颈动脉斑块成分和HDL-C水平对症状性颈动脉狭窄的影响

doi:10.13481/j.1671-587X.20260221

摘要/Abstract

摘要：

目的分析颈动脉内膜剥脱术（CEA）患者颈动脉斑块成分的差异，结合高密度脂蛋白胆固醇（HDL-C）水平，探讨症状性颈动脉狭窄（CAS）发生的影响因素。方法选取本院130例CEA患者作为研究对象，根据剥脱前6个月内是否发生缺血性卒中（IS）或短暂性脑缺血发作（TIA）将患者分为症状性CAS组和无症状性CAS组。收集 2 组患者的性别、年龄和既往病史，测定患者外周血中同型半胱氨酸、糖化血红蛋白、高灵敏度C反应蛋白（hs-CRP）、维生素B₁₂、尿酸、空腹血糖、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和HDL-C水平。采用HE染色评估CAS患者颈动脉斑块指标，天狼星红染色评估CAS患者颈动脉斑块中Ⅲ型胶原/Ⅰ型胶原比值。比较2组患者基线资料的差异，采用多因素Logistic回归模型分析症状性CAS的影响因素，绘制受试者工作特征（ROC）曲线，并计算ROC曲线下面积（AUC）以评价影响因素的预测效能。结果研究共纳入130例患者，其中症状性CAS组60例，无症状性CAS组70例。2组患者的吸烟史、颈动脉斑块纤维帽完整性、白细胞数、新生血管数和Ⅲ型胶原/Ⅰ型胶原比值及HDL-C和空腹血糖水平差异有统计学意义（P<0.05）。多因素Logistic回归分析，颈动脉斑块纤维帽不完整、高白细胞数和高Ⅲ型胶原/Ⅰ型胶原比值均为症状性CAS的独立危险因素，高HDL-C水平为症状性CAS的独立保护因素，上述4个因素对于症状性CAS均具有一定的预测价值（AUC>0.6）。结论颈动脉斑块纤维帽不完整、高白细胞数和高Ⅲ型胶原/Ⅰ型胶原比值是症状性CAS的危险因素，高HDL-C水平是其保护因素，这4个因素可作为症状性CAS的独立预测因子。

关键词: 斑块, 症状性颈动脉狭窄, 纤维帽, 炎症, 胶原, 高密度脂蛋白胆固醇

Abstract:

Objective To analyze the differences in carotid plaque composition in the patients who underwent carotid endarterectomy （CEA）， and to explore the influencing factors for symptomatic carotid artery stenosis （CAS） in combination with high-density lipoprotein cholesterol （HDL-C） levels. Methods A total of 130 CEA patients in our hospital were selected as the subjects. The patients were divided into symptomatic CAS group and asymptomatic CAS group based on whether they experienced ischemic stroke （IS） or transient ischemic attack （TIA） within 6 months before CEA. The gender， age， and medical history of the patients in two groups were collected. The levels of homocysteine， glycated hemoglobin， high-sensitivity C-reactive protein （hs-CRP）， vitamin B₁₂， uric acid， fasting blood glucose， total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， and HDL-C in peripheral blood of the patients were measured. HE staining was used to evaluate the indexes of carotid artery plaque in the CAS patients； Sirius red staining was used to evaluate the collagen Ⅲ/collagen Ⅰ ratio in carotid artery plaques of the CAS patients. The differences in baseline data between two groups were compared； multivariate Logistic regression model was used to analyze the influencing factors for symptomatic CAS； receiver operating characteristic （ROC） curves were plotted， and the area under the ROC curve （AUC） was calculated to evaluate the predictive efficacy of the influencing factors. Results A total of 130 patients were included in the study， with 60 cases in symptomatic CAS group and 70 cases in asymptomatic CAS group. There were statistically significant differences between two groups in smoking history， fibrous cap integrity， white blood cell count， neovascularization count， collagen Ⅲ/collagen Ⅰ ratio， HDL-C level， and fasting blood glucose level （P<0.05）. The multivariate Logistic regression analysis results showed that incomplete fibrous cap of carotid plaque， high white blood cell count， and high collagen Ⅲ/collagen Ⅰ ratio were the independent risk factors for symptomatic CAS， while high HDL-C level was an independent protective factor for symptomatic CAS. These four factors showed certain predictive value for symptomatic CAS （AUC>0.6）. Conclusion Incomplete fibrous cap of carotid plaque， high white blood cell count， and high collagen Ⅲ/collagen Ⅰ ratio are the risk factors for symptomatic CAS， while high HDL-C level is a protective factor. These four factors can serve as the independent predictors for symptomatic CAS.

Key words: Plaque, Symptomatic carotid artery stenosis, Fibrous cap, Inflammation, Collagen, High-density lipoprotein cholesterol

中图分类号:

R743.1

白丽杨,马迪,黄朔,王川,梁嘉欣,王天,崔柳萍,赵灵敏,谢美珍,姚梦月,陈盈,王丽娟. 颈动脉斑块成分和HDL-C水平对症状性颈动脉狭窄的影响[J]. 吉林大学学报(医学版), 2026, 52(2): 491-498.

Liyang BAI,Di MA,Shuo HUANG,Chuan WANG,Jiaxin LIANG,Tian WANG,Liuping CUI,Lingmin ZHAO,Meizhen XIE,Mengyue YAO,Ying CHEN,Lijuan WANG. Effect of carotid plaque composition and HDL-C levels on symptomatic carotid artery stenosis[J]. Journal of Jilin University(Medicine Edition), 2026, 52(2): 491-498.

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参考文献 29

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Variable	Asymptomatic CAS group (n=70）	Symptomatic CAS group (n=60)	χ2/Z	P
Gender（n/%）
Male	52(74.3)	52(86.7)	3.095	0.079
Female	18(25.7)	8(13.3)	3.095	0.079
Alcohol consumption (n/%)	24(34.3)	26(43.3)	1.117	0.290
Smoking (n/%)	28(40.0)	38(63.3)	7.038	0.008
Heart disease (n/%)	14(20.0)	6(10.0)	2.482	0.115
Stroke (n/%)	20(28.6)	14(23.3)	0.459	0.498
Hypertension (n/%)	45(64.3)	29(48.3)	3.353	0.067
Diabetes (n/%)	20(28.6)	22(36.7)	0.968	0.325
Age [M（P25,P75）, year]	68.0(64.0，70.0)	66.5(62.0，69.0)	-0.853	0.394
TC [M（P25,P75）, mmol·L^-1]	3.60(3.09，4.27)	3.49(3.14，3.82)	-1.635	0.102
TG [M（P25,P75）, mmol·L^-1]	1.22(0.87，1.68)	1.34(0.91，1.65)	0.308	0.758
LDL-C [M（P25,P75）, mmol·L^-1]	2.09(1.79，2.63)	2.09(1.82，2.32)	-0.888	0.375
HDL-C [M（P25,P75）, mmol·L^-1]	0.98(0.84，1.15)	0.87(0.77，1.03)	-2.495	0.013
Homocysteine [M（P25,P75）, μmol·L^-1]	12.44(9.46，16.48)	11.48(10.40，15.41)	-0.112	0.911
HbA1c [M（P25,P75）, %]	6.10(5.80，6.40)	6.15(5.80，7.90)	0.964	0.335
Hs-CRP [M（P25,P75）, ng?L^-1]	2.32(1.47，4.69)	2.74(1.52，4.85)	-0.420	0.674
Vitamin B₁₂ [M（P25,P75）, pmol·L^-1]	285(237，433)	294(200，437)	-0.673	0.501
Uric acid [M（P25,P75）, μmol·L^-1]	324.0(275.0，398.0)	342.5(283.0，393.0)	0.738	0.461
Fasting blood glucose [M（P25,P75）, mmol·L^-1]	5.23(4.90，5.97)	5.92(5.11，7.56)	2.681	0.007

Variable	Asymptomatic CAS group (n=70）	Symptomatic CAS group (n=60)	χ2/Z	P
Incomplete fibrous cap integrity(n/%)	36(51.4)	54(90.0)	22.564	<0.001
Hemorrhage (n/%)	48(68.6)	46(76.7)	1.057	0.304
Calcification (n/%)	40(57.1)	30(50.0)	0.663	0.415
White blood cell count [M（P25,P75）]	45.00(20.00，84.67)	93.84(54.13，131.37）	-4.467	<0.001
Neovascularization count [M（P25,P75）]	0.40(0.20，1.20)	0.80(0.40，1.65)	-2.936	0.003
Collagen Ⅲ/collagen Ⅰ ratio [M（P25,P75）]	2.47(1.02，4.83)	5.50(3.36，11.63)	-4.189	<0.001

Variable	Assignment
Fibrous cap integrity	Complete fibrous cap=0，Incomplete fibrous cap=1
White blood cell count	<28.90=1，28.90-49.30=2，49.30-83.55=3，>83.55=4
Collagen Ⅲ/collagen Ⅰ ratio	<1.83=1，1.83-3.80=2，3.80-8.28=3，>8.23=4
HDL-C level	Continuous variable（0.63-1.92 mmol·L^-1）

Factor	β	SE	Wald χ²	OR	95%CI		P
Factor	β	SE	Wald χ²	OR	Lower limit	Upper limit	P
Model 1
Fibrous cap integrity	1.699	0.577	8.681	5.467	1.766	16.926	0.003
White blood cell count	0.796	0.218	13.336	2.216	1.446	3.396	<0.001
Collagen Ⅲ/collagen Ⅰ ratio	0.507	0.228	4.939	1.660	1.062	2.595	0.026
HDL-C level	-1.894	0.829	5.223	0.150	0.030	0.764	0.022
Model 2
Fibrous cap integrity	1.627	0.602	7.305	5.089	1.564	16.562	0.007
White blood cell count	0.890	0.252	12.505	2.435	1.487	3.987	<0.001
Collagen Ⅲ/collagen Ⅰ ratio	0.593	0.244	5.878	1.809	1.120	2.920	0.015
HDL-C level	-2.399	1.096	4.792	0.091	0.011	0.778	0.029