高血压患者颈动脉粥样硬化斑块形成的危险因素及颈动脉不同狭窄程度下的斑块特性分析-现代医学

高血压患者颈动脉粥样硬化斑块形成的危险因素及颈动脉不同狭窄程度下的斑块特性分析

单位：昆明医科大学第二附属医院超声医学科, 云南昆明 650000

分类号：R445.1

出版年·卷·期（页码）：2025·53·第五期（719-725）

摘要：

目的： 探究高血压患者颈动脉粥样硬化(CAS)斑块形成的危险因素并比较颈动脉不同狭窄程度下的斑块特性，进一步加强高血压患者心脑血管疾病的预防和管理。方法： 回顾性收集2021年1月至2023年12月于昆明医科大学第二附属医院超声医学科行颈动脉超声检查的高血压患者310例，根据超声检查结果分为斑块组(n=188)和无斑块组(n=122)，收集并分析两组患者临床资料及颈动脉超声参数，单因素分析结合Logistic回归分析探究高血压患者CAS斑块形成的危险因素；再将有斑块组分为颈动脉狭窄率<50%组(n=147)和颈动脉狭窄率≥50%组(n=41)，对比两组患者斑块特征。结果： 年龄、糖尿病史、载脂蛋白B(ApoB)是高血压患者CAS斑块形成的危险因素(P<0.05)；颈动脉狭窄率≥50%组双侧颈总动脉内-中膜厚度(IMT)、最大斑块厚度(MPH)更厚，且以多发斑块、低回声及混合回声斑块为主；颈动脉狭窄率<50%组以非多发斑块、等回声及高回声斑块为主，差异有统计学意义(P<0.05)。结论： 年龄、糖尿病史、ApoB是高血压患者CAS斑块形成的危险因素。高血压患者应尽早干预并行颈动脉超声检查明确斑块性质及动脉硬化情况，尽可能避免心脑血管不良事件的发生。

Objective: To investigate the risk factors for carotid atherosclerotic plaque formation in hypertensive patients and to compare plaque characteristics at different degrees of carotid artery stenosis and to further enhance the prevention and management of cardiovascular and cerebrovascular diseases in hypertensive patients. Methods: A retrospective study was conducted on 310 hypertensive patients who underwent carotid ultrasonography at the Department of Ultrasound Medicine, The Second Affiliated Hospital of Kunming Medical University, from January 2021 to December 2023. Based on ultrasound results, the patients were divided into plaque group(n=188) and non-plaque group(n=122). Clinical data and carotid ultrasound parameters were collected and analyzed. Univariate analysis and Logistic regression analysis were used to explore the risk factors. The plaque group was further divided into two subgroups: carotid stenosis<50%(n=147) and carotid stenosis ≥50%(n=41). Plaque characteristics were compared between the two subgroups. Results: Age, history of diabetes, and apolipoprotein B(ApoB) were identified as risk factors for carotid atherosclerotic plaque formation in hypertensive patients(P<0.05). In the carotid stenosis ≥50% group, bilateral common carotid artery intima-media thickness(IMT) and maximum plaque thickness(MPH) were significantly thicker, with a predominance of multiple plaques, hypoechoic, and mixed echogenic plaques. In contrast, the carotid stenosis<50% group had a predominance of single plaques, isoechoic, and hyperechoic plaques, with statistically significant differences(P<0.05). Conclusion: Age, history of diabetes, and ApoB are risk factors for the formation of carotid atherosclerotic plaques in hypertensive patients. Early intervention and carotid ultrasonography should be performed in hypertensive patients to assess plaque properties and arterial sclerosis, thus minimizing the occurrence of cardiovascular and cerebrovascular events.

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