Early Identification Of Carotid Artery Vulnerable Plaque In Asymptomatic Patients And Analysis Of Influencing Factors Of Arteriosclerotic Plaque Formation And Stability

Objective:To explore the influencing factors of plaque formation and stability in patients with asymptomatic carotid atherosclerotic plaques,so as to identify vulnerable atherosclerotic plaque early and find high-risk population of cardiovascular and cerebrovascular events,conducting clinical intervention as early as possible to reduce relevant diseases mortality and disability.Methods:A total of 302 asymptomatic patients with carotid atherosclerotic plaques were selected from our physical examination center.The patients were divided into 3 groups based on the results of carotid color Doppler ultrasound:Vulnerable plaque(UP)group,146 cases,atherosclerotic stable plaque(SP)group,106 cases,and another 50 cases without plaque during the same period as the control group,comparing the general conditions and lifestyle differences of the 3 groups of patients and serological indicators,the univariate analysis and multivariate Logistic regression were used to analyze the related influencing factors of plaque formation and stability in patients with asymptomatic carotid atherosclerosis.The ROC curve was used to analyze the efficacy of independent and combined serum markers in the diagnosis of vulnerable plaques,and the predictive efficacy of the three diagnostic methods including plaque score,10-year ICVD,and serum markers were compared.Results:1.Univariate analysis:Age,gender,smoking,hypertension,diabetes,high density lipoprotein cholesterol(HDL-C),Matrix metalloproteinases-9(MMP-9),Lectin-like oxidized low-denisty lipoprotein receptor-1(LOX-1),Human cartilage glycoprotein-39(YKL-40)and Pregnancy-associated plasma protein-A(PAPP-A)in plaque group and free group,the differences were statistically significant(P<0.05),and there was statistically significant difference between the two groups(P<0.05)for the 10-year risk of ischemic cardiovascular disease(ICVD).There were significant differences in smoking,diabetes mellitus,HDL-C,LDL-C,carotid plaque score(CPS),MMP-9,LOX-1,YKL-40,PAPP-A and ICVD in 10 years between stable plaque group and unstable plaque group(P<0.05).2.Logistic multivariate regression analysis:Hypertension,diabetes,high PAPP-A,and YKL-40 are risk factors for plaque formation,and women are protective factors for plaque formation(Sex:OR=0.339,P=0.03 7;Hypertension:OR=0.277,P=0.001;Diabetes:OR=0.320,P=0.027;PAPP-A:OR=2.679,P=0.000;YKL-40:OR=1.009,P=0.020).Diabetes,high LDL-C,CPS,MMP-9,LOX-1,YKL-40 are risk factors for unstable plaque formation,and high HDL-C is a protective factor for unstable plaque formation(HDL-C:OR=0.208,P=0.005;Diabetes:OR=0.419,P=0.014;LDL-C:OR=1.820,P=0.010;Plaque score:OR=1.334,P=0.006;MMP-9:OR=1.015,P=0.000;LOX-1:OR=1.008,P=0.009;YKL-40:OR=1.007,P=0.013).3.Analysis of ROC curves of serum markers MMP-9,LOX-1 and YKL-40:The area under the curve(AUC)for the diagnosis of vulnerable plaques by MMP-9 is 0.847(95%CI:0.791?0.903),the sensitivity is 88.36%,the specificity is 70.75%,the positive predictive value is 80.63%,and the diagnostic accuracy is 80.95%;the AUC of LOX-1 for vulnerable plaques is 0.630(95%CI:0.560?0.700),the sensitivity is 85.62%,the specificity is 24.53%,the positive predictive value is 60.98%,and the diagnostic accuracy rate is 59.925%;the AUC for YKL-40 diagnosis of vulnerable plaque is 0.646(95%CI:0.576?0.716),the sensitivity is 81.51%,the specificity is 25.47%,the positive predictive value is 60.10%,and the diagnostic accuracy rate is 57.94%.The AUC of the three factors combined to diagnose vulnerable plaque is 0.850(95%CI:0.795?0.905),the sensitivity is 87.67%,the specificity is 81.13%,the positive predictive value was 86.49%,and the diagnostic accuracy rate was 84.92%,which is significantly better than individual diagnostic efficacy of 3 factors.4.ROC curve analysis of CPS,10-year ICVD and serum markers in the diagnosis of vulnerable plaques:CPS diagnostic accuracy is 61.90%(95%CI:0.586?0.721,P=0.000),10-year ICVD diagnostic accuracy is 56.75%(95%CI:0.52?0.661,P=0.014)and the diagnostic accuracy of serum markers is 84.92%(95%CI:0.795?0.905,P=0.000).Conclusion:1.CPS,MMP-9,LOX-1,YKL-40,diabetes mellitus and LDL-C are independent risk factors for the formation of unstable plaque,while high HDL-C is a protective factor for the formation of unstable plaque.2.The sensitivity and accuracy of the three serum markers including MMP-9,LOX-1 and YKL-40 in the diagnosis of vulnerable plaque are significantly better than the individual diagnostic efficacy of other three factors.3.Serum markers are superior to plaque score and 10-year ICVD in predicting potential ASCCVD patients.We can combine cervical vascular ultrasound and serum markers to accurately screen high-risk groups of cardiovascular and cerebrovascular diseases.