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

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。

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

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.