采用核磁共振观察中等剂量瑞舒伐他汀治疗对糖尿病患者颈动脉粥样硬化斑块的影响  

Effects of moderate dose rosuvastatin on carotid plaque in patients with diabetes mellitus evaluated by magnetic resonance imaging

作　　者：杜瑞雪[1] 蔡剑鸣[2] 王庆军[2] 骆雷鸣[1] 王晓娜[1] 曹瑞华[1] 吴红梅[1] 叶平[1] Du Ruixue;Cai Jianming;Wang Qingjun;Luo Leiming;Wang Xiaona;Cao Ruihua;Wu Hongmei;Ye Ping

机构地区：[1]解放军总医院第二医学中心心血管内科,北京100853 [2]解放军总医院第一医学中心放射科,北京100853

出　　处：《中华心血管病杂志》2022年第6期570-576,共7页Chinese Journal of Cardiology

基　　金：国家重点研发计划课题(2020YFC2004805);中央保健科研课题(W2017BJ15)。

摘　　要：目的观察调脂治疗对糖尿病患者颈动脉粥样硬化(AS)斑块的影响。方法2009年3月—2012年2月进行的REACH研究纳入了核磁共振证实有明确颈动脉AS斑块、从未服用调脂药物的无症状患者,予中等剂量瑞舒伐他汀治疗24个月。分别于基线、治疗后3、24个月检测血脂水平,行颈动脉核磁共振检查,并采用图像分析软件测量颈动脉管壁及脂核体积。本研究回顾性分析了REACH研究的患者,按照病史分为糖尿病组及非糖尿病组,比较调脂治疗后两组患者血脂水平及颈动脉AS斑块核磁共振参数的变化情况并分析其相关性。结果本研究共纳入颈动脉AS斑块患者38例,其中糖尿病组13例(34.2%),非糖尿病组25例(65.8%)。基线时糖尿病组糖化血红蛋白水平高于非糖尿病组(P<0.05),其他指标差异无统计学意义。治疗后与自身基线比较,两组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)以及甘油三酯(TG)水平在3、24个月时均下降(P均<0.05),糖尿病组高密度脂蛋白胆固醇(HDL-C)变化不明显;非糖尿病组该指标在24个月升高[(1.38±0.33)mmol/L比(1.26±0.26)mmol/L,P<0.05]。核磁共振结果显示,糖尿病组脂核体积及其百分比在3个月时无明显改变,24个月时呈轻度下降趋势,分别为64.86(45.37,134.56)mm^(3)比75.76(48.20,115.64)mm^(3)和15.84%(11.47%,24.85%)比16.95%(11.64%,22.91%),但差异无统计学意义(P均>0.05);非糖尿病组脂核体积及其百分比则在治疗3个月时即降低,分别为63.01(44.25,188.64)mm^(3)比72.49(51.91,199.59)mm^(3)和13.76%(8.81%,27.64%)比16.04%(11.18%,27.05%),24个月时进一步下降至55.63(27.18,179.40)mm^(3),以及12.71%(8.39%,24.41%)(P均<0.05)。治疗后两组管壁体积、管腔体积及管壁体积百分比(PWV)未发现明显变化(P均>0.05)。两组颈动脉AS斑块各参数的变化与血脂各参数的变化在3、24个月时均未发现相关性(P均>0.05)。结论调脂治疗对糖尿病和非糖尿病患者颈动脉AS斑块影Objective To observe the effect of lipid regulating therapy on carotid atherosclerotic plaque in diabetic patients.Methods The REACH study,conducted between March 2009 and February 2012,enrolled asymptomatic patients with magnetic resonance imaging(MRI)confirmed carotid atherosclerotic plaque,who had never taken lipid-lowering drugs.Patients were treated with a moderate dose of rosuvastatin for 24 months.Blood lipid levels were measured and carotid MRI was performed at baseline,3 and 24 months after treatment.The volume of carotid wall and lipid-rich necrotic core(LRNC)were measured by image analysis software.This study retrospectively analyzed patients in the REACH study.Patients were divided into diabetes group and non-diabetic group.The changes of blood lipid level and MRI parameters of carotid atherosclerotic plaque were compared between the two groups and their correlation was analyzed.Results A total of 38 patients with carotid atherosclerotic plaque were included in this study,including 13 patients(34.2%)in the diabetic group and 25 patients(65.8%)in the non-diabetic group.Baseline parameters were comparable between the two groups,except higher HbA1c level in diabetes group(P<0.05).Compared with baseline,the total cholesterol(TC),low density lipoprotein cholesterol(LDL-C)and triglyceride(TG)levels were significantly decreased at 3 and 24 months in both two groups(P<0.05).The change of high-density lipoprotein cholesterol(HDL-C)in diabetes group was not obvious,while it was significantly increased in non-diabetic group at 24 months((1.38±0.33)mmol/l vs.(1.26±0.26)mmol/l,P<0.05).MRI results showed that the volume and percentage of LRNC remained unchanged at 3 months,slightly decreased at 24 months(64.86(45.37,134.56)mm^(3) vs.75.76(48.20,115.64)mm^(3),P>0.05)and(15.84%(11.47%,24.85%)vs.16.95%(11.64%,22.91%),P>0.05)in diabetic group.In non-diabetic group,the volume and percentage of LRNC were significantly decreased at 3 months(63.01(44.25,188.64)mm^(3) vs.72.49(51.91,199.59)mm^(3),P<0.05)and(13.76%(8.81%,2

关 键 词：动脉粥样硬化 降血脂药物 磁共振成像 颈动脉斑块 

分 类 号：S511[农业科学—作物学]