Cholesterol Crystals are Associated with Carotid Plaque Vulnerability: An Optical Coherence Tomography Study
Cholesterol Crystals are Associated with Carotid Plaque Vulnerability: An Optical Coherence Tomography Study
复制标题
胆固醇晶体与颈动脉斑块脆弱性相关：光学相干断层扫描研究。
DOI：
10.1016/j.jstrokecerebrovasdis.2019.104579
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发表时间：
2020-02-01
影响因子：
2.5
通讯作者：
Liu, Xinfeng
中科院分区：
文献类型：
--
作者：
Shi, Xuan;Cai, Haodi;Liu, Xinfeng
目的：易损性颈动脉斑块与脑血管事件相关。胆固醇结晶常见于动脉粥样硬化斑块中。然而，胆固醇晶体在颈动脉斑块失稳中的潜在作用尚不清楚。我们的目标是确定胆固醇晶体和颈动脉斑块易损性之间的联系。方法：对95例颈动脉斑块患者进行光相干断层扫描。观察患者的临床特征和斑块形态。用多因素Logistic回归分析有无胆固醇结晶患者在斑块特征(血栓、钙化、新生血管和巨噬细胞聚集)和临床参数(年龄、症状、冠心病、总胆固醇、甘油三酯和C反应蛋白)方面的差异。结果：66例颈动脉粥样硬化患者中，16例有胆固醇结晶，50例无胆固醇结晶。有胆固醇结晶者56.3%(9/16)出现与同侧颈内动脉有关的脑血管缺血症状，而无胆固醇结晶者仅26.0%(13/50)有脑血管缺血症状(OR=3.66；95%CI，1.13~11.82；P=0.025)。有胆固醇结晶的斑块中，75.0%伴有巨噬细胞聚集(OR，4.14；95%CI，1.17~14.65；P=0.04)。在有胆固醇结晶的节段中，与没有胆固醇晶体的节段相比，钙化的发生率更高(62.5%比32.0%，P=0.03)。有胆固醇结晶和钙化的斑块70.0%为症状性斑块(OR，6.38；95%CI，1.46~27.91；P=0.01)。斑块破裂和胆固醇结晶之间没有联系。多因素Logistic回归分析显示年龄和巨噬细胞积聚与胆固醇结晶独立相关。结论：伴有胆固醇结晶的颈动脉粥样硬化斑块更容易伴有巨噬细胞和钙化堆积。有胆固醇结晶斑块的患者出现更多的脑血管症状。因此，胆固醇晶体，特别是与巨噬细胞和钙化一起，可能是古老的颈动脉斑块的重要组成部分。
Objective: Vulnerable carotid plaque is associated with cerebrovascular events. Cholesterol crystals are often seen in the atherosclerotic plaques. However, the potential role of cholesterol crystals in carotid plaques destabilization is unknown. We aimed to identify the association between cholesterol crystals and carotid plaque vulnerability. Methods: Optical coherence tomography assessment of carotid plaque was performed in 95 patients. Clinical characteristics and plaque morphology were examined. The differences in plaque characteristics (thrombus, calcification, neovascularization, and macrophage accumulations) and clinical parameters (age, symptom, coronary heart disease, total cholesterol, triglycerides, and C-reactive protein) between patients with or without cholesterol crystals were analyzed with multivariate logistic regression. Results: Among 66 patients with acceptable carotid atherosclerotic optical coherence tomography images, 16 were with and 50 were without cholesterol crystals. 56.3% patients (9 of 16) with cholesterol crystals had cerebrovascular ischemic symptom related to ipsilateral internal carotid artery, whereas only 26.0% patients (13 of 50) without cholesterol crystals had symptom (OR, 3.66; 95% CI, 1.13-11.82; P =.025). 75.0% of the plaques with cholesterol crystals had concomitant macrophage accumulation (OR, 4.14; 95% CI, 1.17-14.65; P =.04). In segments with cholesterol crystals, a higher presence of calcification could be demonstrated compared to those without cholesterol crystals (62.5% versus 32.0%, P =.03). 70.0% plaques with cholesterol crystals and calcification were classified as symptomatic plaques (OR, 6.38; 95% CI, 1.46-27.91; P =.01). No association between plaque rupture and cholesterol crystals was identified. Multivariate logistic regression showed that age and macrophage accumulation were independently associated with cholesterol crystals. Conclusions: Carotid atherosclerotic plaques with cholesterol crystals were more likely to have concomitant macrophage and calcification accumulations. Patients with cholesterol crystals plaque experienced more cerebrovascular symptoms. Thus, cholesterol crystals, especially together with macrophage and calcification, may serve as an important component of venerable carotid plaques.