McNally J S, Burton T M, Aldred B W, Kim S-E, McLaughlin M S, Eisenmenger L B, Stoddard G J, Majersik J J, Miller D V, Treiman G S, Parker D L
From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
Department of Neurology (T.M.B., J.J.M.).
AJNR Am J Neuroradiol. 2016 Nov;37(11):2092-2099. doi: 10.3174/ajnr.A4849. Epub 2016 Jun 16.
MR imaging-detected carotid intraplaque hemorrhage indicates vulnerable plaque with high stroke risk. Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. Our purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage in humans.
In this cross-sectional study, 65 patients with carotid disease underwent carotid MR imaging and blood draw. Systemic clinical confounders and local lumen imaging markers were recorded. To determine the association of low vitamin D levels with MR imaging detected intraplaque hemorrhage, we performed multivariable Poisson regression by using generalized estimating equations to account for up to 2 carotid arteries per patient and backward elimination of confounders. MR imaging detected intraplaque hemorrhage volume was also correlated with vitamin D levels and maximum plaque thickness. Thirty-five patients underwent carotid endarterectomy, and histology-detected intraplaque hemorrhage was correlated with vitamin D levels and total plaque area.
Low vitamin D levels (<30 ng/mL, prevalence ratio = 2.05, = .03) were a significant predictor of MR imaging detected intraplaque hemorrhage, along with plaque thickness (prevalence ratio = 1.40, < .001). MR imaging detected intraplaque hemorrhage volume linearly correlated with plaque thickness (partial = 0.45, < .001) and low vitamin D levels (partial = 0.26, = .003). Additionally, histology-detected intraplaque hemorrhage area linearly correlated with plaque area (partial = 0.46, < .001) and low vitamin D levels (partial = 0.22, = .03). The association of intraplaque hemorrhage volume with low vitamin D levels was also higher with ischemic stroke.
Low vitamin D levels and plaque thickness predict carotid intraplaque hemorrhage and outperform lumen markers of vulnerable plaque. This research demonstrates a significant link between low vitamin D levels and carotid intraplaque hemorrhage.
磁共振成像检测到的颈动脉斑块内出血提示斑块易损，卒中风险高。血管紧张素II在动物模型中可刺激斑块内出血，而维生素D对血管紧张素系统具有高度调节作用。我们的目的是确定低维生素D水平是否可预测人类颈动脉斑块内出血。
在这项横断面研究中，65例颈动脉疾病患者接受了颈动脉磁共振成像检查及血液采集。记录全身临床混杂因素和局部管腔成像标记物。为确定低维生素D水平与磁共振成像检测到的斑块内出血之间的关联，我们使用广义估计方程进行多变量泊松回归，以考虑每位患者最多2条颈动脉的情况，并对混杂因素进行向后消除。磁共振成像检测到的斑块内出血体积也与维生素D水平及最大斑块厚度相关。35例患者接受了颈动脉内膜切除术，组织学检测到的斑块内出血与维生素D水平及总斑块面积相关。
低维生素D水平（<30 ng/mL，患病率比 = 2.05，P = .03）是磁共振成像检测到斑块内出血的显著预测因素，同时还有斑块厚度（患病率比 = 1.40，P < .001）。磁共振成像检测到的斑块内出血体积与斑块厚度呈线性相关（偏相关系数 = 0.45，P < .001）以及与低维生素D水平呈线性相关（偏相关系数 = 0.26，P = .003）。此外，组织学检测到的斑块内出血面积与斑块面积呈线性相关（偏相关系数 = .46，P < .001）以及与低维生素D水平呈线性相关（偏相关系数 = 0.22，P = .03）。斑块内出血体积与低维生素D水平的关联在缺血性卒中患者中也更高。
低维生素D水平和斑块厚度可预测颈动脉斑块内出血，且优于易损斑块的管腔标记物。本研究证明了低维生素D水平与颈动脉斑块内出血之间存在显著关联。
