升主动脉扩张及主动脉瓣功能障碍对二叶式主动脉瓣患者主动脉弹性影响的磁共振成像研究  

Effects of ascending aorta dilatation and aortic valve dysfunction on aortic elasticity of patients with bicuspid aortic valve:a magnetic resonance imaging study

作　　者：潘怡君 单艳 汪咏莳 李军[4] 徐鹏举 林江 曾蒙苏 PAN Yi-jun;SHAN Yan;WANG Yong-shi;LI Jun;XU Peng-ju;LIN Jiang;ZENG Meng-su(Shanghai Institute of Medical Imaging,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Cardiac Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海市影像医学研究所,上海200032 [2]复旦大学附属中山医院放射科,上海200032 [3]复旦大学附属中山医院心脏超声诊断科,上海200032 [4]复旦大学附属中山医院心脏外科,上海200032

出　　处：《复旦学报（医学版）》2021年第6期711-720,共10页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金青年项目(81901818);上海市自然科学基金(19ZR1451000);国家自然科学基金(82071991)。

摘　　要：目的通过磁共振成像研究升主动脉扩张和主动脉瓣功能障碍对二叶式主动脉瓣(bicuspid aortic valve,BAV)患者中段升主动脉(middle ascending aorta,mid-AA)和近端降主动脉(proximal descending aorta,PDA)弹性的影响。方法前瞻性选取复旦大学附属中山医院2019年10月至2021年3月间130名BAV患者和30名健康志愿者做3.0 T磁共振检查,测量其主动脉扩张度。根据升主动脉直径和主动脉瓣功能将BAV患者分为4组:BAV伴正常或轻度瓣膜功能障碍且升主动脉不扩张组(BAV-CTL组,n=30);BAV伴正常或轻度瓣膜功能障碍且升主动脉扩张组(Dilated BAV-NF组,n=40);BAV伴中重度主动脉瓣狭窄(aortic stenosis,AS)且升主动脉扩张组(Dilated BAV-AS组,n=30);BAV伴中重度主动脉瓣关闭不全(aortic insufficiency,AI)且升主动脉扩张组(Dilated BAV-AI组,n=30)。在右肺动脉平面测量mid-AA和PDA的面积,计算其扩张度。采用Student’s t检验和Mann-Whitney U检验比较连续性变量,卡方检验或Fisher精确检验比较分类变量。结果在无严重瓣膜功能障碍者中,BAV伴升主动脉扩张组较不扩张组mid-AA扩张度降低[2.77(IQR:1.45~6.26)vs.1.52(IQR:1.08~2.19),P=0.004]。在升主动脉扩张者中,BAV伴中重度AI组主动脉扩张度较伴正常或轻度瓣膜功能障碍组高[mid-AA:1.52(IQR:1.08-2.19)vs.2.29(IQR:1.60~4.08),P=0.006;PDA:3.70(IQR:2.89~4.70)vs.4.79(IQR:2.93~6.80),P=0.024];BAV伴中重度AI组主动脉扩张度较伴中重度AS组高[mid-AA:1.60(IQR:0.99~2.26)vs.2.29(IQR:1.60~4.08),P=0.022;PDA:3.73(IQR:2.38~4.40)vs.4.79(IQR:2.93~6.80),P=0.014]。结论升主动脉扩张和AI是影响BAV患者主动脉弹性的主要因素,主动脉扩张对弹性的影响局限于升主动脉,而AI对主动脉弹性的影响范围更广。Objective To study the effects of ascending aorta dilatation and aortic valve dysfunction on the elasticity of the middle ascending aorta(mid-AA)and proximal descending aorta(PDA)in patients with bicuspid aortic valve(BAV)by using magnetic resonance imaging(MRI).Methods From Oct 2019 to Mar 2021,a total of 130 BAV patients and 30 healthy volunteers from Zhongshan Hospital,Fudan University were prospectively undergone 3.0 T MRI for aortic distensibility.BAV patients were categorized into 4 groups according to the diameter of ascending aorta and aortic valve function as follows:BAV with normal or mild aortic valve dysfunction and nondilated ascending aorta(AA)(BAV-CTL,n=30),BAV with normal or mild aortic valve dysfunction and dilated AA(Dilated BAV-NF,n=40),BAV with moderate to severe aortic stenosis and dilated AA(Dilated BAV-AS,n=30),and BAV with moderate to severe aortic insufficiency and dilated AA(Dilated BAV-AI,n=30).The cross-sectional areas and distensibility of mid-AA and PDA were assessed at the level of right pulmonary artery.Student’s t test and Mann-Whitney U test were used to compare the continuous variables between the groups,while chi-square test or Fisher exact test was used to compare the categorical variables.Results Dilated BAV-NF group had decreased mid-AA distensibility[2.77(IQR:1.45-6.26)vs.1.52(IQR:1.08-2.19),P=0.004]than BAV-CTL group.Compared with the Dilated BAV-NF,Dilated BAV-AI had elevated distensibility at midAA and PDA[mid-AA:1.52(IQR:1.08-2.19)vs.2.29(IQR:1.60-4.08),P=0.006;PDA:3.70(IQR:2.89-4.70)vs.4.79(IQR:2.93-6.80),P=0.024].Compared with the Dilated BAV-AS,Dilated BAV-AI again showed elevated distensibility at mid-AA and PDA[mid-AA:1.60(IQR:0.99-2.26)vs.2.29(IQR:1.60-4.08),P=0.022;PDA:3.73(IQR:2.38-4.40)vs.4.79(IQR:2.93-6.80),P=0.014].Conclusion Ascending aorta dilatation and aortic insufficiency are the main factors affecting aortic elasticity in patients with BAV.The effect of aortic dilatation on aortic elasticity is limited to the ascending aorta,while the effect of aortic

关 键 词：二叶式主动脉瓣(BAV) 主动脉扩张度 主动脉瓣狭窄(AS) 主动脉瓣关闭不全(AI) 磁共振成像(MRI) 

分 类 号：R445.2[医药卫生—影像医学与核医学]