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

Abstract

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

CLC Number:

R743.1

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.

Figures/Tables 5

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References 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

Effect of carotid plaque composition and HDL-C levels on symptomatic carotid artery stenosis

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