抗血小板药物使用与颈动脉粥样硬化斑块内出血的多对比度磁共振成像研究  

Relationship between antiplatelet drugs and carotid intraplaque hemorrhage on multicontrast MRI

作　　者：卢明明 彭鹏 崔园园[1] 赵锡海[3] 蔡剑鸣[1] Lu Mingming;Peng Peng;Cui Yuanyuan;Zhao Xihai;Cai Jianming(Department of Radiology,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院放射科,北京100853 [2]武警部队特色医学中心医学影像科 [3]清华大学生物医学影像研究中心

出　　处：《中华老年心脑血管病杂志》2019年第10期1019-1022,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市科技计划项目(Z161100000516194)

摘　　要：目的本研究旨在利用多对比度MRI技术探讨抗血小板药物使用与颈动脉斑块内出血(IPH)之间的相关性。方法回顾性分析经超声检测至少有一侧颈动脉存在粥样硬化斑块的症状性患者108例,其中存在颈动脉IPH患者(IPH患者)41例,无颈动脉IPH患者(无IPH患者)67例。对所有患者进行双侧颈动脉多对比度MR血管壁成像,分析颈动脉IPH与患者临床特征。结果与无IPH患者比较,IPH患者使用抗血小板药物及吸烟比例显著增高(70.7%vs 46.3%,68.3%vs 47.8%,P<0.05),使用他汀类药物比例显著降低(29.3%vs 52.2%,P<0.05);IPH患者的颈动脉最大管壁厚度、管壁面积、狭窄程度显著高于无IPH患者,差异有统计学意义(P<0.01)。logistic回归分析显示,在校正混杂因素之前,使用抗血小板药物与IPH显著相关(OR=2.80,95%CI:1.23~6.41;P=0.014)。进一步校正患者颈动脉最大管壁厚度和颈动脉狭窄后,使用抗血小板药物与IPH之间仍有相关性(OR=3.33,95%CI:1.06~10.45;P=0.039)。结论颈动脉粥样硬化患者抗血小板药物的使用可能与IPH的发生有关,可为颈动脉粥样硬化患者合理、规范使用抗血小板药物提供一定理论参考。Objective To study the relationship between antiplatelet drugs and intraplaque hemorrhage(IPH)on multicontrast MRI.Methods One hundred and eight patients with symptomatic atherosclerotic plaques in at least one side of carotid artery were divided into IPH group(n=41)and IPH-free group(n=67).The patients underwent multicontrst MRI.The clinical characteristics of carotid IPH patients were analyzed.Results The ratio of patients who were using antiplatelet drugs and smoking was significantly higher while that of patients who were using statins was significantly lower in IPH group than in IPH-free group(70.7%vs 46.3%,68.3%vs 47.8%,P<0.05;29.3%vs 52.2%,P<0.05).The maximal wall thickness was significantly thicker,the maximum wall area was significantly larger,and the incidence of stenosis was significantly higher in IPH group than in IPH-free group(P<0.01).Logistic regression analysis showed that antiplatelet drugs were positively related with carotid IPH before adjustment for confounding factors(OR=2.80,95%CI:1.23-6.41,P=0.014)and were still positively related with carotid IPH after adjustment for maximal wall thickness and stenosis(OR=3.33,95%CI:1.06-10.45,P=0.039).Conclusion Antiplatelet drugs are related with the occurrence of IPH,which can provide the theoretical reference for the rational and standardized use of antiplatelet drugs in carotid atherosclerosis patients.

关 键 词：血小板聚集抑制剂 颈动脉疾病 磁共振成像 

分 类 号：R543.4[医药卫生—心血管疾病]