2010-2021 年颈动脉内膜切除术患者中不稳定颈动脉斑块特征增加

Tetiana Motsak, Barend M. Mol, Joost Hoekstra, Gerard Pasterkamp, Gert J. de Borst, Dominique De Kleijn
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摘要

背景:过去几十年来,人们一直在研究颈动脉斑块特征与既往症状和未来心血管事件的关系。我们的研究表明,2002-2011年间颈动脉粥样硬化斑块切除术患者的不稳定斑块特征正在减少。然而,过去十年中斑块组成随时间发生的变化尚未得到研究。在本研究中,我们调查了过去十年颈动脉内膜切除术患者颈动脉斑块的特征。研究方法分析了2010年至2021年期间纳入Athero-Express生物库的1,362名颈动脉内膜切除术患者的动脉粥样硬化斑块,以研究组织学斑块特征在2年时间间隔内的时间依赖性变化。这些结果与我们之前在 2002-2011 年间获得的斑块组成随时间变化的数据进行了比较。结果:与2002-2011年期间易损斑块特征减少相反,2010-2021年期间易损斑块特征显著增加:大脂核、斑块内出血、巨噬细胞和钙化。当调整与这些斑块特征相关的混杂因素(如手术时间和术前症状)后,钙化每增加 2 年的调整后几率比为 1,177 (95% 置信区间,1,070-1,293;p<;0,001),斑块内出血为1,352(95% 置信区间,1,229-1,487;p<0,000),由>40% 脂肪组成的斑块为1,277(95% 置信区间,1,159-1,407;p<0,000),巨噬细胞为1,388(95% 置信区间,1,262-1,528;p<0,000)。结论:我们的研究表明,尽管西欧心血管死亡率总体下降,但2010-2021年与斑块易损性相关的斑块特征有所增加。关键词斑块易损性 动脉粥样硬化 颈动脉内膜切除术 时间依赖性变化
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Unstable carotid plaque characteristics increase between 2010-2021 in carotid endarterectomy patients
Background: Over the past decades, carotid plaque characteristics have been studied in association with previous symptoms and future cardiovascular events. We showed that destabilizing atherosclerotic plaque characteristics in carotid atherectomy patients between 2002 -2011 were decreasing. Time-dependent changes in plaque composition in the last decade, however, have not been studied. In this study, we investigate carotid plaque characteristics in carotid endarterectomy patients over the last decade. Methods: Atherosclerotic plaques from 1,362 carotid endarterectomy patients included in the Athero-Express biobank between 2010 and 2021 were analyzed to examine time dependent changes in histological plaque characteristics in intervals of 2 years. These results were compared with our previous time dependent plaque composition data between 2002-2011. Results: In contrast to the period 2002-2011 where vulnerable plaque characteristics were decreasing, the period 2010-2021 showed significant increase in vulnerable plaque characteristics: large lipid cores, intraplaque hemorrhage, macrophages, and calcification. When adjusted for confounders related to these plaque characteristics, such as time to operation and pre-operative symptoms, the adjusted odds ratios per 2 years increase in time were 1,177 (95% confidence interval, 1,070-1,293; p<0,001) for calcification, 1,352 (95% confidence interval, 1,229-1,487; p<0,000) for intraplaque hemorrhage, 1,277 (95% confidence interval, 1,159-1,407; p<0,000) for plaques consisting of >40% of fat and 1,388 (95% confidence interval, 1,262-1,528; p<0,000) for macrophages. Conclusion: Our study shows an increase in plaque characteristics associated with plaque vulnerability in 2010-2021 despite an overall decrease in cardiovascular mortality in Western Europe. Keywords: Plaque vulnerability, Atherosclerosis, Carotid endarterectomy, Time dependent changes
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