他汀应用与颅内动脉粥样硬化性狭窄管壁特征相关性研究

发布时间：2018-04-22 16:09

本文选题：颅内动脉粥样硬化性疾病 + 高分辨磁共振　；参考：《首都医科大学》2017年硕士论文

【摘要】：目的:症状性颅内动脉粥样硬化性疾病(SICAD)的发病率、复发率均较高,其导致肢体残疾、认知障碍及卒中后抑郁的风险对社会和家庭均构成了重大威胁。高分辨磁共振(HR-MRI)技术可通过显示颅内动脉斑块纤维帽完整性、斑块内出血以及斑块强化等特征反映斑块稳定性,但对斑块进行定量分析的研究尚少。他汀类药物可增加斑块稳定性、降低其破裂风险,但应用HR-MRI技术观察他汀类药物对于颅内动脉斑块作用效果的研究较少。本研究拟通过对比SICAD症状侧血管与非症状侧血管的管壁形态、斑块特征及其强化特征,探索不稳定斑块的量化评价方法以及他汀对动脉粥样硬化斑块各项特征的影响。研究对象与方法:2015年4月至2017年3月,经筛选后对56例就诊于首都医科大学宣武医院的SICAD患者,进行两个步骤的分组,第一步:根据狭窄血管是否为责任血管分为症状组与非症状组;第二步:对于症状组患者,根据发病前是否服用他汀类药物分为未用他汀组和服用他汀组。所有患者均于3.0T核磁共振行3D-SPACE序列黑血技术扫描,重建后测量血管狭窄最严重处及参考血管的血管面积(outer wall area OWA)、管腔面积(lumen area LA)、打药前后斑块信号强度等,计算管壁面积(wall area WA)、狭窄程度(stenosis degree SD)、斑块负荷(plaque burden PB)、管壁强化指数(enhancement index EI)等指标,分析:(1)症状组血管与非症状组血管各项特征的差异,应用ROC曲线对比各量化指标的曲线下面积;(2)比较未用他汀组与服用他汀组管壁各项指标的不同,评估发病前他汀类药物对于颅内动脉斑块特征的影响。结果:(1)与非症状组相比,症状组管腔面积明显更小、斑块负荷及狭窄程度更重(P0.05);增强后斑块信号、管壁指数更高(P=0.012、0.031);取95%可信区间(CI)对比以上各指标的ROC曲线下面积(AUC),差异无统计学意义(P0.05)。(2)与未用他汀组相比,应用他汀组斑块强化体积减小(P=0.046),余管壁形态、斑块特征及强化特征的差异无统计学意义(P0.05)。结论:HR-MRI黑血技术可实现管壁各项特征的量化评估,尤其对于不稳定斑块的特征识别具有较高的特异性及灵敏性。其中管腔面积、狭窄程度、斑块负荷、增强后斑块信号、管壁指数可作为斑块易损性的参考指标,用于高危患者的筛选及其个体化诊疗。发病前他汀的应用可减小斑块强化部分的体积,随LDL-C水平的降低,他汀减小斑块强化部分的作用增加。
[Abstract]:Objective: the incidence and recurrence rate of symptomatic intracranial atherosclerotic disease (SICAD) are high. The risk of physical disability, cognitive impairment and post-stroke depression pose a great threat to society and family. High-resolution magnetic resonance imaging (HR-MRI) technique can reflect plaque stability by displaying the integrity of the fibrous cap of intracranial artery plaque, intraplaque hemorrhage and plaque enhancement, but the quantitative analysis of plaque is still rare. Statins can increase plaque stability and reduce the risk of plaque rupture, but there is little research on the effect of statins on intracranial artery plaque by HR-MRI technique. The aim of this study was to investigate the quantitative evaluation of unstable plaques and the effects of statins on the characteristics of atherosclerotic plaques by comparing the wall morphology, plaque characteristics and enhancement characteristics of symptomatic and non-symptomatic vessels of SICAD. Subjects and methods: from April 2015 to March 2017, 56 SICAD patients who were admitted to Xuanwu Hospital of Capital Medical University were divided into two groups. The first step was divided into symptomatic group and non-symptomatic group according to whether the stenotic vessel was responsible; the second step was that the patients in the symptom group were divided into two groups according to whether or not to take statins before onset. All the patients were scanned by 3D-SPACE sequence black blood technique at 3.0T MRI. After reconstruction, the area of wall area OWAA, lumen area LAA, and the signal intensity of plaque before and after treatment were measured. In order to analyze the differences of vascular characteristics between symptomatic group and symptomatic group, we calculated the wall area, stenosis degree, plaque load, enhancement index EIe, etc, and analyzed the differences of vascular characteristics between symptomatic group and asymptomatic group. ROC curve was used to compare the area under the curve of each quantitative index) to compare the differences of the wall indexes between the untreated group and the group treated with statins, and to evaluate the effect of statins on the plaque characteristics of intracranial artery before onset. Results compared with the asymptomatic group, the lumen area of the symptomatic group was significantly smaller, the plaque load and the degree of stenosis were heavier than that of the non-symptomatic group, and the plaque signal was enhanced. The area under the ROC curve of 95% CI was compared with that of the control group. There was no significant difference in the area under the ROC curve. There was no significant difference between the two groups. Compared with the group without statin, the enhancement volume of plaque in the statin group was decreased by 0.046, and the shape of the remaining wall was decreased. There was no significant difference in plaque characteristics and enhancement features between the two groups (P 0.05). Conclusion the mass HR-MRI black blood technique can be used to quantitatively evaluate the characteristics of vascular wall, especially for the feature recognition of unstable plaques with high specificity and sensitivity. Among them, lumen area, stenosis degree, plaque load, plaque signal after enhancement, wall index can be used as a reference index for plaque vulnerability, which can be used for screening and individualized diagnosis and treatment of high-risk patients. The effect of statins on plaque enhancement was increased with the decrease of LDL-C level.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

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