740 2016 9 1 41 9 [ ] (AIS) 2014 3 2015 2 588 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=1.043 95%CI 1.027~1.061 P=0.000) (OR=1.973 95%CI 1.377~2.828 P=0.000) (OR=1.454 95%CI 1.004~2.106 P=0.047) (OR=1.011 95%CI 1.002~1.020 P=0.016) AIS AIS AIS [ ] [ ] R743.3 [ ] A [ ] 0577-7402(2016)09-0740-06 [DOI] 10.11855/j.issn.0577-7402.2016.09.08 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 730000, China * Corresponding author, E-mail: lzuszh@163.com This work was supported by the Science and Technology Planning Program of Lanzhou (2011-1-134) [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. 2014 to Feb. 2015. 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 1.027-1.061, P=0.000), male gender (OR=1.973, 95%CI 1.377-2.828, P=0.000), diabetes (OR=1.454, 95%CI 1.004-2.106, P=0.047) and systolic blood pressure (OR=1.011, 95%CI 1.002-1.020, 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 [ ] (2011-1-134) [ ] [ ] 730000 ( ) [ ] E-mail lzuszh@163.com
Med J Chin PLA, Vol. 41, No. 9, September 1, 2016 741 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 1 1.1 2014 3 2015 2 AIS 588 357 231 65.3±11.4(35~93) [15] CT MRI 7d 10d 3 630 360 270 65.2±10.6(35~97) CT MRI AIS (P>0.05 1) 1.2 1.2.1 4h 24h CT MRI C (BMI) BMI= (kg)/ (m) 2 1.2.2 2 140mmHg ( ) 90mmHg 7.00mmol/L 2h 11.10mmol/L 5.72mmol/L ( ) 1.70mmol/L 1979 [16] CT (CTA) 10 /d >1 30g/d >1 1.2.3 Philips IU22 5~12MHz 2 IMT IMT<1.0mm 1.0mm IMT 1.5mm IMT>1.5mm IMT 0.5mm 50% [17]
742 2016 9 1 41 9 >20% 1.3 SPSS 19.0 Kolmogorov-Smirnov x±s t LSD-t Games-Howell M(P 25 P 75 ) χ 2 logistic P<0.05 2 2.1 AIS 588 AIS 341 (57.99%) 248 (42.18%) 630 321 (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 588 3 247 93 248 3 21 (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±11.4 65.2±10.6 0.815 Male [n(%)] 357(60.71) 360(57.14) 0.206 Plaque detection results [n(%)] 0.014 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) 0.533 Vulnerable plaque 248(42.18) 213(33.81) 0.003 2 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) 0.000 Male [n(%)] 138(55.87) 50(53.76) 169(68.15) (1)(2) 0.007 Hypertension [n(%)] 176(71.26) 75(80.65) 200(80.65) (1) 0.029 Diabetes [n(%)] 61(24.70) 27(29.03) 87(35.08) (1) 0.041 Hyperlipidemia [n(%)] 63(25.51) 22(23.66) 61(24.60) 0.934 CHD [n(%)] 13(5.26) 4(4.30) 21(8.47) 0.228 AF [n(%)] 17(6.88) 5(5.38) 14(5.65) 0.804 Smoking [n(%)] 37(14.98) 21(22.58) 43(17.34) 0.253 Drinking [n(%)] 28(11.34) 14(15.05) 30(12.10) 0.645 SBP (mmhg) 136.53±19.62 141.61±18.23 (1) 143.55±19.87 (1) 0.000 DBP (mmhg) 81.05±11.74 80.52±9.37 81.95±12.08 0.517 FBG (mmol/l) 4.97(4.41, 5.93) 5.00(4.53, 5.94) 5.32(4.56, 6.23) 0.215 TC (mmol/l) 3.89(3.31, 4.31) 3.97(3.30, 4.57) 3.90(3.29, 4.52) 0.309 TG (mmol/l) 1.33(1.01, 1.65) 1.22(0.92, 1.64) 1.34(0.99, 1.69) 0.566 HDL-C (mmol/l) 1.12(0.91, 1.30) 1.13(0.96, 1.47) 1.09(0.90, 1.27) (2) 0.100 LDL-C (mmol/l) 2.41(1.82, 2.90) 2.40(1.83, 2.88) 2.41(1.95, 3.03) 0.422 BMI (kg/m 2 ) 22.00(20.00, 23.00) 22.00(20.00, 23.50) 22.00(20.00, 24.00) 0.269 Hcy ( mol/l) 20.00(14.00, 23.00) 20.00(14.00, 23.00) 21.00(15.00, 24.00) (1) 0.117 FIB (g/l) 3.05(3.04, 3.10) 3.05(3.04, 3.12) 3.05(3.04, 3.12) 0.546 CRP (mg/l) 16.52(11.74, 20.68) 15.84(12.85, 24.00) 17.49(12.85, 25.00) 0.225 Leukocyte ( 10 9 /L) 6.49(5.19, 7.40) 6.21(5.08, 7.24) 6.53(5.47, 7.33) 0.237 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
Med J Chin PLA, Vol. 41, No. 9, September 1, 2016 743 2.3 AIS logistic AIS (0= 1= ) 2 logistic AIS (OR=1.043 95%CI 1.027~1.061 P=0.000) (OR=1.973 95%CI 1.377~2.828 P=0.000) (OR=1.454 95%CI 1.004~2.106 P=0.047) (OR=1.011 95%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 0.043 0.008 1.043 1.027-1.061 0.000 Male 0.680 0.184 1.973 1.377-2.828 0.000 Diabetes 0.374 0.189 1.454 1.004-2.106 0.047 SBP 0.011 0.005 1.011 1.002-1.020 0.016 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 1.973 79.41% [26] [27-28] [8,12,29-30] IMT [31] Izzo [32] 2143 56.6 1/3 Marfella [9]
744 2016 9 1 41 9 [13,33] AIS AIS [1] Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review[ J]. Lancet Neurol, 2009, 8(4): 355-369. [2] Chen Y, Chen YB, Tao RF. A guide to the early treatment of AHA/ASA in patients with acute ischemic stroke[ J]. Chin J Pract Intern Med, 2013, 33(S2): 47-50. [,,. AHA/ASA [J]., 2013, 33(S2): 47-50.] [3] Magge R, Lau BC, Soares BP, et al. Clinical risk factors and CT imaging features of carotid atherosclerotic plaques as predictors of new incident carotid ischemic stroke: a retrospective cohort study[ J]. AJNR Am J Neuroradiol, 2013, 34(2): 402-409. [4] Tsivgoulis G, Vemmos K, Papamichael C, et al. Common carotid artery intima-media thickness and the risk of stroke recurrence[ J]. Stroke, 2006, 37(7): 1913-1916. [5] Martinez-Sanchez P, Alexandrov AV. Ultrasonography of carotid plaque for the prevention of stroke[ J]. Expert Rev Cardiovasc Ther, 2013, 11(10): 1425-1440. [6] Howard DP, van Lammeren GW, Redgrave JN, et al. Histological features of carotid plaque in patients with ocular ischemia versus cerebral events[ J]. Stroke, 2013, 44(3): 734-739. [7] McNally JS, McLaughlin MS, Hinckley PJ, et al. Intraluminal thrombus, intraplaque hemorrhage, plaque thickness, and current smoking optimally predict carotid stroke[ J]. Stroke, 2015, 46(1): 84-90. [8] Scholtes VP, Peeters W, van Lammeren GW, et al. Type 2 diabetes is not associated with an altered plaque phenotype among patients undergoing carotid revascularization. A histological analysis of 1455 carotid plaques[ J]. Atherosclerosis, 2014, 235(2): 418-423. [9] Marfella R, Siniscalchi M, Portoghese M, et al. Morning blood pressure surge as a destabilizing factor of atherosclerotic plaque: role of ubiquitin-proteasome activity[ J]. Hypertension, 2007, 49(4): 784-791. [10] v a n L a m m e r e n G W, R eichmann BL, Moll FL, et al. Atherosclerotic plaque vulnerability as an explanation for the increased risk of stroke in elderly undergoing carotid artery stenting[ J]. Stroke, 2011, 42(9): 2550-2555. [11] Hellings WE, Pasterkamp G, Verhoeven BA, et al. Genderassociated differences in plaque phenotype of patients undergoing carotid endarterectomy[ J]. J Vasc Surg, 2007, 45(2): 289-296. [12] Menegazzo L, Poncina N, Albiero M, et al. Diabetes modifies the relationships among carotid plaque calcification, composition and inflammation[ J]. Atherosclerosis, 2015, 241(2): 533-538. [13] Fusegawa Y, Hashizume H, Okumura T, et al. Hypertensive patients with carotid artery plaque exhibit increased platelet aggregability[ J]. Thromb Res, 2006, 117(6): 615-622. [14] Lee W. General principles of carotid Doppler ultrasonography[ J]. Ultrasonography, 2014, 33(1): 11-17. [15] The Neurology Branch of Chinese Medical Association. The diagnostic points of various cerebrovascular diseases[ J]. Chin J Neurol, 1996, 29(6): 379-380. [. [J]., 1996, 29(6): 379-380.] [16] Xu JM. Nomenclature and criteria for diagnosis of ischemic heart disease--international Society and Association of Cardiology/ Joint recommendation of World Health Organization on clinical nomenclature standardization[ J]. Foreign Med Sci Sect Cardiovusc Dis, 1979, (6): 33. [. / [J]., 1979, (6): 33.] [17] Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006- 2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011[ J]. Cerebrovasc Dis, 2012, 34(4): 290-296. [18] Chen HS, Liu MC. Research progress of collateral circulation in ischemic stroke[ J]. Med J Chin PLA, 2015, 40(6): 427-432. [,. [J]., 2015, 40(6): 427-432.] [19] Wu JH, Sun ZQ, Xing XR. Safety of low molecular heparin calcium combined with antiplatelet agents for acute ischemic stroke[ J]. Med J Chin PLA, 2012, 37(6): 666-667. [,,. [J]., 2012, 37(6): 666-667.] [20] Hermus L, Lefrandt JD, Tio RA, et al. Carotid plaque formation and serum biomarkers[ J]. Atherosclerosis, 2010, 213(1): 21-29. [21] Howard D P, van L am m eren G W, R o t hwel l PM, et al. Symptomatic carotid atherosclerotic disease: correlations between plaque composition and ipsilateral stroke risk[ J]. Stroke, 2015, 46(1): 182-189. [22] Rubinat E, Marsal JR, Vidal T, et al. Subclinical carotid atherosclerosis in asymptomatic subjects with type 2 diabetes mellitus[ J]. J Cardiovasc Nurs, 2016, 31(2): E1-E7. [23] Choi T Y, Li D, Nasir K, et al. Differences in coronary atherosclerotic plaque burden and composition according to increasing age on computed tomography angiography[ J]. Acad Radiol, 2013, 20(2): 202-208. [24] Lansky AJ, Ng VG, Maehara A, et al. Gender and the extent of coronary atherosclerosis, plaque composition, and clinical
Med J Chin PLA, Vol. 41, No. 9, September 1, 2016 745 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): 3318-3323. [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): 23-28. [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): 800-811. [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: 56-62. [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): 1324-1331. [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): 2143-2150. [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): 2471-2476. [33] Iwata S, Jin Z, Schwartz JE, et al. Relationship between ambulatory blood presure and aortic arch atherosclerosis[ J]. Atherosclerosis, 2012, 221(2): 427-431. ( 2016-05-10 2016-07-28) ( )