家族性高胆固醇血症纯合子患者冠状动脉及颈动脉血管病变的影像学分析——双源CT和高分辨MRI研究

Characterizing Atherosclerosis Lesions of Carotid and Coronary Artery in Patients with Homozygous Familial Hypercholesterolemia-An MRI and Dual Source MSCT Study

目的:评价家族性高胆固醇血症纯合子(HoFH)患者临床前期冠状动脉、颈动脉硬化(AS)病变的特征,探讨两大血管病变之间的相关性。材料和方法:9例HoFH患者(女4例,男5例,年龄16.00±3.17岁)分别行颈动脉高分辨MR成像和双源CT冠状动脉血管造影。颈动脉和冠状动脉分节段进行分析并评分。Spearman相关分析用于评价颈动脉和冠状动脉评分之间的相关性。结果:9名患者均在颈动脉和冠状动脉见到AS病变。冠状动脉110个节段中,38个节段存在病变,34.2%位于右冠状动脉,65.8%位于左主干、左前降支和左回旋支。颈动脉54个节段中47个节段发现病变,颈内动脉和颈总动脉分叉是最常受累的节段。冠状动脉和颈动脉平均评分为5.89±2.20和7.22±1.99,两者之间具有显著的相关性(r=0.72,P=0.029)。结论:HoFH患者颈动脉和冠状动脉临床前期即可见动脉硬化病变。高分辨MR和多排CTA可作为HoFH患者的疗效评价和随访的重要方法。

Purpose To investigate the preclinical atherosclerosis lesions of coronary and carotid artery in patients with homozygous familial hypercholesterolemia（HoFH）and the potential relationships between them.Materials and Methods Nine HoFH patients（four females,five males,mean age 16.00±3.17 years）were recruited in this study.All patients underwent carotid artery HRMRI and coronary artery DSMSCT scan.The carotid arteries and coronary arteries were segmented and atherosclerosis lesions were determined based on a visual estimation.Stenosis rate of the arteries was also scored.Spearman.model was employed to identified the correlation between scores of carotid and coronary arteries Results Calcified and mixed atherosclerotic lesion of the carotid and coronary artery were found in all 9 subjects.In coronary arteries,AS lesions were found in 38 of 110 segments,34.2%（13/38）in the right coronary arteries（RCA）,65.8%（25/38）in the left main stem（LM）,left anterior descending（LAD）and LCX.In carotid arteries,AS lesions were found in 47 of 54 segments,bifurcation of ICA and CCA were the most common invaded segments.The mean stenosis scores of coronary artery and carotid artery were 5.89±2.20 and 7.22±1.99,respectively.There was strong correlation between them（r=0.72;P=0.029,〈0.05）.Conclusion The atherosclerosis lesion in HoFH patients can be detected before the clinic symptom.HRMRI and DSMCT could be a useful non-invasive method to detect the AS lesions of carotid arteries and coronary arteries in HoFH patients.