血脂及其相关性剩留风险对老年人颈动脉斑块组份及稳定性的影响

Effect of lipid and its residual risks on the components and stability of carotid plaque in the elderly

目的探讨血脂及其相关性剩留风险对老年人颈动脉斑块组份及稳定性的影响。方法颈动脉B超示颈动脉低回声或混合回声斑块的老年患者86例,一周内行3.0T亚秒级高分辨率超导型智能磁共振颈部斑块对比增强扫描,观察低密度脂蛋白胆固醇(LDL-C)达标组和未达标组患者的颈动脉斑块纤维帽是否完整、脂核大小、滋养血管及炎症反应程度;分析达标组甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)的水平与斑块组份及稳定性的关系。结果 LDL-C达标组的颈动脉斑块纤维帽不完整例数、斑块面积、脂核面积、脂核占整个斑块面积百分比、Ktrans均较未达标组小,差异有统计学意义(P均<0.05);但LDL-C达标组仍有6例(16.2%)患者检出易损斑块(脂核占整个斑块面积>40%为6例、Ktrans为0.097±0.013),与稳定斑块患者相比,6例TG水平均较高(2.18±1.62 vs 1.59±0.34)、4例HDL-C水平较低(1.07±0.21 vs 1.31±0.42),差异有统计学意义(P均<0.05)。结论 DCE-M R技术中的Ktrans可成为衡量斑块稳定性的新指标;高TG和/或低HDL-C与斑块稳定性关系密切,即使LDL-C达标,仍可能存在血脂相关性剩留风险,全面的血脂管理及其相关性剩留风险评估极为重要。

Objective To study the effect of lipid and its residual risks on the components and stability of carotid plaque in the elderly. Methods 86 elderly patients with carotid artery of low echo or mixed echo plaques were screened by B type ultrasound. The patients received 3.0T magnetic resonance contrast enhancement scanning of carotid plaque in one week. We observed the cases of fibrous cap incompleteness, the lipid necrotic core size and the extent of vasa vasorum and inflammatory response. The relationships between the components and stability of plaques and triglyceride （TG）and high density lipoprotein cholesterin（HDL-C） levels in the target achieved group were also analyzed. Results The pro- portion of fibrous cap incompleteness, plaque area, lipid necrotic core area and lipid necrotic core percentage in the tar- get achieved group were smaller than those in the target unachieved group. Kt ValUe was also lower in the target achieved group. The differences between the two groups had statistical significance（ P 〈 0.05 ） ; But there were still six patients （ 16. 2% ） with vulnerable plaques in the target achieved group （ the lipid necrotic core percentage 〉 40% , Ktrans 0. 097 ± 0. 013 ）. The cases of high TG level were 6 （2.18 ± 1.62 vs 1.59 ± 0.34）and the cases of low HDL-C level were 4（1.07 ±0.21 vs 1.31 ±0.42）. The differences had statistical significance （P〈0.05）. Conclusion K＋ of dynamic contrast material-enhanced （DCE） magnetic resonance （MR） imaging may be a new indicator to measure the stability of plaques; High TG and/or low HDL-C is closely related to the stability of plaque. Even if the LDL-C level has reached the target, the lipid＇ s residual risk may exist. So the assessment of lipid and its residual risk is extremly important.