弗明汉危险评分在无症状老年人颈动脉易损斑块筛查中的价值研究

目的 探讨弗明汉危险评分（Framingham risk score，FRS）在无症状老年人（≥60岁）颈动脉易损斑块筛查中的价值。方法 根据颈动脉粥样硬化斑块的3D MR管壁成像特征，将受试者分为有易损斑块组和无易损斑块组，计算每位受试者的FRS并比较两组之间FRS的差异。采用单因素Logistic回归，计算FRS在判别颈动脉易损斑块时的OR 和95%CI。采用ROC曲线分析FRS对颈动脉易损斑块的判别能力，并确定合适的截断值。结果 共纳入134例受试者，平均年龄72.3±5.5岁，男性62例（46.3%），17例（12.7%）有颈动脉易损斑块。有易损斑块组的FRS高于无易损斑块组[37.8%（27.4%～60.0%）vs 16.6%（8.9%～27.4%），P =0.002]。在判别颈动脉易损斑块时，FRS每升高10%对应的OR =1.556（95%CI 1.204～2.011，P =0.001），ROC曲线下面积为0.732，当截断值FRS=20%时，敏感度和特异度分别为76.5%、59.8%。结论 FRS可用于初步筛查无症状老年人有无颈动脉易损斑块，当FRS>20%时，需对颈动脉易损斑块进行影像学检查及评估。

The Value of Framingham Risk Score for Screening Carotid Vulnerable Atherosclerotic Plaques in the Asymptomatic Elderly

Objective To investigate the value of Framingham risk score (FRS) in screening carotid vulnerable
atherosclerotic plaques in the asymptomatic elderly (≥60 years old).
Methods FRS of every subject was calculated and the MR imaging characteristics of carotid
atherosclerotic plaques on 3D MR vessel wall imaging were evaluated. All patients were divided
into vulnerable plaque group and non-vulnerable plaque group based on the imaging results. FRS
was compared between the two groups. Univariate logistic regression was used to calculate the OR
and 95%CI of FRS in determining carotid vulnerable plaques. The area under the curve (AUC) of
receiver operating characteristic (ROC) was used to evaluate the ability of FRS in assessing carotid
vulnerable plaques and determine the appropriate cut-off value.
Results A total of 134 subjects were included in this study, with a mean age of 72.3±5.5 years old
and 62 males (46.3%). 17 cases (12.7%) had carotid vulnerable plaques. The FRS in vulnerable
plaques group was significantly higher than that in non-vulnerable plaques group [37.8% (27.4%-
60.0%) vs 16.6% (8.9%-27.4%), P =0.002]. In determining carotid vulnerable plaques, the OR of
FRS per an increase of 10% was 1.556 (95%CI 1.204-2.011, P =0.001). ROC curve analysis showed
that the AUC of FRS in determining the carotid vulnerable plaques was 0.732, and the appropriate
cut-off value of FRS was 20%, with the sensitivity of 76.5% and specificity of 59.8%.
Conclusions FRS can be preliminarily used to screen carotid vulnerable plaques. An advancedimaging examination is needed to evaluate carotid vulnerable plaques for the asymptomatic elderly
when FRS is higher than 20%.