皮肤自发荧光与颈动脉粥样硬化斑块的关系研究

背景　颈动脉粥样硬化斑块是心脑血管疾病重要的危险因素，多用超声评价，但超声检查对设备、人员、经费要求较高。皮肤自发荧光（SAF）能够独立预测心脑血管事件发生及死亡等，操作简便、迅速、无创，因此探讨SAF与颈动脉粥样硬化斑块的关系对于颈动脉病变的预测有一定意义。目的　探讨在我国社区人群中SAF与颈动脉粥样硬化斑块病变的相关性。方法　2018年9-12月对北京某社区年龄>40岁的6 055例居民进行横断面调查研究，对所有受访者进行SAF检测、临床病史采集、体格检查、血液学检测及颈动脉B超检查。根据B超结果是否存在颈动脉粥样硬化斑块分为颈动脉粥样硬化斑块组和无颈动脉粥样硬化斑块组。以颈动脉粥样硬化斑块为因变量，以标准化性别、年龄、BMI、吸烟、糖尿病、高血压、脂代谢紊乱、高尿酸血症、慢性肾功能不全等传统心脑血管病变危险因素及SAF为自变量进行Logistic回归分析，探讨SAF对颈动脉粥样硬化斑块的影响。结果　6 055例调查对象B超提示存在颈动脉粥样硬化斑块者2 953例，无颈动脉粥样硬化斑块者3 102例。颈动脉粥样硬化斑块组SAF测量值为77.2（70.8，85.1） AU，明显高于无颈动脉粥样硬化斑块组SAF测量值73.4（68.0，80.1）AU （P<0.001）。Logistic回归分析结果显示，SAF是颈动脉粥样硬化斑块的影响因素〔OR=1.006，95%CI（1.000，1.012），P=0.043〕。以SAF值的第25、50、75百分位值69.2、75.1、82.4 AU为界，分为SAF低、中、高、明显升高4组，SAF明显升高组颈动脉粥样硬化斑块风险是SAF低值组的1.200倍〔OR=1.200，95%CI（1.012，1.423），P=0.036〕。亚组分析显示，校正传统心血管危险因素后，年龄<60岁人群中SAF明显升高组颈动脉粥样硬化斑块风险是SAF低值组的1.751倍〔OR=1.751，95%CI（1.270，2.415），P=0.001〕；吸烟人群中SAF明显升高组颈动脉粥样硬化斑块风险是SAF低值组的1.903倍〔OR=1.903，95%CI（1.297，2.792），P=0.001〕。结论　SAF与颈动脉粥样硬化斑块独立相关，在<60岁人群及吸烟人群中SAF明显升高者相比SAF低值者与颈动脉粥样硬化斑块相关性更明显。

Relationship between Skin Autofluorescence Value and Carotid Artery Atherosclerotic Plaque Disease

Background　Carotid atherosclerotic plaque is an important risk factor for cardiovascular and cerebrovascular diseases. Ultrasound is often used to evaluate carotid atherosclerotic plaque，but ultrasonic examination has relative high requirements on equipment，operator's ability and fund. Skin autofluorescence（SAF），a simple，rapid and non-invasive method，has a predictive value for cerebrovascular events and death. So we discussed the relationship between SAF value and carotid atherosclerotic plaque. Objective　To discuss the relationship between SAF value and carotid atherosclerotic plaque in community-dwelling Chinese populations. Methods　6 055 eligible residents aged over 40 in a Beijing community were invited to conduct a cross-sectional study from September 2018 to December 2018. SAF test，clinical history collection，physical examination，hematology test and carotid B-ultrasonography examination were performed in all subjects. According to the results of B-ultrasonography，the subjects were divided into carotid lesion group and non-carotid lesion group. With carotid lesion as dependent variable，and traditional risk factors of cardiovascular and cerebrovascular diseases such as standardized gender，age，BMI，smoking，diabetes，hypertension，dyslipidemia，hyperuricemia，chronic renal insufficiency and SAF as independent variables，Logistic regression analysis was performed to explore the relationship between SAF value and carotid atherosclerotic plaque. Results　Carotid lesion group（n=2 953） had much higher SAF value than non-carotid lesion group（n=3 102）〔77.2（70.8，85.1） AU vs 73.4（68.0，80.1） AU〕（P<0.001）. Binary Logistic regression analysis showed that SAF value was associated with the risk of carotid artery disease〔OR=1.006，95%CI（1.000，1.012），P=0.043〕. Analysis of subgroups stratified by quartiles of SAF value〔low（less than 69.2 AU），intermediate（greater than 69.2 but less than 75.1 AU），high（greater than 75.1 but less than 82.4 AU），very high（greater than 82.4 AU）〕 revealed that the risk of carotid artery lesion in very high SAF subgroup increased by a factor of 1.200〔OR=1.200，95%CI（1.012，1.423），P=0.036〕 compared with that of low SAF subgroup. Further analysis found that in people younger than 60 years，the risk of carotid artery disease in very high SAF subgroup was 1.751 times higher than that in low SAF subgroup〔OR=1.751，95%CI（1.270，2.415），P=0.001〕；in smokers，the risk of carotid artery disease in very high SAF subgroup was 1.903 times higher than that in low SAF subgroup〔OR=1.903，95%CI（1.297，2.792），P=0.001〕. Conclusion　SAF is independently associated with carotid atherosclerotic plaque. Significantly increased SAF is more significantly correlated with carotid artery lesions than low SAF in people under 60 years old or smokers.