维持性血液透析患者心血管钙化进展的相关影响因素分析

目的:探讨维持性血液透析(MHD)患者心血管钙化进展的影响因素。方法:选择MHD6月的患者104例,完善相关实验室检查,胸部螺旋CT检测冠状动脉钙化评分(CACS,Agston法),腹部侧位平片检测腹主动脉钙化评分(AACS,Kauppila法),心脏超声检测心脏瓣膜钙化情况。随访观察3年,探讨心血管钙化进展情况及其影响因素。结果:随访基线时钙化总阳性率为69.23%,随访3年后钙化总阳性率升至81.18%,CACS、AACS、心脏瓣膜钙化均较基线明显加重。Logistic回归分析显示舒张早期和舒张晚期二尖瓣口最大血液速度之比(E/A值)、时间平均血磷、时间平均钙磷乘积、基线CACS、碳酸钙的使用均是CACS进展的独立危险因素(P0.05)。研究期间17例(16.34%)患者死亡,因心脑血管疾病死亡患者基线钙化情况更为严重。结论:MHD患者心血管钙化发生率高,且随透析时间延长逐年加重,临床血磷、钙磷乘积等指标控制达标情况及基线CAC等均影响远期CAC进展。     

老年维持性血液透析患者心血管钙化危险因素分析

目的:调查老年维持性血液透析(MHD)患者心血管钙化发生率,分析影响老年MHD患者心血管钙化的危险因素。方法:选取2014年1月至2015年1月,于四川省15家血液透析中心透析的老年MHD患者。收集患者相关临床及实验室资料,腹部侧位X线片,骨盆X线片及心脏彩色超声心动图评估患者心血管钙化情况。根据患者是否存在腹主动脉、髂股动脉或心脏瓣膜钙化分为钙化与非钙化组,比较两组间各项临床指标差异,并利用多因素Logistic回归分析影响老年MHD患者心血管钙化的危险因素。结果:共纳入79例老年MHD患者,男性41例,女性38例,平均年龄(68.61±6.72)岁,透析龄平均(61.95±44.83)个月,糖尿病肾病占老年MHD患者原发病因首位(25.3%);②老年MHD患者心血管钙化发生率高达81.0%;钙化组(n=64)年龄、脉压差、矫正钙高于无钙化组(n=15)(P0.05), HGB、TC水平低于无钙化组(P0.05);③Logistic回归分析显示钙、HGB和TC是老年MHD患者心血管钙化危险因素(P0.05);④Logistic回归分析显示年龄、高磷是老年MHD患者心脏瓣膜钙化的独立危险因素(P0.05)。结论:老年MHD患者的心血管钙化发生率高达81.0%;高钙、高磷、低HGB和低TC是老年MHD患者心血管钙化危险因素,改善上述指标,可能会降低老年MHD患者心血管钙化发生率,减少心血管事件发生率及病死率。     

规律血液透析患者甲状旁腺激素水平对腹主动脉钙化的效应分析

目的探讨维持性血液透析(MHD)患者腹主动脉钙化(AAC)的相关危险因素。方法通过X线腹部侧位片对177例MHD患者进行AAC评分,按腹主动脉钙化有无将患者分为钙化组和非钙化组,比较两组患者的人口学特征、透析龄、心血管事件、高血压病史、高脂血症病史、糖尿病病史、碳酸钙及活性维生素D用药史以及血钙、血磷、全段甲状旁腺激素(i PTH)、高敏C反应蛋白(hs-CRP)等实验室指标的不同,通过Logistic回归分析AAC发生的相关危险因素,并比较不同PTH水平组患者AAC的发生率。结果 177例MHD患者中58.2%(103例)存在腹主动脉钙化,钙化组患者心血管事件的发生率显著高于非钙化组(33.3%vs 9.4%,P=0.001)。单因素分析显示钙化组患者高龄、长透析龄、高hs-CRP、高脂血症、高血压、碳酸钙用药史、活性维生素D用药史人数显著高于非钙化组,差异有统计学意义(P0.005)。Logistic回归分析显示:高龄、高脂血症、高血压、长透析龄、高i PTH、高hs-CRP、活性维生素D和碳酸钙用药史是AAC的危险因素。随着血清i PTH水平的增高,AAC的发生率也随之增加,即使在矫正了年龄、性别、吸烟、透析龄、高血压、糖尿病、高hs-CRP、活性维生素D用药史、碳酸钙用药史等影响因素后,这种作用依然存在。结论 MHD患者腹主动脉钙化发生率明显高于正常人群。研究发现年龄、高脂血症、高血压、透析龄、高PTH、高hs-CRP、活性维生素D和碳酸钙用药史是AAC的危险因素,其中高i PTH水平是MHD患者AAC的独立危险因素。     

糖尿病肾病患者心血管钙化的发生率及特点

目的:观察糖尿病肾病患者心血管钙化的发生情况,并分析其影响因素。方法:选取慢性肾脏病(CKD)2~5期非透析糖尿病肾病患者270例(2期40例、3期121例、4期63例、5期46例),完善心血管钙化的相关实验室检查,选用螺旋CT评分冠状动脉钙化,腹部侧位平片评分腹主动脉钙化,心脏彩超观察心脏瓣膜钙化情况,并采用Logistic回归分析心血管钙化的相关危险因素。结果:CKD 2~5期患者血磷逐渐升高,血钙逐渐降低,全段甲状旁腺激素逐渐升高,25羟维生素D逐渐下降(P0.01)。所有患者心血管钙化发生率为70.3%,其中冠状动脉钙化、腹主动脉钙化和瓣膜钙化发生率分别为55.1%、43.4%和23.9%。CKD 2~5期心血管钙化的总发生率分别为72.5%、73.6%、66.7%和63.0%。心血管钙化与年龄、糖尿病病程、高血压病程、心血管疾病史、颈部血管粥样斑块等相关,而与性别、血脂异常、血钙、血磷、全段甲状旁腺激素及CKD分期无关。其中年龄、心脑血管疾病史和颈部血管粥样斑块是冠状动脉和腹主动脉钙化的独立危险因素,年龄是心脏瓣膜钙化的独立危险因素。结论:糖尿病肾病患者心血管钙化发生率高,在CKD 2期钙磷代谢紊乱不明显时即已出现明显钙化。心血管钙化发生率与传统心血管疾病危险因素相关,而与钙磷代谢指标及CKD分期无显著相关。     

老年维持性血液透析患者主动脉瓣和二尖瓣钙化的发生情况及危险因素

目的探讨老年维持性血液透析(MHD)患者心脏瓣膜钙化的危险因素。方法对75例老年MHD患者进行心脏彩超检查,根据有无瓣膜(主动脉瓣、二尖瓣)钙化分为钙化组(27例)和无钙化组(48例)。记录两组的一般临床资料,检测肾功能、钙磷代谢指标、全段甲状旁腺素(i PTH)、营养指标及N末端B型脑钠肽前体(NT-pro BNP)、超敏C反应蛋白(hs CRP)水平。通过Logistic回归分析老年MHD患者心脏瓣膜钙化的危险因素。结果 75例患者中27例存在心脏瓣膜钙化。钙化组的平均年龄、透析龄、血磷(P)、钙磷乘积(Ca×P)、i PTH、NT-pro BNP、hs CRP水平均显著高于无钙化组(P0.01)。但血白蛋白(ALB)水平显著低于无钙化组(P0.05)。多因素Logistic回归分析示年龄、透析龄、血P、i PTH、NT-pro BNP、hs CRP是老年MHD患者心脏瓣膜钙化的危险因素(P0.05),血ALB是保护性因素(P0.05)。结论在MHD患者,特别是老年、长透析龄患者群中,血P、i PTH、NT-pro BNP、hs CRP是心脏瓣膜钙化的危险因素,ALB是保护性因素。通过监测以上指标,可为MHD患者心脏瓣膜钙化提供预测价值。     

老年腹膜透析患者心脏瓣膜钙化的危险因素

目的探讨维持性腹膜透析的老年患者心脏主动脉瓣和二尖瓣钙化发病可能的危险因素。方法对48例老年腹透患者采用超声心动图检查心脏瓣膜钙化情况同时搜集患者的生化结果以及透析相关指标,应用Logistic回归分析主动脉瓣和二尖瓣钙化的危险因素。结果在入选的48例老年透析患者中,28例存在主动脉瓣或二尖瓣钙化,主动脉瓣钙化27例,二尖瓣钙化12例,其中包括主动脉和二尖瓣双瓣膜钙化11例,多因素Logistic回归分析表明,钙磷乘积(OR=2.718,P=0.014)、前白蛋白(OR=0.809,P=0.006)与主动脉瓣钙化独立相关,年龄(OR=1.447,P=0.016)、钙磷乘积(OR=3.675,P=0.003)、高密度脂蛋白(OR=5.898,P=0.020)、糖尿病史(OR=3.830,P=0.017)与二尖瓣钙化独立相关。结论老年腹透患者心脏瓣膜钙化发病率高,其中以主动脉瓣钙化更多见,钙磷乘积、低前白蛋白血症是主动脉瓣钙化的独立危险因素,年龄、钙磷乘积、高密度脂蛋白、糖尿病史是二尖瓣钙化的独立危险因素。     

心脏瓣膜钙化对维持性血液透析患者远期预后的影响

目的:评估终末期肾病维持性血液透析(MHD)患者心脏瓣膜钙化对死亡率和死亡原因的影响.方法:96例MHD患者中男性55例,女性41例,平均年龄55±12岁,平均透析时间57±30周.全部患者行超声心动图检查,根据有无心脏主动脉瓣和二尖瓣钙化将其分为瓣膜钙化组(31例)和无瓣膜钙化组(65例).结果:瓣膜钙化组和无瓣膜钙化组1年存活率分别为75％和95％ (P＜0.01).瓣膜钙化组患者年龄大,糖尿病比例高,粥样硬化性血管疾病发生率高;实验室检查证实C反应蛋白、血清钙、血清磷和甲状旁腺激素水平均高于无瓣膜钙化组患者,而血清白蛋白低于后组;两组左室射血分数无差异.全部患者平均随访75周( 12 ～ 40周),随访期间死亡25例,两组心血管疾病死亡率分别为25.8％和6.1％(P＜0.01),多变量COX回归分析发现:心脏瓣膜钙化是预测非心血管源性死亡( HR 2.23,95％ CI 1.02～4.25,P＜0.01)及心血管源性死亡(HR3.50,95％ CI 2.23 ～5.52,P＜0.01)的独立危险因素,且与年龄、性别、透析时间、C反应蛋白水平及是否合并粥样硬化性血管疾病或糖尿病存在相关性. 结论:MHD患者有无心脏瓣膜钙化对心血管源性及非心血管源性死亡预测具有意义.     

维持性血液透析患者血清成纤维细胞生长因子23与血管钙化和左心室肥厚的关系

目的:观察182例维持性血液透析(MHD)患者的血清成纤维细胞生长因子23(FGF23)水平、影响因素及与血管钙化和左心室肥厚(LVH)的关系。方法:检测血清全段FGF23水平,钙、磷、全段甲状旁腺素(iPTH)、25羟维生素D及常规实验室指标,记录调节钙磷代谢的用药情况,螺旋CT检测冠脉钙化评分(CACS),腹部侧位平片检测腹主动脉钙化评分(AACS),心脏超声检测心脏指标。结果:所有患者的血清FGF23水平显著升高,根据FGF23水平用四分位法将患者分为四组:组1 FGF23为77.7~1 260.8 Pg/ml,组2 FGF23为1 290.9~5 934.6 pg/ml,组3 FGF23为6 969.8~27 219.7 pg/ml,组4 FGF23为27 487.3~234 869.2 pg/ml,随着组间FGF23水平升高,患者年龄更大,踝臂指数更低,血红蛋白更低,血磷更高(P0.05),FGF23与血磷的相关系数为0.435(P0.01)。同时,血清25羟维生素D水平呈下降趋势,lgiPTH、活性维生素D的处方率、左心室质量指数(LVMI)、LVH的患病率均呈上升趋势,但无统计学差异。除了AACS≥5的患者随FGF23升高腹主动脉钙化的患病率增加外(P=0.048),其余各组血管钙化患病率及严重程度有升高趋势,但无统计学差异。结论:血清FGF23水平在MHD患者中明显升高,与血磷升高正相关。高FGF23水平的患者腹主动脉钙化(AACS≥5)的患病率增加,未发现血清FGF23与冠状动脉钙化、LVH患病率的相关性。     

维持性血液透析患者心脏瓣膜钙化与血脂异常的关系

目的 探讨维持性血液透析（MHD）患者心脏瓣膜钙化与血脂代谢紊乱的关系.方法 菲利普IU33 彩色多普勒超声诊断仪检测80 例患者心脏瓣膜钙化情况,将患者分为钙化组（18 例）和对照组（62 例）,比较两组患者血红蛋白、血清白蛋白、血脂、心脏结构等指标.结果 钙化组年龄及透析龄高于对照组（P 〈0.01）,左房扩大及左心室舒张功能减退（LVDD）发生率高于对照组（P 〈0.01）;总胆固醇（TC）、低密度脂蛋白胆固醇（LDL C）、载脂蛋白B（Apo B）均高于对照组.结论 维持性血液透析患者心脏瓣膜钙化与年龄、透析龄、血脂异常有关,易发生心脏结构异常.     

外周血中性粒细胞/淋巴细胞比值与透析患者冠状动脉钙化的关系

目的 通过透析患者资料分析该人群冠状动脉钙化(CAC)的危险因素,探讨中性粒细胞/淋巴细胞比值(NLR)对CAC的预测价值。方法 采用横断面调查方法,对163例透析患者(包括血液透析102例,腹膜透析61例)进行回顾性研究,根据多层螺旋CT评估结果,采用Agatston冠状动脉钙化积分(CACS)进行冠状动脉钙化程度的评估,将透析患者分成无钙化组59例(CACS 0～10分)和钙化组104例(CACS≥11分)。对两组患者的NLR、年龄、透析龄、高敏C反应蛋白(hs-CRP)、血钙、血磷、全段甲状旁腺激素(iPTH)、白蛋白(Alb)、血红蛋白、血清肌酐等指标进行统计学比较。应用Spearman相关性分析得出与CAC相关的因素,二元Logistic回归分析CAC发生的危险因素,受试者工作特征(ROC)曲线探讨NLR对CAC的预测价值。结果 163例透析患者中CAC总检出率为63.8%。钙化组NLR显著高于无钙化组(P＜0.001)。将钙化组分为轻度钙化组(CACS 11~400分)和重度钙化组(CACS＞400分),两亚组间NLR差异无统计学意义。Spearman相关性分析显示NLR与CAC显著相关(r＝0.403,P＜0.001)。二元Logistic回归分析结果显示年龄(OR=1.069,P＜0.001)、透析龄(OR=1.024,P＜0.001)、糖尿病(OR=15.871,P＝0.012)、NLR(OR=1.720,P＝0.001)是CAC的危险因素。ROC曲线分析结果显示,NLR与年龄的联合指标预测透析患者发生CAC时,曲线下面积为0.810(95%CI 0.739~0.880,P＜0.001),显著高于NLR(0.742,95%CI 0.666~0.818,P＜0.001)和年龄(0.754,95%CI 0.674~0.834,P＜0.001)单独分析时的曲线下面积。结论 高龄、透析龄和高水平NLR的透析患者发生CAC的风险较高,且NLR与年龄的联合指标对CAC的发生有着较好的预测价值。     

Coronary artery calcification correlates with the presence and severity of valve calcification

Aim

To investigate the prevalence of coronary artery calcification (CAC) in symptomatic individuals with CT evidence for left heart valve calcification, aortic valve (AVC), mitral valve (MAC) or both.

Methods

This is a retrospective study of 282 consecutive patients with calcification in either the aortic valve or mitral annulus. Calcium scoring of the coronary artery, aortic and mitral valve was measured using the Agatston score.

Results

AVC was more prevalent than MAC (64% vs. 2.5%, p < 0.001), with 34% having both. Absence of CAC was noted in 12.7% of the study population. AVC + CAC were observed in 53.5%, MAC and CAC in 2.1%, and combined AVC, MAC and CAC in 31.6%. The median CAC score was higher in individuals with combined AVC + MAC, followed by those with AVC and lowest was in the MAC group. The majority (40%) of individuals with AVC had CAC score > 400, and only in 16% had CAC = 0. The same pattern was more evident in individuals with AVC + MAC, where 70% had CAC score > 400 and only 6% had CAC score of 0. These results were irrespective of gender. There was no correlation between AVC and MAC but there was modest correlation between CAC score and AVC score (r = 0.28, p = 0.0001), MAC (r = 0.36, p = 0.0001) and with combined AVC + MAC (r = 0.5, p = 0.0001). AVC score of 262 had a sensitivity of 78% and specificity of 92% for the prediction of presence of CAC.

Conclusion

The presence and extent of calcification in the aortic valve or/and mitral valves are associated with severe coronary artery calcification.     

A quantitative study of peripheral arterial calcification and glucose tolerance in elderly diabetics and non-diabetics

Summary A quantitative study of peripheral arterial calcification and glucose tolerance in elderly diabetics and non-diabetics has been performed. A correlation between radiological media calcification and glucose tolerance in non-diabetics was found. Intima calcification was not correlated. Severe media calcification was much more common in diabetics than in non-diabetics.

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Eine quantitative Untersuchung über die Calcifikation peripherer Arterien und die Glucosetoleranz bei älteren Dia-betikern und Nicht-Diabetikern

Zusammenfassung Es wurde eine quantitative Studie über die Verkalkung peripherer Arterien und die Glucosetoleranz bei älteren Diabetikern und Nicht-Diabetikern durchgeführt. Dabei wurde eine Korrelation zwischen der radiologisch feststellbaren Mediaverkalkung und der Glucosetoleranz bei Nicht-Diabetikern gefunden. Die Intimaverkalkung zeigte keine Korrelation. Schwere Mediaverkalkungen waren viel häufiger bei Diabetikern als in Nicht-Diabetikern.

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Etude quantitative de la calcification artérielle périphérique et de la tolérance au glucose chez les diabétiques âgés et les non-diabétiques

Résumé L'étude quantitative de la calcification artérielle periphérique et de la tolérance au glucose a été faite chez les diabétiques âgés et les non-diabétiques. I1 en est ressorti une corrélation entre la calcification de la tunique moyenne en radiologie et la tolérance au glucose chez les non-diabétiques. Il n'y a pas eu de corrélation avec la calcification de la tunique interne. Une grave calcification de la tunique moyenne se rencontre plus souvent chez les diabétiques que chez les non-diabétiques.

     

动脉粥样硬化钙化的研究进展

血管钙化是异位钙化一种,分为中膜钙化和内膜钙化,中膜钙化相关的疾病有肾病、糖尿病等,而内膜钙化主要与动脉粥样硬化有关。血管钙化亦是心血管疾病的一危险因素,是慢性炎症反应的重要指标,动脉粥样硬化钙化即内膜钙化则充分体现了该作用。它的程度直接与粥样硬化疾病的斑块负荷有关。因此受到研究者广泛的关注,现就动脉粥样硬化钙化发生机制、相关因素及实验模型等方面做一综述。     

铁稳态在血管钙化发病机制中的作用

心血管疾病(CVD)在全球范围具有高发病率、高致残率和高致死率的特点,而血管钙化(VC)是造成CVD风险事件终末结局的主要共同病理改变,表明血管钙化是CVD的潜在防治靶点,但鉴于血管钙化的复杂发病机制,目前没有应对血管钙化的有效手段。铁是人体必需的微量元素,研究发现铁含量超载或缺乏导致的铁稳态(IH)异常分别在不同类型的CVD和疾病不同阶段参与血管钙化的发生发展。因此,阐明血管钙化时的铁稳态异常机制,有助于为血管钙化的基础研究和临床防治指出新方向。     

血管钙化的调节机制

血管钙化是动脉粥样硬化、糖尿病、肾病、衰老、收缩性高血压等多种疾病的病理生理基础，是心血管疾病的主要危险因子。最近研究发现血管钙化是一种类似于骨质疏松的主动的调节过程。然而，目前血管钙化的确切机制尚不清楚。可能与基质小泡、向钙性激素、钠依赖的磷酸转运系统、血管平滑肌细胞表型改变、血细胞、巨噬细胞和细胞凋亡等机制有关。     

Differences and similarities between patients with and without end-stage renal disease, with regard to location of intracardiac calcification

It has been known for some time that mitral annulus calcification is common in end-stage renal disease (ESRD) patients on long-term dialysis, as well as in elderly patients without renal failure. However, a systematic comparison of cardiac calcification in these two types of patients has not yet been made. We examined two-dimensional echocardiograms in 33 patients with ESRD (mean age 66 +/- 10 years) and in 34 other patients with intracardiac calcification but no ESRD (mean age 69 +/- 9 years), with particular attention to precise anatomic location of calcification. Age was not significantly different in the two groups. The incidences of posterior mitral annulus calcification and aortic valve calcification were not significantly different in the ESRD and non-ESRD groups, though mitral annulus calcification tended to be larger in ESRD patients. Basal mitral leaflet calcification and papillary muscle calcification was much more common in the ESRD group. Calcification of intervalvar fibrosa and of tricuspid annulus were noted only in ESRD patients.     

Unusual echocardiographic appearances attributable to submitral calcification simulating left ventricular “masses”

Using M-mode and cross-sectional echocardiography, we visualized in five patients abnormal large echos attributable to anterior submitral calcification or sclerosis (on or near the ventricular aspect of the anterior mitral leaflet). Such abnormal echos on M-mode echocardiography could have been mistaken for a mass in the left ventricular chamber. Autopsy in two cases confirmed the presence of nonrheumatic anterior submitral calcification. Echocardiographic features of anterior submitral calcification which are helpful in differentiating it from neoplastic or thrombotic ventricular masses include (1) less diastolic mobility and more echo density; (2) continuity with the base of the anterior mitral leaflet and/or the posterior aortic root region, whereas tumors or thrombi are attached to the left ventricular wall; and (3) calcification in the region of posterior “mitral annulus.” Cross-sectional long-axis views and M-mode scanning from the left ventricle to the aortic root were particularly helpful in making the differentiation.     

Effect of smoking and other traditional risk factors on the onset of coronary artery calcification: Results of the Heinz Nixdorf recall study

Background

Coronary artery calcium (CAC) indicates coronary atherosclerosis and can be present in very early stages of the disease. The conversion from no CAC to any CAC reflects an important step of the disease process as cardiovascular risk is increased in persons even with mildly elevated CAC. We sought to identify risk factors that determined incident CAC>0 in men and women from an unselected general population with a special focus on the role of smoking.

Methods

All 4814 persons that were initially studied in the Heinz Nixdorf Recall Study were invited to participate in the follow-up examination after 5.1 ± 0.3 years. All traditional Framingham risk factors were quantified using standard techniques. Smokers were categorized in never, former and present smokers. The CAC scores were measured from EBCT using the Agatston method.

Results

Overall, out of 342 men and 919 women with zero CAC at baseline, 107 (31.3%) men and 210 (22.9%) women had CAC>0 at second examination. In multivariable analysis, age (OR estimate per 5 years: 1.34 (95%CI: 1.21–1.47)), LDL cholesterol (per 10 mg/dL: 1.05 (95%CI: 1.01–1.10)), systolic blood pressure (per 10 mmHg: 1.19 (95%CI: 1.11–1.28)) and current smoking (1.49 (95%CI: 1.04–2.15)) were independent predictors of CAC onset. The probability of CAC onset steadily increased with age from 23.3% (men) and 15.3% (women) at age 45–49 years to 66.7% (men) and 42.9% (women) at age 70–74 years. The difference in age-dependent conversion rates was quantified by years between reaching a given level of CAC onset probability. We found a consistent pattern with respect to smoking status: presently (formerly) smoking middle-aged men convert to positive CAC 10 (5) years earlier than never smokers, for women (middle-aged to elderly) this time span is 8 (5) years.

Conclusion

Several traditional CVD risk factors are associated with CAC onset during 5 years follow-up. CAC onset is accelerated by approximately 10 (5) years for present (former) compared to never smokers.     

颈动脉斑块内钙化分布特征对斑块稳定性的影响

目的探讨颈动脉斑块内钙化分布特征对斑块稳定性的影响。方法选择行颈动脉内膜剥脱术患者49例,且术前通过二维超声及超声造影观察颈动脉斑块回声类型及斑块内造影剂分布情况,记录斑块回声类型、钙化部位、形态、数量及钙化旁有无新生血管,并进行分组,以术后病理结果为金标准,比较各组内不同钙化特征对斑块稳定性的影响。结果不同部位各钙化组、不同形态各钙化组及钙化旁有无新生血管的斑块稳定性比较,差异无统计学意义(χ~2=0. 415,P=0. 813;χ~2=2. 164,P=0. 339;χ~2=3. 352,P=0. 095);不同数量各钙化组的斑块稳定性比较,差异有统计学意义(χ~2=5. 555,P=0. 029)。结论钙化数量对颈动脉斑块稳定性有一定影响,多发钙化可导致斑块不稳定。