Analysis Of Risk Factors Of Vulnerable Carotid Plaque

Background:At present,with society’s ageing progression,the incidence of stroke is increasing and patients are getting younger and younger.Stroke is the main cause of death in China.Research shows that 50% of strokes were caused by the shedding of atherosclerotic plaques in the internal carotid artery.The evaluation of the carotid artery which is a window reflecting the blood vessels of the whole body,is one of the important methods to evaluate the cerebral vessels.The natures of carotid plaque determine the risk level of stroke and the reasonable use of lipid-lowering drugs.Poor stability of carotid plaques is the key factor leading to stroke.We named this unstable plaque "vulnerable plaque".Clinically,we usually use carotid artery ultrasound to judge the stability of plaque and predict the risk of plaque shedding.However,this method is relatively lacking diversity,and greatly influenced by the subjectivity of the examining physician,furthermore the evaluation results are limited.Therefore,it is of great significance to further search for the factors that affect the stability of plaque for the prevention and treatment of stroke.Purpose:In this experiment,the vulnerability of carotid atherosclerotic plaques was analyzed,and the related risk factors were discussed,so as to achieve early diagnosis and treatment,reduce the incidence of cerebrovascular diseases and reduce the risk of recurrence.Method:With retrospective research method,The basic information of 574 patients such as age,sex,smoking history,drinking history,past history(hypertension,diabetes),laboratory data(total cholesterol,triglyceride,High density lipoprotein HDL),Low density lipoprotein LDL),apolipoprotein b(apo lipoprotein b),C-reactive protein CRP,Homocysteine HCY),serum calcium ion,fasting blood glucose,glycated hemoglobin,white blood cells,D dimer)and ultrasonographic examination.The carotid artery plaque properties were evaluated by ultrasound.According to the carotid artery ultrasound results were divided into two groups: non-plaque group(normal IMT,thickened IMT)and plaque group,and then plaque group was divided into two subgroups: vulnerable plaque group(mixed echo plaque,hypoecho plaque)and stable plaque group(hyperecho plaque).Through the comparison of these four groups of data,the independent risk factors of vulnerable carotid plaque were discussed.All the inspection results are completed by qualified ultrasound and laboratory doctors in our hospital.The data was analyzed by SPSS24.0.The differences between groups were analyzed by T-test,Chi-square test and nonparametric test.The correlation between indicators with statistical significance and vulnerable plaques was analyzed by Pearson correlation analysis.Logistic regression method was used to analyze whether there were independent risk factors.All statistical results were statistically significant with P<0.05.Results:By analyzing the indexes of 574 patients with carotid artery color Doppler ultrasound,the results are as follows:1.There is a correlation between the plaque group and the non-plaque group in sex ratio,age,diabetes,hypertension,smoking history and drinking history,which has statistical significance(P < 0.05).2.Correlation of blood lipids: CHOL,TG,LDL,HDL and apo B in the plaque group were higher than those in the non-plaque group,there were statistically differences in CHOL(u=6889.0,P < 0.05),TG(u=6287.5,P < 0.05)and LDL(U = 67588)between two groups.There was no significant difference in HDL(u=6684.5,P>0.05)between the same two groups.When comparing the vulnerable plaque group to the stable plaque group,CHOL,TG,LDL and apo B were higher in the vulnerable plaque group,while HDL was lower in the vulnerable plaque group.There were statistically differences in levels of CHOL(u=4898.0,P < 0.05),LDL(u=4920.5,P < 0.05)and APOB(U = 440.05),but no significant difference in TG(u=4706.0,P>0.05)and HDL(u=3776.0,P>0.05)between the vulnerable plaque group and the stable plaque group.3.C-reactive protein correlation: CRP in the plaque group was higher than the non-plaque group,and the CRP of patients in different groups was statistically significant(U = 8003.5,P < 0.05).Comparing the vulnerable plaque group and the stable plaque group,the CRP of the vulnerable plaque group was higher than that of the stable plaque group,and there was significant difference between the two groups(U =3868.5,P < 0.05).4.The correlation of homocysteine(HCY): HCY in the plaque group was higher when comparing to the non-plaque group,and the difference of Hcy between the two was statistically significant(U = 9025.0,P < 0.05).When comparing HCY in the vulnerable plaque group to the stable plaque group,the vulnerable plaque group was higher(U = 4345.0,P < 0.05),and the difference between hte two groups was statistically significant.5.Correlation of blood glucose.Fasting blood glucose in the plaque group is higher compar to that in the non-plaque group,the difference of fasting blood glucose between the two groups is statistically significant(u=8291.5,P < 0.05).When comparing thethe vulnerable plaque group to the stable plaque group,fasting blood glucose in the vulnerable plaque group was higher,but no significant difference(u=4753.0,P>0.05)between the two groups.The glycosylated hemoglobin in the plaque group was higher than that in the non-plaque group,the differencebetween the two groups was statistically significant(u=8928.0,P < 0.05).When comparing to the the vulnerable plaque group and the stable plaque group,the glycosylated hemoglobin in the vulnerable plaque group is higher,and the difference of glycosylated hemoglobin between the two groups was statistically significant(u=4486.0,P < 0.05).6.Correlation of white blood cell counts(WBC).WBC in the plaque group was higher when comparing to the non-plaque group,the difference was statistically significant(u=8433.0,P < 0.05).WBC in the vulnerable plaque group were higher when comparing to the stable plaque group,and there was no significant difference between the two groups(u=4359.0,P>0.05).7.Correlation of calcium ions.the calcium ion in the plaque group was higher compare to the non-plaque group,the difference between the two groups was statistically significant(u=6832.0,P < 0.05).calcium ion in the vulnerable plaque group was higher when comparing to that in the stable plaque group,there was no significant difference between the two groups of patients(u=4394.0,P>0.05).8.D-dimer correlation: D-dimer in the plaque group was higher when comparing to the non-plaque group,the difference was statistically significant(u=8493.0,P < 0.05).D-dimer in vulnerable plaque group was lower compar to that in the stable plaque group(u=3867.0,P>0.05),there was no significant difference between the two groups.9.Through Pearson correlation analysis,the correlation coefficient between LDL level and vulnerable plaque was r=0.724,P<0.05,which indicates that LDL level was positively correlated to the vulnerable plaque.The correlation coefficient between apo B level and vulnerable plaque is r=0.922,P<0.05,which indicates that apo B level was positively correlated with vulnerable plaque.The correlation coefficient between Hcy level and vulnerable plaque was r=0.936,P<0.05,which indicates that Hcy level was positively correlated with vulnerable plaque.The correlation coefficient between glycosylated hemoglobin level and vulnerable plaque was r=0.131,P<0.05,which indicates that glycosylated hemoglobin level was positively correlated with vulnerable plaque.The correlation coefficient between CHOL level and vulnerable plaque is r=0.741,P<0.05,which indicates that CHOL level is positively correlated with vulnerable plaque.The correlation coefficient between CRP level and vulnerable plaque is r=0.831,P<0.05,which indicates that CRP level is positively correlated with vulnerable plaque.And the correlation Hcy>apo B>CRP > CHOL>LDL > glycosylated hemoglobin.10.Using presence of vulnerable plaque as dependent variable,using CHOL,TG,HDL,LDL,apo B,Hcy,CRP,serum calcium,fasting blood glucose,glycosylated hemoglobin,white blood cell couonts and D dimer as independent variables,through regression analysis,the results showed that LDL(OR value was1.581,95%CI was 0.563-4.439,P 95%CI was 0.532-2.216,P<0.05),apo B(OR was 1.564,95%CI was0.499-4.898,P<0.05),Hb A1c(OR was 1.313,95%CI was 0.690-2.497)were the independent risk factors of vulnerable plaque,CHOL,TG,HDL,CRP,Calcium ions,fasting blood glucose,WCC,D-dimer were not the independent risk factors of vulnerable plaque.Conclusion:LDL,apo B,HCY and Hb A1 c are independent risk factors of vulnerable plaque in the internal carotid artery,which can be used as a reference index to predict plaque stability and intervention of vascular plaque formation.