颈动脉血管重构与斑块稳定性关系的研究  

Relation between carotid remodeling and plaque stability

作　　者：崔豹[1] 马露[1] 曾源 李依霞 韩旭[1] 蔡幼铨[1] 蔡剑鸣[1] 

机构地区：[1]解放军总医院放射诊断科,北京100853 [2]解放军第三〇六医院干部病房

出　　处：《中华老年心脑血管病杂志》2015年第4期375-378,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金："十二五"全军科研计划(CWS11J065)

摘　　要：目的应用高分辨率磁共振成像技术,探讨颈动脉重构指数（CRI）与动脉粥样硬化斑块组织学特性及临床因素的相关性。方法入选至少一侧颈动脉含有1.5 mm以上厚度动脉粥样硬化斑块的高血压患者46例（共74支）,分为有症状组25例和无症状组21例。明确患者症状及是否服用血管紧张素转换酶抑制剂等可能与血管重构相关的临床因素。双盲评价影像资料,采用相关与回归分析CRI与斑块内容物、纤维帽状态、标准化管壁指数及临床因素的关系。结果有症状患者CRI明显高于无症状者（2.38±0.75 vs 2.04±0.60,P=0.038）,CRI与管壁标准化指数呈正相关（r=0.47,P〈0.01）。斑块纤维帽破裂与完整-厚比较,CRI越高纤维帽破裂概率越高（OR=4.63,95%CI：1.41~15.20,P〈0.05）。多因素回归分析显示,高血压患者CRI主要由管壁标准化指数和服用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂情况决定。结论高血压患者颈动脉血管重构与斑块稳定性有相关性。磁共振成像监测CRI或许可以预测纤维帽破裂及缺血性脑卒中发生风险。Objective To study the relation of CRI with plaque tissue characteristics and clinical factors by high resolution MRI.Methods Forty-six hypertension patients（74carotid plaques）with their carotid plaque≥1.5mm were divided into symptomatic group（n=25）and asymptomatic group（n=21）.Their symptoms and vascular remodeling-related clinical factors such administration of angiotensin converting anzyme inhibitors were investigated.Radiological data were evaluated by blind review.Relation of CRI with carotid plaque compositions,fibrous cap,normal wall index and clinical data was analyzed by correlation analysis and regression analysis,respectively.Results The CRI was significantly higher in symptomatic group than in asymptomatic group（2.38±0.75 vs 2.04±0.60,P=0.038）and was positively related with the normal wall index（r=0.47,P〈0.01）.The higher the CRI was,the easier the fibrous cap was ruptured,when the ruptured plaque fibrous cap was compared with the intact-thick fibrous cap（OR=4.63,95%CI：1.41-15.20,P〈0.05）.Multivariate regression analysis showed that the CRI was dependent on the normal wall index and administration of angiotensin converting anzyme inhibitors in hypertension patients.Conclusion Carotid remodeling is related with plaque stability in hypertension patients.MRI monitoring of CRI may predict the risk of fibrous cap rupture and ischemic stroke.

关 键 词：颈动脉疾病 动脉粥样硬化 高血压 血管紧张素转换酶抑制药 磁共振血管造影术 

分 类 号：R544.1[医药卫生—心血管疾病]