颈动脉粥样硬化斑块内出血与斑块稳定性相关性研究

发布时间：2018-03-24 03:07

本文选题：磁共振成像　切入点：颈动脉疾病　出处：《中国人民解放军医学院》2017年硕士论文

【摘要】：目的:应用颈动脉高分辨率磁共振成像技术,探讨斑块内出血(intraplaque hemorrhage, IPH )与斑块稳定性之间的相关性。材料和方法:1.探讨双侧斑块内IPH与斑块稳定性的关系:回顾性分析2009年12月至2012年12月间来我院行颈动脉高分辨磁共振检查的患者,纳入有IPH的患者44例,将患者按单、双侧IPH分为两组,单侧组30例,双侧组14例。采用Wilcoxon秩和检验、卡方检验、Logistic回归分析对两组间的纤维帽状态,斑块易损性及年龄差异进行分析。2.探索IPH出血时期及出血体积与纤维帽破裂(fibrous cap rupture, FCR)之间的相关性:回顾性分析2009年12月至2012年12月间来我院行颈动脉高分辨磁共振检查的患者,纳入有IPH的患者37例,斑块41个。将斑块分为FCR组及无FCR组,FCR组有27例,无FCR组14例。计算FCR的发生率并且测量患者的新鲜出血、近期出血、全部出血的体积。利用Wilcoxon秩和检验、卡方检验、相关性检验及Logistic回归分析对各时期出血的体积与FCR的相关性进行分析。结果:1.双侧IPH组患者的年龄小于单侧IPH组患者(66.62±9.36岁vs. 73.70±9.06岁,P=0.027 );另外双侧IPH组患者斑块最大斑块厚度(6.34±1.93mm vs. 5.05±1.25mm,P=0.035 )和溃疡的发生率(50%vs. 13.3%,P=0.025)明显高于单侧IPH组患者。Logistic回归分析发现,双侧IPH与溃疡的发生具有明显的相关性(OR=6.50,95%CI 1.47-28.70,P=0.014),模型1校正性别后,两者仍具有显著相关性(OR=5.71,95%CI 1.12-29.21,P=0.036)。然而,模型2中额外校正年龄(P=0.131)或最大斑块厚度(P=0.139)后,双侧IPH与溃疡的发生不具有显著相关性。2.存在FCR的斑块,其新鲜出血的体积明显大于无FCR的斑块(109.83±75.49 mm3 vs.30.54±20.62 mm3,P=0.002)。Logogisc回归分析出血体积与FCR之间的相关性,新鲜出血的体积OR值为1.74 (95% CI,1.13-2.67, P=0.012),而近期出血的体积OR值为1.36 (95%CI, 0.84-2.18,P=0.208)。矫正了各类影响因素后,新鲜出血的体积及近期出血的体积的OR值分别为1.78 (95%CI,1.12-2.82, P=0.015)及1.43(95%CI, 0.86-2.38, P=0.172)。ROC曲线分析显示,新鲜出血体积的AUC明显大于近期出血体积(AUC: 0.79 vs. 0.64)。结论:1.与单侧IPH患者相比,双侧IPH患者的年龄较轻、斑块负荷更重、溃疡发生率更高。本研究结果提示,双侧IPH患者的斑块易损性明显重于单侧IPH患者,需要临床加以关注。2.新鲜出血的体积是FCR的独立相关因子,不同时期出血的体积可为判断斑块FCR发生的可能性提供参考依据。
[Abstract]:Objective: to apply high resolution magnetic resonance imaging of carotid artery. To investigate the relationship between intraplaque hemorrhage (IPH) and plaque stability. Materials and methods: 1. To explore the relationship between IPH and plaque stability in bilateral plaques: a retrospective analysis of carotid arteries in our hospital from December 2009 to December 2012. Patients with high resolution magnetic resonance imaging, Forty-four patients with IPH were divided into two groups according to unilateral and bilateral IPH: unilateral group (30 cases) and bilateral group (14 cases). The fibrous cap status between the two groups was analyzed by Wilcoxon rank sum test and chi-square test logistic regression analysis. Analysis of plaque vulnerability and age differences. 2. To explore the correlation between IPH bleeding period and volume and fibrous cap rupture: a retrospective analysis was conducted from December 2009 to December 2012 in our hospital for high resolution magnetic resonance (HRM) of carotid artery. Resonance examination of the patient, There were 37 patients with IPH and 41 plaques. The plaques were divided into FCR group (27 cases) and no FCR group (27 cases) and no FCR group (14 cases). The incidence of FCR was calculated and the fresh bleeding and recent bleeding were measured. Volume of total bleeding. Wilcoxon rank sum test, chi-square test, Correlation test and Logistic regression analysis were used to analyze the correlation between the volume of hemorrhage and FCR in each stage. Results: 1.The age of bilateral IPH group was lower than that of unilateral IPH group (66.62 卤9.36 years old vs 73.70 卤9.06 years old vs 0.027), and that of bilateral IPH group was the largest. The incidence of plaque thickness (6.34 卤1.93mm vs 5.05 卤1.25mm P0.035) and ulcers (50 vs. 13.3 vs 0.025) was significantly higher than that of patients with unilateral IPH by logistic regression analysis. There was a significant correlation between bilateral IPH and the occurrence of ulcers. After model 1 adjusted for sex, there was still a significant correlation between bilateral IPH and ulcers. However, in model 2, the additional correction age (P0.131) or the maximum thickness of plaque was 0.139). There was no significant correlation between bilateral IPH and ulceration. 2. The volume of fresh bleeding in plaque with FCR was significantly larger than that in plaque without FCR (109.83 卤75.49 mm3 vs.30.54 卤20.62mm ~ 0.002). Logogisc regression analysis showed the correlation between hemorrhage volume and FCR. The volume OR value of fresh bleeding was 1.74 95% CIQ 1.13-2.67, and the volume OR of recent bleeding was 1.36 ~ 95 CI, 0.84-2.18 ~ 0.2080.The OR values of fresh bleeding volume and recent bleeding volume were 1.78 95 CI 1.12-2.82 (P0. 015) and 1. 4395 CI 0. 86-2. 38. P=0.172).ROC curve analysis showed that, after adjusting for various factors, the OR values of fresh bleeding and recent bleeding volume were 1.78 95 CI 1.12-2.82 (P0. 015) and 1. 4395% CI 0.86-2.38, respectively. P=0.172).ROC curve analysis showed that the volume of fresh bleeding and the volume of recent bleeding were 1.78 95 CI 1.12-2.82) and 1.4395 CI 0.86-2.38, respectively. The AUC of fresh hemorrhage volume was significantly larger than that of recent bleeding volume AUC: 0.79 vs 0.64. Conclusion compared with unilateral IPH patients, bilateral IPH patients are younger in age, heavier in plaque load, and higher in the incidence of ulcers. The plaque vulnerability of bilateral IPH patients is significantly more severe than that of unilateral IPH patients. 2. The volume of fresh bleeding is an independent factor related to FCR. The volume of bleeding in different periods can provide a reference for judging the possibility of plaque FCR.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.4;R445.1

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