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1 [ ] (AIS) AIS 630 AIS (247 ) (93 ) (248 ) 3 logistic AIS 57.99% 50.95% 42.18% 33.81% AIS (P<0.05) (P<0.05) logistic (OR= %CI 1.027~1.061 P=0.000) (OR= %CI 1.377~2.828 P=0.000) (OR= %CI 1.004~2.106 P=0.047) (OR= %CI 1.002~1.020 P=0.016) AIS AIS AIS [ ] [ ] R743.3 [ ] A [ ] (2016) [DOI] /j.issn Clinical distribution characteristics and analysis on risk factors of carotid vulnerable plaque in patients with acute ischemic stroke LI Jing, TIAN Ting, SHI Zheng-hong *, FENG Bin, ZHAO Li-li Department of Neurology, Second Hospital of Lanzhou University, Lanzhou , China * Corresponding author, lzuszh@163.com This work was supported by the Science and Technology Planning Program of Lanzhou ( ) [Abstract] Objective To analyze the distribution characteristics of carotid plaque, and explore the risk factors for carotid vulnerable plaque in patients with acute ischemic stroke (AIS). Methods The clinical data were collected from 588 patients with AIS and 630 patients without AIS matched in gender and age admitted to the Department of Neurology, Second Hospital of Lanzhou University from Mar to Feb The distribution characteristics of carotid plaque between the two groups were analyzed. All AIS patients were classified as non-plaque group (n=247), stable plaque group (n=93) and vulnerable plaque group (n=248) according to the carotid ultrasonography results. The clinical data were compared among the different three groups, and multivariate logistic regression analysis was performed to identify the independent risk factors for carotid vulnerable plaque in AIS patients. Results The detection rates of carotid plaque in AIS group and control group were 57.99% and 50.95%, and the detection rates of vulnerable plaque in the two groups were 42.18% and 33.81%, respectively; the detection rates of both carotid plaque and vulnerable plaque were statistically higher in AIS group than in control group (P<0.05). The age, gender, history of hypertension, diabetes and the level of systolic blood pressure among the three groups showed statistically significant differences (P<0.05); the multivariate logistic regression analysis revealed that age (OR=1.043, 95%CI , P=0.000), male gender (OR=1.973, 95%CI , P=0.000), diabetes (OR=1.454, 95%CI , P=0.047) and systolic blood pressure (OR=1.011, 95%CI , P=0.016) were the independent risk factors for carotid vulnerable plaque in patients with AIS. Conclusions The embolism accompanied by carotid vulnerable plaque rupture or abscission may lead to the occurrence of AIS; the age, gender, diabetes and systolic blood pressure [ ] ( ) [ ] [ ] ( ) [ ] lzuszh@163.com

2 Med J Chin PLA, Vol. 41, No. 9, September 1, are the independent risk factors for carotid vulnerable plaque in patients with AIS. [Key words] stroke; plaque, atherosclerotic; risk factors; carotid ultrasonography [1] (atherosclerosis AS) [2] 30% [3] (intima-media thickness IMT) 0.1mm 18% [4] [5] [6-9] [10-13] [14] (acute ischemic stroke AIS) AIS AIS AIS ±11.4(35~93) [15] CT MRI 7d 10d ±10.6(35~97) CT MRI AIS (P>0.05 1) h 24h CT MRI C (BMI) BMI= (kg)/ (m) mmHg ( ) 90mmHg 7.00mmol/L 2h 11.10mmol/L 5.72mmol/L ( ) 1.70mmol/L 1979 [16] CT (CTA) 10 /d >1 30g/d > Philips IU22 5~12MHz 2 IMT IMT<1.0mm 1.0mm IMT 1.5mm IMT>1.5mm IMT 0.5mm 50% [17]

3 >20% 1.3 SPSS 19.0 Kolmogorov-Smirnov x±s t LSD-t Games-Howell M(P 25 P 75 ) χ 2 logistic P< AIS 588 AIS 341 (57.99%) 248 (42.18%) (50.95%) 213 (33.81%) (χ 2 =9.253 P=0.010) AIS (χ 2 =6.077 P=0.014 χ 2 =9.052 P=0.003) ( 1) 2.2 AIS (P<0.05) (P<0.05) (P<0.05) (P<0.05) ( 2) 1 AIS Tab.1 Baseline data and carotid plaque distribution characteristics of patients in AIS and control group Item AIS group (n=588) Control group (n=630) P value Age (year) 65.3± ± Male [n(%)] 357(60.71) 360(57.14) Plaque detection results [n(%)] Plaque 341(57.99) 321(50.95) Non-plaque 247(42.01) 309(49.05) Plaque stability [n(%)] Stable plaque 93(15.81) 108(17.14) Vulnerable plaque 248(42.18) 213(33.81) AIS Tab. 2 Comparison of clinical data among different carotid plaque groups of AIS patients Item Non-plaque (n=247) Stable plaque (n=93) Vulnerable plaque (n=248) P Value Age (year) 61.0(51.0, 70.0) 70.0(63.5, 76.0) (1) 70.0(61.0, 76.0) (1) Male [n(%)] 138(55.87) 50(53.76) 169(68.15) (1)(2) Hypertension [n(%)] 176(71.26) 75(80.65) 200(80.65) (1) Diabetes [n(%)] 61(24.70) 27(29.03) 87(35.08) (1) Hyperlipidemia [n(%)] 63(25.51) 22(23.66) 61(24.60) CHD [n(%)] 13(5.26) 4(4.30) 21(8.47) AF [n(%)] 17(6.88) 5(5.38) 14(5.65) Smoking [n(%)] 37(14.98) 21(22.58) 43(17.34) Drinking [n(%)] 28(11.34) 14(15.05) 30(12.10) SBP (mmhg) ± ±18.23 (1) ±19.87 (1) DBP (mmhg) 81.05± ± ± FBG (mmol/l) 4.97(4.41, 5.93) 5.00(4.53, 5.94) 5.32(4.56, 6.23) TC (mmol/l) 3.89(3.31, 4.31) 3.97(3.30, 4.57) 3.90(3.29, 4.52) TG (mmol/l) 1.33(1.01, 1.65) 1.22(0.92, 1.64) 1.34(0.99, 1.69) HDL-C (mmol/l) 1.12(0.91, 1.30) 1.13(0.96, 1.47) 1.09(0.90, 1.27) (2) LDL-C (mmol/l) 2.41(1.82, 2.90) 2.40(1.83, 2.88) 2.41(1.95, 3.03) BMI (kg/m 2 ) 22.00(20.00, 23.00) 22.00(20.00, 23.50) 22.00(20.00, 24.00) Hcy ( mol/l) 20.00(14.00, 23.00) 20.00(14.00, 23.00) 21.00(15.00, 24.00) (1) FIB (g/l) 3.05(3.04, 3.10) 3.05(3.04, 3.12) 3.05(3.04, 3.12) CRP (mg/l) 16.52(11.74, 20.68) 15.84(12.85, 24.00) 17.49(12.85, 25.00) Leukocyte ( 10 9 /L) 6.49(5.19, 7.40) 6.21(5.08, 7.24) 6.53(5.47, 7.33) CHD. Coronary heart disease; AF. Atrial fibrillation; SBP. Systolic blood pressure; DBP. Diastolic blood pressure; FBG. Fasting blood glucose; TC. Total cholesterol; TG. Triglyceride; HDL-C. High density lipoprotein cholesterol; LDL-C. Low density lipoprotein cholesterol; BMI. Body mass index; Hcy. Homocysteine; FIB. Fibrinogen; CRP. C-reactive protein. (1)P<0.05 compared with non-plaque; (2)P<0.05 compared with stable plaque

4 Med J Chin PLA, Vol. 41, No. 9, September 1, AIS logistic AIS (0= 1= ) 2 logistic AIS (OR= %CI 1.027~1.061 P=0.000) (OR= %CI 1.377~2.828 P=0.000) (OR= %CI 1.004~2.106 P=0.047) (OR= %CI 1.002~1.020 P=0.016) AIS ( 3) 3 AIS logistic Tab. 3 Logistic regression analysis of risk factors for carotid vulnerable plaque in AIS patients Variables SE OR 95% CI P value Age Male Diabetes SBP SBP. Systolic blood pressure 3 [18-19] 15% [20] AIS 58.0% 42.2% Howard [6] [7,21] AIS AIS logistic AIS AIS Rubinat [22] [23] van Lammeren [10] 1385 [11,24-25] AIS AIS % [26] [27-28] [8,12,29-30] IMT [31] Izzo [32] /3 Marfella [9]

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6 Med J Chin PLA, Vol. 41, No. 9, September 1, outcomes in acute coronary syndromes[ J]. JACC Cardiovasc Imaging, 2012, 5(3 Suppl): S62-S72. [25] Vrijenhoek JE, Den Ruijter HM, De Borst GJ, et al. Sex is associated with the presence of atherosclerotic plaque hemorrhage and modifies the relation between plaque hemorrhage and cardiovascular outcome[ J]. Stroke, 2013, 44(12): [26] Li L, Yu H, Zhu J, et al. The combination of carotid and lower extremity ultrasonography increases the detection of atherosclerosis in type 2 diabetes patients[ J]. J Diabetes Complications, 2012, 26(1): [27] Kuroda M, Shinke T, Sakaguchi K, et al. Effect of daily glucose fluctuation on coronary plaque vulnerability in patients pretreated with lipid-lowering therapy: a prospective observational study[ J]. JACC Cardiovasc Interv, 2015, 8(6): [28] Park YM, Han SH, Seo JG, et al. The role of insulin resistance and metabolic risk factors on culprit coronary plaque[ J]. Int J Cardiol, 2015, 190: [29] Olson FJ, Strömberg S, Hjelmgren O, et al. Increased vascularization of shoulder regions of carotid atherosclerotic plaques from patients with diabetes[ J]. J Vasc Surg, 2011, 54(5): [30] Edsfeldt A, Goncalves I, Grufman H, et al. Impaired fibrous repair: a possible contributor to atherosclerotic plaque vulnerability in patientswith type II diabetes[ J]. Arterioscler Thromb Vasc Biol, 2014, 34(9): [31] Hong H, Wang H, Liao H. Prehypertension is associated with increased carotid atherosclerotic plaque in the community population of Southern China[ J]. BMC Cardiovasc Disord, 2013, 13: 20. [32] Izzo R, Stabile E, Esposito G, et al. Development of new atherosclerotic plaque in hypertensive patients: an observational registry study from the Campania-Salute network[ J]. J Hypertens, 2015, 33(12): [33] Iwata S, Jin Z, Schwartz JE, et al. Relationship between ambulatory blood presure and aortic arch atherosclerosis[ J]. Atherosclerosis, 2012, 221(2): ( ) ( )

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Supplemental tables and figures

Supplemental tables and figures Supplemental Table S1. Demographic and clinical parameters by quartiles of white Variables blood cell count. WBC quartiles( 1 9 cells/l) Q1(.6-5.3, n=2587) Q2(5.4-6.3, n=263)