低剂量CT血管成像一站式评价心脑动脉斑块易损性及其早期预警价值的研究

Cardiovascular and cerebrovascular disease is the leading cause of death in China, and the incidence is rising year by year. The risk model of Framingham risk score is now in large controversial, hence more accurate models is urgent. The traditional imaging method can only evaluate the degree of arterial stenosis, while atherosclerotic vulnerable plaque is the main cause of acute event of cardiovascular and cerebrovascular disease. Our previous study found that low doses of CT cardiovascular imaging not only can evaluated the degree of arterial stenosis, but also can detected the characteristics of plaque which can judge atherosclerotic plaque vulnerability. We hypotheses that cardiovascular imaging using low dose of CT at the early stage of cardiovascular imaging in high risk population, can estimate plaque vulnerability, combined with inflammatory molecular markers of cardiovascular and cerebrovascular disease, can effectively predict the occurrence of cardiovascular and cerebrovascular disease. This study will be carried out in a prospective cohort, aims to detect artery stenosis and plaque characteristics using one-step low dose CT cardiovascular imaging, to follow-up the incidence of adverse events of cardiovascular and cerebrovascular disease, to predict the risk of cardiovascular events with the combination of the vulnerable plaque and inflammatory markers. The predication model using both the plaques characters and inflammatory markers are expected to further improve the prediction ability of cardiovascular and cerebrovascular disease in risk population, and provide the basis for early intervention and reduction of the burdens of cardiovascular and cerebrovascular disease .

心脑血管疾病是我国首要死因，且发病率逐年上升。Framingham风险预测模型备受争议，迫切需要更为准确的预警模型。传统影像学方法仅能评估动脉狭窄程度，而动脉粥样易损斑块才是引起心脑血管疾病急性事件的主要原因。我们前期研究发现低剂量CT心脑血管成像不仅可确定动脉狭窄程度，还可通过观察粥样硬化斑块特征来判定斑块易损性。本研究假设在发病早期以低剂量CT心脑血管成像估计斑块易损性,结合炎症分子标志物，可有效预测心脑血管疾病的发生。本研究拟在前瞻性队列人群中，采用低剂量CT心脑血管成像同时检测动脉狭窄及粥样斑块特征，随访队列人群心脑血管疾病不良事件的发生率，探索易损斑块与炎症标志物结合预测心脑血管不良事件中的价值。本研究通过低剂量CT一站式心脑血管成像早期识别易损斑块，结合炎症标志物建立心脑血管疾病发病风险的预警模型，有望进一步提高其早期预测能力，为早期干预、降低心脑血管疾病事件的发生提供依据。

项目背景：冠状动脉粥样硬化与颈动脉、脑动脉粥样硬化密切相关，全面准确地评价心脑血管动脉粥样硬化的程度及其关系，早期干预、降低心脑血管事件的发生具有重要的临床意义。主要研究内容：本研究前瞻性入选2008例病例建立研究队列，开发一种CT心脑血管一体化成像早期识别易损斑块技术，评价其图像质量和准确，评估心脑血管斑块负荷危险因素，随访队列人群心脑血管不良事件的发生率，结合分子生物学建立心脑血管疾病发病风险的预警模型；开发心脑血管易损斑块生物标记物检测芯片，阐明心脑血管易损斑块破裂分子机制，为早期干预和降低心脑血管病不良事件发生提供依据。课题共分四部分：1.CT心脑血管一体化成像的关键技术图像质量评价和准确性研究；2.CT心脑血管一体化成像斑块负荷的危险因素分析；3.血浆长链非编RNA HLA复合体11组（lncRNA HCG11）在心脑血管斑块易损性中的分子机制；4.CT心脑血管一体化成像评价斑块易损性预警模型的建立和评价。重要结果：1.本项目开发出CT心脑血管一体化成像的关键技术。2.CT心脑血管一体化成像评价冠状动脉狭窄和脑血管狭窄的准确性高。3.冠状动脉斑块和头颈部动脉斑块的发生有相关性，不同部位的各类型斑块的危险因素不同。4.血浆长链非编RNA HCG11在在HG诱导的内皮细胞损伤机制中起着重要作用。5.易损斑块是主要心血管不良事件的独立危险因素，对心脑血管疾病早期预警具有重要价值。本研究提供一种易损斑块的简单无创的早期筛检工具，为早期预防和降低心脑血管不良事件的发生提供依据。