有症状颈动脉狭窄患者颈动脉斑块的稳定性：高分辨率磁共振成像研究  

Carotid plaque stability in patients with symptomatic carotid stenosis： a study of high-resolution magnetic resonance imaging

作　　者：陈蓓蕾 徐俊 叶靖 李晓波 于海龙 姜超 李军 

机构地区：[1]苏北人民医院神经内科,扬州225009

出　　处：《国际脑血管病杂志》2017年第2期127-133,共7页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金（81471215,81271211）;江苏省自然科学基金（BK20151592）;江苏省社会发展重点病种规范化诊疗项目（BE2015715）

摘　　要：目的探讨高分辨率磁共振成像（high-resolution magnetic resonance imaging, HR-MRI）评价有症状颈动脉狭窄患者斑块稳定性的价值以及不稳定斑块和血管重度狭窄的危险因素。方法纳入有症状颈动脉狭窄患者，通过HR-MRI评价有症状颈动脉狭窄患者颈动脉斑块成分判断斑块的稳定性。收集行颈动脉内膜切除术患者的颈动脉斑块进行病理学检查，比较术前HR-MRI与术后病理学检查结果的一致性。收集所有患者的临床资料，分析颈动脉斑块稳定性和血管狭窄程度的危险因素。结果共219例狭窄程度〉50%的有症状颈动脉狭窄患者接受HR-MRI检查。其中102例（46.6%）存在稳定斑块，117例（53.4%）患者存在不稳定斑块；118例（53.9%）中度狭窄，101例（46.1%）重度狭窄。35例患者接受颈动脉内膜切除术，其中19例（54.3%）HR-MRI显示斑块不稳定，20例（57.1%）病理学检查显示斑块不稳定，二者高度一致（κ＝0.942，P〈0.001）。不稳定斑块组男性（P＝0.007）、高脂血症（P＝0.013）、吸烟（P〈0.001）的患者构成比以及总胆固醇（P＝0.001）、低密度脂蛋白胆固醇（P〈0.001）和空腹血糖（P＝0.001）水平显著高于稳定斑块组。多变量logistic回归分析显示，男性[优势比（odds ratio, OR）2.33，95%可信区间（confidence interval, CI）1.08～5.04；P＝0.032]、吸烟（OR 3.45，95% CI 1.67～7.14；P＝0.001）和空腹血糖水平较高（OR 1.26，95% CI 1.07～1.48；P＝0.006）是斑块不稳定的独立危险因素。中度狭窄组与重度狭窄组患者的所有资料均未显示出显著性差异。结论HR-MRI能准确评估有症状颈动脉狭窄患者的斑块稳定性。性别、吸烟和空腹血糖增高是颈动脉不稳定斑块的独立危险因素。ObjectiveTo investigate the value of high-resolution magnetic resonance imaging （HR-MRI） for assessing the plaque stability as well as the risk factors for unstable plaque and severe stenosis in patients with symptomatic carotid stenosis.MethodsThe patients with symptomatic carotid stenosis were enrolled. HR-MRI was use to evaluate carotid plaque compositions and identify the stability of plaques. The carotid plaques from the patients underwent carotid endarterectomy were collected for pathological examination. The consistency of the preoperative HR-MRI and the postoperative pathological findings were compared. The clinical data of all patients were collected and the risk factors for the stability of carotid plaques and the severity of vascular stenosis were analyzed.ResultsA total of 219 patients with symptomatic carotid stenosis （stenosis 〉50%） who underwent HR-MRI were enrolled. Among them, 102 patients （46.6%） had stable plaques and 117 （53.4%） had unstable plaques; 118 （53.9%） had moderate stenosis and 101 （46.1%） had severe stenosis. Thirty-five patients received carotid endarterectomy, HR-MRI showed that the plaque in 19 （54.3%） of them were instable, and pathological examination showed that the plaque in 20 （57.1%） cases were instable, and both were highly consistent （κ=0.942, P〈0.001）. The proportions of male （P=0.007）, hyperlipidemia （P=0.013）, smoking （P〈0.001）, as well as the levels of total cholesterol （P=0.001）, low-density lipoprotein cholesterol （P〈0.01）, and fasting blood glucose （P=0.001） in the unstable plaque group were significantly higher than those in stable plaque group. Multivariate logistic regression analysis showed that male （odds ratio [OR] 2.33, 95% confidence interval [CI] 1.08-5.04; P=0.032）, smoking （OR 3.45, 95% CI 1.67-7.14; P=0.001）, and higher fasting blood glucose level （OR 1.26, 95% CI 1.07-1.48; P=0.006） were the independent risk factors for unstable plaque. All the data did not show any signif

关 键 词：颈动脉疾病 斑块 动脉粥样硬化 颈动脉狭窄 磁共振成像 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]