【摘要】 目的应用磁共振管壁成像技术探讨老年人胸主动脉粥样硬化斑块的特征及其与高血脂的相关性。方法入组人群为60岁以上、且无任何严重心脑血管症状的老年人。所有受试者均进行胸主动脉多对比度磁共振管壁成像。图像判读人员将定量测量高血脂者和血脂正常者胸主动脉粥样硬化斑块的负荷特征,定性分析其成分特征,并探讨这些特征与高血脂的相关性。将胸主动脉分为3段,即升主动脉段(AAO)、主动脉弓段(AOA)以及降主动脉段(DAO)。结果 66例受试者,高血脂组43例,平均年龄(72.7±6.8)岁,其中男19例(44.2%)。高血脂组胸主动脉粥样硬化斑块的发生率显著高于血脂正常组(95.3%vs 60.9%,P=0.001)。同时,富含脂质坏死核(LRNC)的发生率亦显著高于血脂正常组(88.4%vs 52.2%,P=0.001),而斑块内出血/血栓(IPH/MT)的差异无统计学意义(20.9%vs 21.7%,P=0.939)。高血脂组胸主动脉3个节段的管腔面积(LA)均小于血脂正常组,而管壁面积(WA)及最大管壁厚度(maxWT)均大于血脂正常组,且差异均具有统计学意义(P<0.05)。另外,胸主动脉AS斑块(OR=-0.311,P=0.011)及LRNC(OR=-0.591,P<0.001)均与高密度脂蛋白呈显著负相关。IPH/MT与甘油三酯呈显著正相关(OR=0.25,P=0.043)。结论高血脂的老年人胸主动脉粥样硬化斑块的发生率显著高于血脂正常者,LRNC为其主要成分,并且与高密度脂蛋白的降低显著相关。更多还原

【Abstract】 Objective To investigate the characteristics of atherosclerotic plaque components and burden in the thoracic aorta in the elderly with and without hyperlipidemia,by magnetic resonance vessel wall imaging. Methods Elderly subjects(≥60 years) without serious cerebrovascular diseases were recruited in this study. Thoracic aorta was imaged on MR scanner by acquiring multicontrast vessel wall imaging sequences. The plaque burden was calculated quantitatively,the composition of plaque in the thoracic aorta was evaluated qualitatively,and the correlation was investigated with hyperlipidemia. The characteristics of atherosclerosis among different thoracic aorta segments(AAO: ascending aorta; AOA: aortic arch,and DOA: descending aorta) were determined. Results Of 66 recruited subjects,43 were in hyperlipidemia group,the mean age was 72. 7 ± 6. 8 years old,and 16(44. 2%) were male. The prevalence of plaque(95. 3% vs 60. 9%,P =0. 001) in thoracic aorta was significantly higher in hyperlipidemia group than in normal blood lipid group. Meanwhile,the incidence of lipid rich necrotic core was significantly greater(88. 4% vs 52. 2%,P = 0. 001) in hyperlipidemia group,but no significant difference was found in intraplaque hemorrhage/mural thrombus(20. 9% vs 21. 7%,P = 0. 939) between the two groups. The lumen area in all three segments was significantly smaller,and wall area and maximum wall thickness were larger in hyperlipidemia group than in another group(P < 0. 05). Besides,there was significant correlation between thoracic aortic plaque(OR =-0. 311,P = 0. 011),lipid rich necrotic core(OR =-0. 591,P < 0. 001) and high-density lipoprotein. Significant correlation was found between intraplaque hemorrhage/mural thrombus and triglyceride(OR = 0. 25,P= 0. 043). Conclusion The incidence of plaque in the thoracic aorta was significantly higher in the elderly with hyperlipidemia,the lipid rich necrotic core was dominant composition,and was closely related with the decrease of high-density lipoprotein.更多还原