老年高血压患者颈动脉易损斑块与近期缺血性脑卒中的相关性  

Correlation between carotid vulnerable plaque and recent ischemic stroke in elderly hypertensive patients

作　　者：崔豹[1] 马露[1] 曾源[2] 韩旭[1] 李雪梅[3] 蔡剑鸣[1] 

机构地区：[1]解放军总医院放射诊断科,北京100853 [2]解放军306医院干部病房 [3]解放军总医院门诊部干部诊疗科,北京100853

出　　处：《中华老年心脑血管病杂志》2013年第12期1245-1248,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金："十二五"全军科研计划面上项目(CWS11J065)

摘　　要：目的应用高分辨率磁共振成像技术，探讨老年高血压患者颈动脉粥样硬化易损斑块发生与近期缺血性脑卒中之间的相关性。方法选择连续符合纳入标准的73例患者，分为有症状组44例和无症状组29例，双盲评价影像资料，分析2组斑块成分（宽块内出血、脂质坏死核、纤维帽较薄／破裂）及管腔狭窄程度与30d内发生缺血性脑卒中的相关性。结果与无症状组比较，有症状组患者纤维帽较薄／破裂发生率高，差异有统计学意义（P=0．001）。斑块纤维帽稳定性预测30d内临床症状稳定性的敏感性、特异性和准确率分别为79．5％、65．5％和74．0％，纤维帽较薄／破裂患者发生缺血性脑卒中的危险性是纤维帽完整较厚者的7．39倍，OR值7．39，95％CI：2．69～20．3（P〈0．001）。2组斑块内出血、脂质坏死核及管腔狭窄程度比较，差异无统计学意义（P〉0．05）。结论老年高血压患者颈动脉斑块纤维帽较薄／破裂与30d内发生缺血性脑卒中具有显著相关性，可以作为预测近期临床症状稳定性的影像学指标。Objective To study the correlation between carotid vulnerable plaque and recent ische- mic stroke in elderly hypertensive patients using high-resolution MRI. Methods Seventy-three hypertensive patients were divided into symptomatic group （n= 44） and asymptomatic group （n= 29）. Their imaging data were evaluated by double blind test. Correlation between plaque compo- nents （intraplaque hemorrhage,lipid-rich necrotic core, thin or ruptured fibrous cap, carotid artery luminal stenosis） and ischemic stroke within 30 days was analyzed by high-resolution MRI. Results The incidence of thin or ruptured cap was significantly higher in symptomatic group than in asymptomatic group （P = 0. 001）. The sensitivity, specificity and accuracy of high-resolution MRI were 79.5% ,65.5% and 74.0% respectively. The risk to develop ischemic stroke was 7.39- fold higher in patients with thin or ruptured fibrous cap than in those with intact-thick fibrous cap （OR= 7. 39,95%CI： 2.69-20. 3, P〈0. 001）. No significant difference was observed in intra- plaque hemorrhage, lipid-rich necrotic core, carotid artery luminal stenosis between the two groups （P〉0.05）. Conclusion Thin or ruptured fibrous cap is significantly correlated with ischemic stroke within 30 days in elderly hypertensive patients, and can thus be used as an imaging marker for their clinical symptoms.

关 键 词：高血压 颈动脉狭窄 磁共振成像 动脉粥样硬化 卒中 

分 类 号：R544.1[医药卫生—心血管疾病]