摘要
目的探讨颈内动脉易损斑块成分及形态变化特点，指导临床制定个体化干预方案。方法回顾性搜集2008年3月至2014年7月，因颈内动脉斑块复查高分辨率多对比度MRI的高血压患者临床资料和2次检查的影像资料。以单侧易损斑块为独立样本，共纳入47例。纳入标准：患者符合原发性高血压诊断标准；首次检查斑块主体位于颈内动脉起始处，含有斑块内出血（IPH）或者纤维帽薄或破裂，斑块最大厚度≥1.5 mm；2次检查间隔时间≥0.5年。排除颈动脉闭塞及颈动脉手术患者。采用配对样本t检验比较斑块形态前后变化差异，包括斑块最大厚度、该层面斑块最大面积和斑块处血管横截面积（CSVA）。结果47例患者MRI检查间隔时间为1.83（1.59，1.99）年，11例首次检查没发现IPH斑块，复查时1例发生IPH（检查间隔时间2.16年）；36例首次检查有IPH斑块，复查时1例发生新的出血（检查间隔时间1.42年）。47例易损斑块最大厚度由（3.94±1.44）mm增加到（4.24±1.68）mm，差异有统计学意义（t=2.30，P〈0.05），年均增加5.14%（－3.83，11.34）%；斑块最大面积由（49.19±21.15）mm^2增加到（56.03±24.91）mm^2，差异有统计学意义（t=3.87，P〈0.01），年均增加6.67%（－2.26，19.60）%；CSVA由（66.22±27.51）mm^2增加到（73.68±31.47）mm^2，差异有统计学意义（t=4.08，P〈0.01），年均增加5.18%（－1.63，12.34）%。结论高血压患者颈内动脉易损斑块成分及负荷进展较快，并容易发生血管外向重构，应当合理制定干预方案，定期复查MRI。
Objective To investigate the changes of component and morphology in internal carotid vulnerable plaque, for helping to make clinical intervention strategy individually. Methods A total of 47 patients with internal carotid vulnerable plaques and primary hypertension underwent 2 high-resolution and multi-contrast MRI scans, from March 2008 to April 2014 were retrospectively reviewed. At baseline, the plaque was mainly located at the proximal internal carotid artery, and maximum plaque thickness ≥1.5 mm with intraplaque hemorrhage （IPH） and （or） thin or ruptured fibrous cap. Interscan interval was 0.5 years and above. Patients with carotid occlusion or surgery were excluded. Morphological measurements included maximum plaque thickness, maximum plaque area and cross-sectional vessel area （CSVA） on the level of plaque with maximum thickness. The paired-samples t test was performed to compare the difference of plaque morphology between baseline and follow-up carotid MRI.Results The interscan interval was 1.83 （1.59, 1.99） years for 47 internal carotid vulnerable plaques. One case （interscan interval 2.16 years） showed IPH within those 11 plaques without IPH at baseline, and one case （interscan interval 1.42 years） had new incident IPH within those 36 plaques with IPH at baseline. Maximum plaque thickness increased significantly from （3.94±1.44） mm to （4.24±1.68） mm （t=2.30, P〈0.05） by 5.14%（-3.83, 11.34）% per year. Maximum plaque area increased significantly from （49.19±21.15） mm^2 to （56.03±24.91）mm^2 （t=3.87, P〈0.01） by 6.67%（-2.26, 19.60）% per year. CSVA increased significantly from （66.22±27.51） mm^2 to （73.68±31.47） mm^2 （t=4.08, P〈0.01） by 5.18%（-1.63, 12.34）% per year. Conclusion The progression of component, burden and outer remodeling in the internal carotid vulnerable plaque may be faster in hypertension, therefore reasonable intervention strategy and regular follow-up carotid MRI should be performed.
作者
崔豹
孙兴旺
祝玉芬
杜昱平
崔进国
蔡剑鸣
Cui Bao, Sun Xingwang, Zhu Yufen, Du Yuping, Cui Jinguo, Cai Jianming(Department of Radiology, Chinese PLA Bethune International Peace Hospital, Shijiazhuang 050082, Chin)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2018年第4期295-299,共5页
Chinese Journal of Radiology
基金
北京市科技计划项目（Z161100000516194）
河北省卫生和计划生育委员会科研基金项目（20170967）
白求恩国际和平医院科研计划课题（201617）
关键词
磁共振成像
颈动脉疾病
高血压
动脉硬化
血管重构
Magnetic resonance imaging
Carotid artery diseases
Hypertension
Atheriosclerosis
Vascular remodeling
