Objective: To investigate the correlation between perivascular fat density (PFD) and plaque stability in patients with carotid artery stenosis. Methods: Clinical data of 110 patients with carotid artery stenosis treated at Drum Tower Hospital, Nanjing University Medical School from January 2018 to December 2022 were retrospectively collected. Based on pathological results of carotid plaque specimens obtained from carotid endarterectomy (CEA), patients were categorized into stable plaque group (n=51) and vulnerable plaque group (n=59). All patients underwent preoperative carotid CT angiography (CTA) to measure PFD at the narrowest carotid artery. Preoperative levels of interleukin-6 (IL-6) and other hematological parameters were collected. Multivariable logistic regression analysis was used to identify factors associated with plaque stability in carotid artery stenosis patients. Area under the curve (AUC) of receiver operating characteristic (ROC) was performed to evaluate the predictive value of PFD for plaque stability. Results: The stable plaque group consisted of 43 males and 8 females with a mean age of (67.6±9.0) years, while the vulnerable plaque group comprised 48 males and 11 females with a mean age of (69.3±9.0) years. The proportions of smokers were 31.4% (16/51) and 50.8% (30/59) in the stable and vulnerable plaque groups, respectively. The proportions of patients with diabetes were 33.3% (17/51) and 52.5% (31/59), respectively. IL-6 levels were 3.46(2.67, 5.34) and 4.51(3.62, 5.51) ng/L in the stable and vulnerable groups, respectively. Mean PFD values were (-69.04±5.35) and (-63.24±6.08) HU, respectively, with maximum PFD values of (-62.90±6.98) and (-56.93±5.90) HU, respectively. The differences were statistically significant (all P<0.05). Multivariable logistic regression analysis showed that increased mean PFD (OR=1.167, 95%CI: 1.029-1.324, P=0.016) and elevated IL-6 levels (OR=1.489, 95%CI: 1.151-1.926, P=0.002) were associated with vulnerability of carotid artery plaques. ROC curve analysis results showed that a cut-off value of -65.5 HU, the AUC for predicting plaque stability based on the mean PFD was 0.756 (95%CI: 0.667-0.844, P<0.001), with sensitivity of 64.4% and specificity of 74.5%. Conclusion: Increased mean PFD at the narrowest carotid artery is associated with vulnerability of plaques in patients with carotid artery stenosis.
目的： 探讨颈动脉血管周围脂肪密度（PFD）与颈动脉狭窄患者斑块稳定性的相关性。 方法： 回顾性收集2018年1月至2022年12月南京大学医学院附属鼓楼医院110例颈动脉狭窄患者的临床资料。根据颈动脉内膜剥脱术（CEA）所取颈动脉斑块标本的病理结果，将患者分为斑块稳定组（n=51）和斑块易损组（n=59）。所有患者术前均接受颈动脉CT血管造影（CTA）检查，测量颈动脉最狭窄处PFD。收集患者术前白细胞介素-6（IL-6）等血液学指标的水平。采用多因素logistic回归分析颈动脉狭窄患者斑块稳定性的相关因素。采用受试者工作特征（ROC）曲线下面积（AUC）分析PFD对颈动脉斑块稳定性的预测价值。 结果： 斑块稳定组男43例，女8例，年龄（67.6±9.0）岁；斑块易损组男48例，女11例，年龄（69.3±9.0）岁。斑块稳定组和易损组吸烟史比例分别为31.4%（16/51）、50.8%（30/59），糖尿病病史比例分别为33.3%（17/51）、52.5%（31/59），IL-6水平［M（Q1，Q3）］分别为3.46（2.67，5.34）、4.51（3.62，5.51）ng/L，PFD均值分别为（-69.04±5.35）、（-63.24±6.08）HU，PFD最大值分别为（-62.90±6.98）、（-56.93±5.90）HU，差异均有统计学意义（均P<0.05）。多因素logistic回归分析结果显示，PFD均值增加（OR=1.167，95%CI：1.029~1.324，P=0.016）和IL-6水平升高（OR=1.489，95%CI：1.151~1.926，P=0.002）是颈动脉斑块易损的相关因素。ROC曲线分析结果显示，在cut-off值为-65.5 HU时，PFD均值预测斑块稳定性的AUC为0.756（95%CI：0.667~0.844，P<0.001），灵敏度为64.4%，特异度为74.5%。 结论： 颈动脉最狭窄处PFD均值增加是颈动脉狭窄患者斑块易损的相关因素。.