窄 > 50%的动脉粥样硬化患者且均完成颈动脉 CTA 和颅脑弥散加权成像（DWI）检查。根据 DWI 结果将患者分为急性梗死组（ACI 组）和非急性梗死组（NACI 组）。选取每位患者管腔狭窄最严重的颈动脉段进行分析，将感兴趣区域（ROI）分别放置在颈动脉狭窄侧和轴位同层面对侧颈动脉周围脂肪组织中，测量脂肪密度的均值和最大值。先通过独立样本 t 检验评估 ACI 组和 NACI 组患者狭窄侧与对侧 PFD 之间的差异，再通过配对样本 t 检验评估给两组患者狭窄侧与对侧 PFD 之间差异，最后将狭窄颈动脉 PFD 的均值和最大值纳入二元 logistic 回归分析并绘制 ROC 曲线。结果 ACI 组狭窄侧 PFD 的均值［（-57.87 ± 8.11） vs.（-67.22 ± 8.18），P < 0.001］和最大值［（-46.53 ± 6.33）vs.（-55.44 ± 7.24），P < 0.001］均高于NACI组。两组患者对侧 PFD 均值［（-78.82 ± 7.88）vs.（-81.16 ± 7.94），P = 0.222］和最大值［（-71.32 ± 6.91）vs.（-72.50 ± 6.61），P = 0.469］差异无统计学意义。两组患者配对 t 检验结果显示，ACI 组患者狭窄颈动脉侧 PFD 均值［（-57.87 ± 8.11）vs.（-78.82 ± 7.88），P < 0.001］和最大值［（-46.53 ± 6.33）vs.（-71.32 ± 6.91），P < 0.001］均高于对侧，NACI 组患者狭窄颈动脉侧 PFD 均值［（-67.22 ± 8.18）vs.（-81.16 ± 7.94），P < 0.001］和最大值［（-55.44 ± 7.24）vs.（-72.50 ± 6.61），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 PFD 均值（OR = 1.185，95%CI ：1.048 ~ 1.340）和最大值（OR = 1.195，95%CI ：1.054 ~ 1.353）差异均有统计学意义（P < 0.05）。ROC 曲线分析显示，颈动脉 PFD 均值［ROC 曲线下面积（AUC）0.792，95%CI ： 0.678 ~ 0.879，P < 0.001］与最大值（AUC = 0.812，95%CI ：0.701 ~ 0.896，P < 0.001）对脑梗死发生具有较高预测价值。结论急性脑梗死患者狭窄侧颈动脉周围脂肪密度较对侧增加，说明颈动脉粥样硬化相关的炎症反应已延伸至血管周围脂肪组织内，利用颈动脉 CTA 技术可以反映颈动脉周围脂肪组织的炎症，为脑梗死的早期预防及治疗提供有效依据。

关键词:

颈动脉, 血管周围脂肪密度 , 脑梗死, CT 血管造影

Abstract:

Objective To evaluate the relationship between pericarotid fat inflammation and acute cerebral infarction，and to measure perivascular fat density（PFD）by computed tomography angiography（CTA）to reflect the inflammation of adipose tissue. Methods In this study，patients with unilateral carotid artery atherosclerosis stenosis > 50%，and completing carotid artery CTA and brain diffusion⁃weighted imaging（DWI）were enrolled. According to DWI results，the patients were divided into acute infarction group（ACI group）and non⁃acute infarc⁃ tion group（NACI group）. The section of the carotid artery with the most severe lumen stenosis was selected from each patients；regions of interest（ROI）distribution were placed in the pericarotid adipose tissue on the side of the carotid artery stenosis and on the contralateral side of the axial plane，and the mean and maximum values of fat density were measured. The independent samples t ⁃test was used to evaluate the difference between the stenotic side and the contralateral PFD in the ACI group and the NACI group；the paired samples t⁃test to evaluate the difference between the stenotic side and the contralateral PFD in the two groups，and the mean and maximum values of PFD on the stenosis side of carotid artery were included in binary logistic regression analysis and ROC curve was drawn. Results The mean values（-57.87 ± 8.11 vs. -67.22 ± 8.18，P < 0.001）and maximum values （-46.53 ± 6.33 vs. -55.44 ± 7.24，P < 0.001）of PFD on stenotic side in the ACI group were higher than those inthe NACI group. There was no significant difference in the mean values（-78.82 ± 7.88 vs. -81.16 ± 7.94，P = 0.222） and maximum values（-71.32 ± 6.91 vs. -72.50 ± 6.61，P = 0.469）of PFD on contralateral side between the two groups. The paired t⁃test showed that mean values（-57.87 ± 8.11 vs. -78.82 ± 7.88，P < 0.001）and maximum values（-46.53 ± 6.33 vs. -71.32 ± 6.91，P < 0.001）of PFD on stenotic carotid artery side in the ACI group were higher than those on contralateral side，and mean values（-67.22 ± 8.18 vs. -81.16 ± 7.94，P < 0.001）and maxi⁃ mum values（-55.44 ± 7.24 vs. -72.50 ± 6.61，P < 0.001）of PFD on stenotic carotid artery side in the NACI group were also higher than those on contralateral side. Binary logistic regression analysis showed that mean values（OR = 1.185，95%CI 1.048 ~ 1.340）and maximum values（OR = 1.195，95%CI 1.054 ~ 1.353）of carotid artery PFD after adjusting for confounders were statistically significant（P < 0.05）. ROC curve analysis showed that mean values of carotid artery PFD［area under the curve（AUC）0.792，95%CI 0.678 ~ 0.879，P < 0.001］and the maximum values （AUC = 0.812，95%CI 0.701 ~ 0.896，P < 0.001）had high predictive value for cerebral infarction. Conclusions Fat density around the carotid artery on stenotic side of patients with ACI is higher than that on contralateral side， which indicates that the inflammatory reaction related to carotid atherosclerosis has extended to the perivascular adipose tissue. Carotid CTA technology can reflect the inflammatory of the adipose tissue around carotid artery and provide reference for the early prevention and treatment of cerebral infarction.

Key words:

carotid artery, perivascular fat density, cerebral infarction, computed tomography angi? ography

牛稳邱晓晖刘艺超 .

颈动脉粥样硬化狭窄的血管周围脂肪密度与脑梗死之间的关系 [J]. 实用医学杂志, 2023, 39(1): 103-108.

NIU Wen, QIU Xiaohui, LIU Yichao..

Relationship between perivascular fat density of carotid artery stenosis and cerebral infarction [J]. The Journal of Practical Medicine, 2023, 39(1): 103-108.

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颈动脉粥样硬化狭窄的血管周围脂肪密度与脑梗死之间的关系

Relationship between perivascular fat density of carotid artery stenosis and cerebral infarction

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