颈动脉斑块硬度的定量比较与组织病理学发现：一项观察性研究。
Quantitative comparison between carotid plaque hardness and histopathological findings: an observational study.
机构信息
Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan.
Department of Pathology, Toho University Omori Medical Center, Tokyo, Japan.
出版信息
Diagn Pathol. 2022 Jul 11;17(1):58. doi: 10.1186/s13000-022-01239-y.
BACKGROUND
Plaque hardness in carotid artery stenosis correlates with cerebral infarction. This study aimed to quantitatively compare plaque hardness with histopathological findings and identify the pathological factors involved in plaque hardness.
METHODS
This study included 84 patients (89 lesions) undergoing carotid endarterectomy (CEA) at our institution. Plaque hardness was quantitatively measured immediately after excision using a hardness meter. Collagen and calcification were evaluated as the pathological factors. Collagen was stained with Elastica van Gieson stain, converted to a gray-scale image, and displayed in a 256-step histogram. The median gray-scale median (GSM) was used as the collagen content. The degree of calcification was defined by the hematoxylin-eosin stain as follows: "0:" no calcification, "1:" scattered microcalcification, or "2:" calcification greater than 1 mm or more than 2% of the total calcification. Carotid echocardiographic findings, specifically echoluminance or the brightness of the narrowest lesion of the plaque, classified as hypo-, iso-, or hyper-echoic by comparison with the intima-media complex surrounding the plaque, and clinical data were reviewed.
RESULTS
Plaque hardness was significantly negatively correlated with GSM [Spearman's correlation coefficient: -0.7137 (p < 0.0001)]: the harder the plaque, the higher the collagen content. There were significant differences between plaque hardness and degree of calcification between "0" and "2" (p = 0.0206). For plaque hardness and echoluminance (hypo-iso-hyper), significant differences were found between hypo-iso (p = 0.0220), hypo-hyper (p = 0.0006), and iso-hyper (p = 0.0015): the harder the plaque, the higher the luminance. In single regression analysis, GSM, sex, and diabetes mellitus were significant variables, and in multiple regression analysis, only GSM was extracted as a significant variable.
CONCLUSIONS
Plaque hardness was associated with a higher amount of collagen, which is the main component of the fibrous cap. Greater plaque hardness was associated with increased plaque stability. The degree of calcification may also be associated with plaque hardness.
背景
颈动脉狭窄斑块的硬度与脑梗死相关。本研究旨在定量比较斑块硬度与组织病理学发现，并确定与斑块硬度相关的病理因素。
方法
本研究纳入了在我院行颈动脉内膜切除术（CEA）的 84 例患者（89 处病变）。在切除后立即使用硬度计定量测量斑块硬度。胶原蛋白和钙化被评估为病理因素。胶原蛋白用弹力纤维 Van Gieson 染色染色，转换为灰度图像，并以 256 步灰度直方图显示。灰度中值（GSM）被用作胶原蛋白含量。钙化程度通过苏木精-伊红染色定义如下：“0”：无钙化，“1”：散在微钙化，或“2”：钙化大于 1 毫米或占总钙化的 2%以上。回顾颈动脉超声心动图结果，特别是斑块最狭窄处的回声亮度或明亮度，与斑块周围的内-中膜复合体相比较，分为低回声、等回声或高回声。并回顾临床数据。
结果
斑块硬度与 GSM 显著负相关（Spearman 相关系数：-0.7137（p<0.0001））：斑块越硬，胶原蛋白含量越高。斑块硬度和钙化程度在“0”和“2”之间有显著差异（p=0.0206）。对于斑块硬度和回声亮度（低-等-高），在低-等（p=0.0220）、低-高（p=0.0006）和等-高（p=0.0015）之间存在显著差异：斑块越硬，亮度越高。在单回归分析中，GSM、性别和糖尿病是显著变量，在多回归分析中，只有 GSM 被提取为显著变量。
结论
斑块硬度与更多的胶原蛋白相关，胶原蛋白是纤维帽的主要成分。斑块硬度越大，斑块稳定性越高。钙化程度也可能与斑块硬度相关。
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